Samdariya, S., Lewis, S., Kauser, H., Ahmed, I., & Kumar, D. (2015). A randomized controlled trial evaluating the role of honey in reducing pain due to radiation induced mucositis in head and neck cancer patients. Indian Journal of Palliative Care, 21, 268–273. 

To study the analgesic effect of honey for mucositis-related pain in patients with head and neck cancer receiving chemotherapy and radiation therapy

Patients were randomized to honey treatment and control groups. Patients were given 20 ml of honey 15 minutes before, 15 minutes after, and six hours after radiation treatment (RT). They were instructed to rinse the honey on the oral mucosa then swallow slowly to smear it on oral and pharyngeal mucosa. All patients also were told to gargle salt soda and benzydamine alternatively every three hours throughout RT and for three months after completion. Pain scores were obtained weekly. As needed, IV antibiotics were given for positive oral cultures, steroids were given for grade 3 mucositis, and gentian violet was applied for moist desquamation.

• N = 69  
• MEAN AGE = 53.4 years
• MALES: 52.2%, FEMALES: 47.8%
• KEY DISEASE CHARACTERISTICS: All participants had locally advanced head and neck cancer.
• OTHER KEY SAMPLE CHARACTERISTICS: In both groups, 72% pf participants had T3, T4, and stage 4A disease. Both groups received a mean RT dose of 69.76 Gy, and the majority received six cycles of cisplatin.

• SITE: Single site  
• SETTING TYPE: Outpatient  
• LOCATION: India

• PHASE OF CARE: Active antitumor treatment

Randomized, controlled trial

• Faces Visual Analog Scale (VAS) for pain (0–10 scale)

In the experimental group, pain scores ranged from 1.83–3.08, and in the control group, scores ranged from 1.36–6.54 across the seven weeks of RT. From week 2 onward, the mean pain score in the experimental group was lower than that of control group (p = 0.000). After RT, mean scores ranged from 1.36–0.36 in patients using honey and from 4.87–1.57 in controls (p < 0.002). Some patients experiened dyspepsia, nausea, and vomiting with honey.

The use of honey was associated with less pain from mucositis in this study.

• Small sample (< 100)
• Risk of bias (no appropriate attentional control condition)
• Unintended interventions or applicable interventions not described that would influence results 
• Measurement validity/reliability questionable
• Other limitations/explanation: There was no mention of any other analgesic use. Compliance with oral protocols was not discussed. No information was provided regarding the use of steroids or antibiotics as outlined in the study protocol.

The findings of this study suggested that honey may be beneficial in reducing pain associated with mucositis caused by chemoradiation therapy in patients with head and neck cancer. Honey is known to have antioxidant and anti-inflammatory properties, which may be helpful for this purpose. Honey is a low-risk intervention, and based on this study's findings, additional well-designed research in larger samples is warranted.