Search JIM Advanced Search

Journal of Integrative Medicine ›› 2014, Vol. 12 ›› Issue (4): 359-366.doi: 10.1016/S2095-4964(14)60025-X

• Research Article • Previous Articles     Next Articles

Effects of cinnamon on perineal pain and healing of episiotomy: A randomized placebo-controlled trial

Azam Mohammadia, Sakineh Mohammad-Alizadeh-Charandabib, Mojgan Mirghafourvandc, Yousef Javadzadehd, Zahra Fardiazare, Fatemeh Effati-Daryania   

  1. Students Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
    Iranian Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
    Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
    Department of Pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
    Women Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  • Received:2014-02-03 Accepted:2014-03-11 Online:2014-07-10 Published:2014-07-15


Analgesic and wound-healing effects of cinnamon, a widely used spice, have been shown in laboratory rats. However, we found no human studies in this area. 


The aim of this study was to assess the effect of cinnamon on perineal pain and healing of episiotomy incision. 

Design, Setting, Participants and Interventions

In this double-blind, randomized, placebo-controlled trial, 144 postpartum women were allocated into two groups, using stratified block randomization, 1 h after completion of episiotomy repair. They received cinnamon or placebo ointment, 2 mL every 12 h for 10 d. 

Main Outcome Measures

Perineal pain and wound healing were assessed using visual analogue scale (0-10) and Redness, Edema, Ecchymosis, Discharge, Approximation scale (0-15), respectively. General linear model was used to compare the groups on the outcomes adjusted for baseline values and stratified factors. 


Follow-up rate was 100% up to the 8 h time point in both groups, and 86% (62 of 72) in the cinnamon group and 85% (61 of 72) in the placebo group at day 10-11 after delivery. Pain score in the cinnamon group was significantly lower than that in the placebo group at (4±1) h (adjusted difference: -0.6, 95% confidence interval: -1.0 to -0.2) and (8±1) h (-0.9, -1.4 to -0.3) after intervention, and on the 10-11th day after delivery (-1.4, -2.0 to -0.7). Also the cinnamon group showed significantly more improvement than the control group in healing score at (8±1) h (-0.2, -0.4 to -0.04) and the 10-11th day after delivery (-1.6, -2.0 to -1.1). 


Cinnamon can be used for reducing perineal pain and improving healing of episiotomy incision.

Key words: Cinnamomum zeylanicum, Episiotomy, Postpartum period, Pain, Wound healing, Randomized controlled trial

Figure 1

Flowchart of the study"



Figure 2

Mean score of pain intensity in the cinnamon and placebo groups at different time points"

Figure 3

Mean score of healing status in the cinnamon and placebo groups at different time points3.4 Secondary outcomesThere was no significant difference (P>0.05) between the groups at baseline and the (8±1) h in terms of REEDA components except wound approximation (P=0.02). During 10 d postpartum, in the intervention group vs the placebo group, there was no redness (39% vs 15%), no edema (71% vs 34%), no ecchymosis (95% vs 82%), no discharge (13% vs 23%) and complete closure (65% vs 39%). Wound-healing scores in the cinnamon group was significantly less than those in the placebo group in 4 of 5 components (P<0.01 for redness and edema, P=0.021 for ecchymosis, and P=0.003 for approximation). The difference between groups was not statistically significant (P=0.1). However, in the placebo group two patients had serosanguinous discharge (scored 2) and two others had bloody purulent discharge (scored 3), while no one in the cinnamon group had such discharges. Due to existence of significance difference at baseline between the groups in terms of approximation, we also compared change score of this component on day 10-11 (in relation to the baseline), which was also significantly better in the cinnamon group (P=0.025)."

