Can honey help with throat pain?

Honey for Throat Pain

Honey is recommended as an analgesic adjunct for post-tonsillectomy throat pain when combined with standard analgesics (paracetamol/NSAIDs), but there is insufficient evidence to recommend it for acute pharyngitis or general sore throat. 1

Evidence-Based Recommendations

Post-Tonsillectomy Setting

• Postoperative honey is specifically recommended as an analgesic adjunct following tonsillectomy, providing superior pain relief when combined with paracetamol, NSAIDs, or oral opioids 1
• This recommendation is notable because honey has no reported side-effects in this context 1
• The evidence supporting honey use is limited to the post-surgical tonsillectomy population, not general sore throat 1

Acute Pharyngitis and General Sore Throat

• For acute sore throat or pharyngitis, honey-containing preparations have not demonstrated consistent benefit 1
• Studies examining Manuka honey in saline rinses for chronic rhinosinusitis patients showed no significant differences in symptom scores, endoscopy findings, or microbiology compared to saline alone 1
• A thyme/honey nasal spray study in post-operative chronic rhinosinusitis patients similarly showed no significant differences compared to placebo 1

First-Line Treatment Algorithm

For acute sore throat, the evidence-based approach is:

1. Start with ibuprofen or paracetamol as first-line analgesics 2, 3

   • Both medications have equivalent efficacy and safety for short-term use 2
   • Ibuprofen may have slightly better efficacy for pain relief, particularly after 2 hours 3

2. Do NOT use honey as primary treatment for acute pharyngitis based on current guideline evidence 1

3. Reserve honey use for post-tonsillectomy patients as an adjunct to standard analgesics 1

Important Clinical Caveats

• The 2021 tonsillectomy guideline is the only high-quality source recommending honey, and this is specifically for post-surgical throat pain, not infectious pharyngitis 1
• Studies of honey in chronic rhinosinusitis (a different condition) failed to show benefit, which suggests limited generalizability 1
• Complementary treatments including herbal remedies have inconsistent evidence for sore throat and are not recommended as primary treatment 1, 3

What NOT to Use

• Zinc gluconate is not recommended for sore throat treatment 2, 3
• Herbal treatments and acupuncture have inconsistent evidence (C-1 to C-3 level) 1, 3
• Local antibiotics or antiseptics are not recommended due to the mainly viral origin of most sore throats 3