HONEY-POT clinical trial - Manuka Honey for Post-Tonsillectomy Pain

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Claire Perry - Manuka Doctor

Claire leads our Product Development Team, ensuring that our products are truly natural and effective. She is one of the industry’s most experienced Manuka Honey Experts.

  • The HONEY-POT trial is a first of its kind study in the UK, which could show promising results for the treatment of post-tonsillectomy pain
  • Manuka honey could be routinely recommended for post-tonsillectomy pain
  • Tonsillectomy is one of the most common surgical procedures performed in the UK
  • Manuka honey has shown to possess anti-bacterial and anti-inflammatory properties with huge potential for wound repair.

What is the potential for Manuka honey on post-tonsillectomy pain?

Manuka honey could be routinely recommended for post-tonsillectomy pain, and is being investigated by Ear, Nose and Throat surgeons at the East & North Hertfordshire Teaching NHS Trust Lister Hospital, Hertfordshire.

The HONEY-POT clinical trial is a double blind, randomised, placebo controlled clinical trial, which is currently recruiting patients. This clinical trial could potentially demonstrate important findings for the use of Manuka honey for the treatment of post-tonsillectomy pain.

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Tonsillectomy is one of the most common surgical procedures performed in the UK and can be a painful operation to recover from, particularly in adults. Current pain management involves using simple over the counter painkillers like paracetamol, ibuprofen and topical analgesic throat sprays. Commonly, stronger painkillers like codeine and liquid morphine are needed to control the pain. Whilst these are generally effective, they can be associated with significant side effects and prolonged use is not recommended.

Using Manuka Honey alongside may reduce the need for the stronger painkillers.

Participants of the HONEY-POT trial are taking 15ml of 1000 MGO Monofloral Manuka honey three times daily for 14 days for maximum antimicrobial effect.

Chief Investigator and Consultant ENT/Head & Neck Surgeon at the Lister Hospital Hertfordshire Mr George Mochloulis reported

“Our priority is that patients receive the best possible care and we continue to optimise the recovery in the post operative period using evidence based treatment. This clinical trial, the first of its kind in the UK, could provide the evidence to use Manuka honey routinely for the treatment of post-tonsillectomy pain for thousands of patients across the UK.

We are starting with adult patients, but could extend to children if the results are favourable. It is exciting to consider that honey, which has been used for centuries to treat various ailments, could be utilised in modern surgical practice as a relatively low cost alternative to conventional analgesics. Recent systematic review and multidisciplinary consensus suggest a potential place for the inclusion of honey for this purpose. Clinical efficacy over placebo remains to be conclusively demonstrated.”

What is the evidence behind Manuka honey?

Manuka honey has been used for the treatment of wounds in ancient writings across the world for thousands of years before the advent of modern medicine. There is evidence that Manuka honey can significantly reduce pain scores in the immediate postoperative period. As well as a potential for Manuka honey to reduce the need for opioid based analgesia, reduce the incidence of re-admission to hospital, reduce the rate of infection and reduce the rate of post tonsillectomy bleeds.

This Monofloral Manuka honey has been shown to possess anti-bacterial and anti-inflammatory properties [1] with huge potential for wound repair and antibacterial activities. It is produced by bees fed on the flowers of the New Zealand Manuka bush (Leptospermum scoparium) and contains a significantly higher concentration of the 1,2-dicarbonyl compound methylglyoxal, which may account for its antibacterial activity; this agent may release small amounts of hydrogen peroxide which may also contribute to its antibacterial activity [2].

Manuka honey has been reported to stimulate the formation of new blood capillaries and the growth of fibroblasts and epithelial cells when applied topically to wounds [3,4]. It is now part of the routine armamentarium of products used in the treatment of burns and external skin wounds in NHS Plastic surgery departments in the United Kingdom (UK). The clinical efficacy of Manuka honey in the oral and oropharyngeal cavities is controversial and quality, placebo controlled, randomized clinical trials are lacking. There are a number of systematic reviews that have described some benefit of Manuka honey in the treatment of radiation induced oro-mucositis, particularly in reducing treatment interruptions, preventing weight loss and pain control [5-8].

“We are delighted to be involved in this industry leading tonsillectomy study run by the East & North Hertfordshire Teaching NHS Trust. There is huge potential for Manuka honey to be used in post operative care to support thousands of patients each year suffering with post tonsillectomy pain. Manuka honey is already common treatment within the NHS for burns and wounds, so this makes a natural next step for Manuka honey, nature’s antimicrobial powerhouse.”

Claire Perry, Research and Development Director, Manuka Doctor

Article References

[1] Henatsch D, Wesseling F, Kross KW, Stokroos RJ. Honey and beehive products in otorhinolaryngology: a narrative review. Clin Otolaryngol. 2016;41(5):519–31.

[2] Nolan VC, Harrison J, Wright JEE, Cox JAG. Clinical significance of manuka and medicalgrade honey for antibiotic-resistant infections: A systematic review. Antibiotics. 2020;9(11):1– 24.

[3] Carter DA, Blair SE, Cokcetin NN, Bouzo D, Brooks P, Schothauer R, et al. Therapeutic manuka honey: No longer so alternative. Front Microbiol. 2016;7(APR):1–11.

[4] Kamaratos A V., Tzirogiannis KN, Iraklianou SA, Panoutsopoulos GI, Kanellos IE, Melidonis AI. Manuka honey-impregnated dressings in the treatment of neuropathic diabetic foot ulcers. Int Wound J. 2014;11(3):259–63.

[5] Bardy J, Molassiotis A, Ryder WD, Mais K, Sykes A, Yap B, et al. A double-blind, placebocontrolled, randomised trial of active manuka honey and standard oral care for radiationinduced oral mucositis. Br J Oral Maxillofac Surg [Internet]. 2012;50(3):221–6. Available from: http://dx.doi.org/10.1016/j.bjoms.2011.03.005

[6] Hawley P, Hovan A, McGahan CE, Saunders D. A randomized placebo-controlled trial of manuka honey for radiation-induced oral mucositis. Support Care Cancer. 2014;22(3):751– 61.

[7] Yang C, Gong G, Jin E, Han X, Zhuo Y, Yang S, et al. Topical application of honey in the management of chemo/radiotherapy-induced oral mucositis: A systematic review and network meta-analysis. Int J Nurs Stud [Internet]. 2019;89:80–7. Available from: https://doi.org/10.1016/j.ijnurstu.2018.08.007

[8] Cho HK, Jeong YM, Lee HS, Lee YJ, Hwang SH. Effects of honey on oral mucositis in patients with head and neck Cancer: A meta-analysis. Laryngoscope. 2015;125(9):2085–92.