[1] Graham ID, Carroli G, Davies C, Medves JM . Episiotomy rates around the world: an update[J]. Birth, 2005,3(23):219-223
[2] Khani S, Zare K . The frequency of episiotomy and its related factors[J]. Iran J Nurs, 2012,24(74):45-52
[3] Francisco AA, de Oliveira SMJV, de Oliveira Santos J, da Silva FMB . Evaluation and treatment of perineal pain in vaginal postpartum[J]. Acta Paul Enferm, 2011,24(1):94-100
doi: 10.1590/S0103-21002011000100014
[4] East CE, Sherburn M, Nagle C, Said J, Forster D . Perineal pain following childbirth: prevalence, effects on postnatal recovery and analgesia usage[J]. Midwifery, 2012,28(1):93-97
doi: 10.1016/j.midw.2010.11.009
[5] Signorello LB, Harlow BL, Chekos AK, Repke JT . Postpartum sexual functioning and its relationship to perineal trauma: a retrospective cohort study of primiparous women[J]. Am J Obstet Gynecol, 2001,184(5):881-890
doi: 10.1067/mob.2001.113855
[6] Eisenach JC, Pan PH, Smiley R, Lavand’homme P, Landau R, Houle TT . Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression[J]. Pain, 2008,140(1):87-94
doi: 10.1016/j.pain.2008.07.011
[7] Gutke A, Lundberg M , ?stgaard HC, ?berg B.Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms[J]. Eur Spine J, 2011,20(3):440-448
doi: 10.1007/s00586-010-1487-6
[8] Simon LS . Nonsteroidal anti-inflammatory drugs and their risk: a story still in development[J]. Arthritis Res Ther, 2013,15(Suppl 3):S1
[9] Tork Zahrani SH, Amirali Akbari S, Valaei N . Comparison of the effect of betadine and water in episiotomy wound healing[J]. Feyz J Kashan Univ Med Sci, 2002,5(20):80-85
[10] Masoumi Z, Keramat A, Hajiaghaei R . Systematic review on effect of herbal medicine on pain after perineal episiotomy and cesarean cutting[J]. J Med Plants, 2012,10(40):1-16
[11] Sheikhan F, Jahdi F, Khoei EM, Shamsalizadeh N, Sheikhan M, Haghani H . Episiotomy pain relief: use of Lavender oil essence in primiparous Iranian women[J]. Complement Ther Clin Pract, 2012,18(1):66-70
doi: 10.1016/j.ctcp.2011.02.003
[12] Behmanesh F, Aghamohammadi A, Zeinalzadeh M, Khafri S . Effects of olive oil sitz bath on improvement of perineal injury after delivery[J]. Koomesh, 2013,14(3):309-315
[13] Vardanjani SAE, Shafai FS, Mohebi P, Deyhimi M, Delazar A, Ghojazadeh M, Malekpour P . Wound healing benefits of curcumin for perineal repair after episiotomy: results of an Iranian randomized controlled trial[J]. Life Sci J, 2010,9(4):5536-5541
[14] Ranasinghe P, Pigera S, Premakumara GA, Galappaththy P, Constantine GR, Katulanda P . Medicinal properties of ‘true’ cinnamon(Cinnamomum zeylanicum): a systematic review[J]. BMC Complement Altern Med, 2013,13:275
doi: 10.1186/1472-6882-13-275
[15] Jakhetia V, Patel R, Khatri P, Pahuja N, Garg S, Pandey A, Sharma S . Cinnamon: a pharmacological review[J]. J Adv Sci Res, 2010,1(2):19-23
[16] Arzi A, Sarkaki A, Aghel N, Nazari Z, Saeidnejad S . Study of analgesic effect of hydroalcoholic extract of cinammom[J]. Sci Med J, 2011,10(3):271-279
[17] Dashti Rahmatabadi MH, Vahidi Merjardi AR, Pilavaran AA, Farzan F . Effect of cinnamon extract on formalin induced pain in rat[J]. J Shaheed Sadoughi Univ Med Sci, 2009,17(2):190-199
[18] Kamath JV, Rana AC, Chowdhury AR . Pro-healing effect of Cinnamomum zeylanicum bark[J]. Phytother Res, 2003,17(8):970-972
doi: 10.1002/(ISSN)1099-1573
[19] Ranasinghe P, Jayawardena R, Galappaththy P , Constantine GR, de Vas Gunawardana N, Katulanda P.Response to Akilen et al. Efficacy and safety of ‘true’ cinnamon(Cinnamomum zeylanicum) as a pharmaceutical agent in diabetes: a systematic review and meta-analysis[J]. Diabet Med, 2013,30(4):506-507
doi: 10.1111/dme.12141
[20] Lara-Mu?oz C, De Leon SP, Feinstein AR, Puente A, Wells CK . Comparison of three rating scales for measuring subjective phenomena in clinical research. I. Use of experimentally controlled auditory stimuli[J]. Arch Med Res, 2004,35(1):43-48
doi: 10.1016/j.arcmed.2003.07.007
[21] Hill PD . Psychometric properties of the REEDA[J]. J Nurse Midwifery, 1990,35(3):162-165
doi: 10.1016/0091-2182(90)90166-3
[22] Farahpour MR, Habibi M . Evaluation of the wound healing activity of an ethanolic extract of Ceylon cinnamon in mice[J]. Vet Med (Praha), 2012,57(1):53-57
doi: 10.17221/VETMED
[23] Chericoni S, Prieto JM, Iacopini P, Cioni P, Morelli I . In vitro activity of the essential oil of Cinnamomum zeylanicum and eugenol in peroxynitrite-induced oxidative processes[J]. J Agric Food Chem, 2005,53(12):4762-4765
doi: 10.1021/jf050183e
[24] Zarifkar A, Shandaryan HMS, Mokhtary M, Ay J . An evaluation on antinociceptive effects of eugenol by formalin test in rats[J]. J Dent Med, 2003,16(1):61-67
[25] Peana AT, Marzocco S, Popolo A, Pinto A .( -)-Linalool inhibits in vitro NO formation: probable involvement in the antinociceptive activity of this monoterpene compound[J]. Life Sci J, 2006,78(7):719-723
doi: 10.1016/j.lfs.2005.05.065
[26] Peana AT , D’Aquila PS, Chessa ML, Moretti MD, Serra G, Pippia P.(-)-Linalool produces antinociception in two experimental models of pain[J]. Eur J Pharmacol, 2003,460(1):37-41
doi: 10.1016/S0014-2999(02)02856-X
[27] Hong JW, Yang GE, Kim YB, Eom SH, Lew JH, Kang H . Anti-inflammatory activity of Cinnamon water extract in vivo and in vitro LPS-induced models[J]. BMC Complement Altern Med, 2012,12(1):237-245
doi: 10.1186/1472-6882-12-S1-P237
[28] Golmakani N, Motlagh ER, Tara F, Assili J, Shakeri MT . The effects of turmeric(Curcuma longa L) ointment on healing of episiotomy site in primiparous women[J]. Iran J Obstet Gynecol Infertil, 2009,11(4):29-39
[29] Lee SK, Hong CH, Huh SK, Kim SS, Oh OJ, Min HY, Park KK, Chung WY, Hwang JK . Suppressive effect of natural sesquiterpenoids on inducible cyclooxygenase(COX-2) and nitric oxide synthase(iNOS) activity in mouse macrophage cells[J]. J Environ Pathol Toxicol Oncol, 2002,21(2):141-148
[30] Williams MK, Chames MC . Risk factors for the breakdown of perineal laceration repair after vaginal delivery[J]. Am J Obstet Gynecol, 2006,195(3):755-759
doi: 10.1016/j.ajog.2006.06.085
[31] Vakilian K, Atarha M, Bekhradi R, Ghebleh F, Hatami Z, Ceraj A . The effect of lavender in care of postpartum episiotomy wounds[J]. J Shahrekord Univ Med Sci, 2008,10(3):63-69
[1] Sherman Gu, Arthur Yin Fan. Controversial conclusions from two randomized controlled trials for acupuncture's effects on polycystic ovary syndrome or in vitro fertilization support. Journal of Integrative Medicine, 2020, 18(2): 89-91.
[2] Gerli E.G. Herr, Fábio Goulart da Silva, Francisco José Cidral-Filho, Fabricia Petronilho, Lucinéia Gainski Danielski, Mariana Pereira de Souza Goldim, Afonso Shiguemi Inoue Salgado, Franciane Bobinski, Daniel Fernandes Martins, Eliane R. Winkelmann. Effects of the use of bioceramic wraps in patients with lower limb venous ulcers: A randomized double-blind placebo-controlled trial. Journal of Integrative Medicine, 2020, 18(1): 27-.
[3] Rebecca Kulbida, Alexander Mathes, Johannes Loeser. Beneficial effects of hirudotherapy in a chronic case of complex regional pain syndrome. Journal of Integrative Medicine, 2019, 17(5): 383-386.
[4] Xin-yu Yue, Zhuo-qi Feng, Xi-yi Yu, Jia-min Hu, Xiao-Jing He, Shi Shu. Fire-needle acupuncture for upper limb spastic paralysis after stroke: Study protocol for a randomized controlled trial. Journal of Integrative Medicine, 2019, 17(3): 167-172.
[5] Ya-ru Huangfu, Wei Peng, Bao-jun Guo, Zhi-fu Shen, Li Li, Shi-wei, Liu, Hui Zheng, You-ping Hu. Effects of acupuncture in treating insomnia due to spleen-stomach disharmony syndrome and its influence on intestinal microbiome: Study protocol for a randomized controlled trial. Journal of Integrative Medicine, 2019, 17(3): 161-167.
[6] Stefania Lamponi, Anna Maria Aloisi, Claudia Bonechi, Marco Consumi, Alessandro Donati, Gemma Leone, Claudio Rossi, Gabriella Tamasi, Luana Ghiandai, Ersilia Ferrini, Paolo Fiorenzani, Ilaria Ceccarelli, Agnese Magnani. Evaluation of in vitro cell and blood compatibility and in vivo analgesic activity of plant-derived dietary supplements. Journal of Integrative Medicine, 2019, 17(3): 213-220.
[7] Pádraic J.Dunne, Julie Lynch, Lucia Prihodova, Caoimhe O'Leary, Atiyeh Ghoreyshi, Sharee A. Basdeo, Donal J.Cox, Rachel Breen, Ali Sheikhi, Áine Carroll, Cathal Walsh, Geraldine McMahon, Barry White. Burnout in the emergency department: Randomized controlled trial of an attention-based training program. Journal of Integrative Medicine, 2019, 17(3): 173-180.
[8] Arthur Yin Fan, Hui Ouyang, Xinru Qian, Hui Wei, David Dehui Wang, Deguang He, Haihe Tian, Changzhen Gong, Amy Matecki, Sarah Faggert Alemi. Discussions on real-world acupuncture treatments for chronic low-back pain in older adults. Journal of Integrative Medicine, 2019, 17(2): 71-76.
[9] Michelle T. Jesse, Mathew Kulas, Josephine Unitis, Nemie Beltran, Marwan Abouljoud. Acupuncture in living liver and kidney donors: a feasibility study. Journal of Integrative Medicine, 2019, 17(1): 3-7.
[10] Ralph Fernando Rosas, Aline Armiliato Emer, Ana Paula Batisti, Daniela Dero Ludtke, Bruna Lenfers Turnes, Franciane Bobinski, Francisco José Cidral-Filho, Daniel Fernandes Martins. Far infrared-emitting ceramics decrease Freund’s adjuvant-induced inflammatory hyperalgesia in mice through cytokine modulation and activation of peripheral inhibitory neuroreceptors. Journal of Integrative Medicine, 2018, 16(6): 396-403.
[11] J.M. Oliver-Baxter, H.S. Whitford, D.A. Turnbull, M.J. Bond. Effects of vitamin supplementation on inflammatory markers and psychological wellbeing among distressed women: A randomized controlled trial. Journal of Integrative Medicine, 2018, 16(5): 322-328.
[12] Ching-Feng Su. Home care with acupuncture increased the quality of life in a patient with advanced cancer with neuropathic pain induced by bone metastasis: A case report. Journal of Integrative Medicine, 2018, 16(3): 208-210.
[13] Sepideh Hamdamian, Soheila Nazarpour, Masoumeh Simbar, Sepideh Hajian, Faraz Mojab, AtefehTalebi. Effects of aromatherapy with Rosa damascena on nulliparous women’s pain and anxiety of labor during first stage of labor. Journal of Integrative Medicine, 2018, 16(2): 120-125.
[14] Parunkul Tungsukruthai, Preecha Nootim, Wiwan Worakunphanich, Nareerat Tabtong. Efficacy and safety of herbal steam bath in allergic rhinitis: A randomized controlled trial. Journal of Integrative Medicine, 2018, 16(1): 39-44.
[15] Zahra Hajmohammadi, Mojtaba Heydari, Majid Nimrouzi, Pouya Faridi, Mohammad Javad Zibaeenezhad, Gholamhossein Ranjbar Omrani, Mesbah Shams . Rhus coriaria L. increases serum apolipoprotein-A1 and high-density lipoprotein cholesterol levels: A double-blind placebo-controlled randomized clinical trial. Journal of Integrative Medicine, 2018, 16(1): 45-50.
Full text



[1] Wei-xiong Liang. Problems-solving strategies in clinical treatment guideline for traditional Chinese medicine and integrative medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 1-4
[2] Jun Hu, Jian-ping Liu. Non-invasive physical treatments for chronic/recurrent headache. Journal of Chinese Integrative Medicine, 2008, 6(1): 31
[3] Yi-ting He, Qing-lin Zha, Jian-ping Yu, Yong Tan, Cheng Lu, Ai-ping Lv. Principal factor analysis of symptoms of rheumatoid arthritis and their correlations with efficacy of traditional Chinese medicine and Western medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 32-36
[4] Dong Yang, Yong-ping Du, Qing Shen, Wei Chen, Yan Yu, Guang-lei Chen. Expression of alpha-smooth muscle actin in renal tubulointerstitium in patients with kidney collateral stasis. Journal of Chinese Integrative Medicine, 2008, 6(1): 41-44
[5] Xue-mei Liu, Qi-fu Huang, Yun-ling Zhang, Jin-li Lou, Hong-sheng Liu, Hong Zheng. Effects of Tribulus terrestris L. saponion on apoptosis of cortical neurons induced by hypoxia-reoxygenation in rats. Journal of Chinese Integrative Medicine, 2008, 6(1): 45-50
[6] Zhi-chun Jin. Problems in establishing clinical guideline for integrated traditional Chinese and Western medicine. Journal of Chinese Integrative Medicine, 2008, 6(1): 5-8
[7] SUN Ming-yu, ZUO Jian, DUAN Ji-feng, HAN Jun, FAN Shi-ming, ZHANG Wei, ZHU Li-fang, YAO Ming-hui. Antitumor activities of kushen flavonoids in vivo and in vitro. Journal of Chinese Integrative Medicine, 2008, 6(1): 51-59
[8] Wei Zhang, Xiang-feng Lu, Xiao-mei Zhang, Jian-jun Wu, Liang-duo Jiang. A rat model of pulmonary fibrosis induced by infusing bleomycin quickly through tracheal intubation. Journal of Chinese Integrative Medicine, 2008, 6(1): 60-67
[9] A-gao Zhou, Yong Zhang, Gang Kui, De-Yun Kong, Hai-liang Ge, Qiu-hua Ren, Jia-rong Dong, Sheng Hong, Xu-ming Mao, Yin Wang, Hui-zheng Zhang, Shu-jun Wang. Influence of traditional Chinese compound recipes with different efficacy on body weight, tumor weight and immune function in H22 cancer-bearing mice. Journal of Chinese Integrative Medicine, 2008, 6(1): 77-82
[10] Daniel Weber, Janelle M Wheat, Geoffrey M Currie. Inflammation and cancer: Tumor initiation, progression and metastasis,and Chinese botanical medicines. Journal of Chinese Integrative Medicine, 2010, 8(11): 1006-1013