Clinical Question: Can herbal tea help reduce the pain associated with acute pharyngitis?

Setting: Outpatient (any)

Study Design: Randomized controlled trial (double-blinded)

Synopsis: “Demulcents” is a general category of products that are soothing and relieve irritation. They are not topical anesthetics but have been used for many years to treat sore throat. This study evaluated the effectiveness of a demulcent mixture containing licorice root, elm inner bark, marshmallow root, and licorice root aqueous dry extract (an herbal tea called Throat Coat).

Sixty patients with acute pharyngitis by any cause were randomly assigned to receive treatment with the herbal tea or a placebo tea with a similar taste and smell four to six times daily for as long as symptoms remained. No other treatment was allowed. Treatment allocation was concealed from the enrolling physician. Using a 10-point scale, patients rated pain relief after one minute and then every five minutes for 30 minutes, at three and 24 hours after the first dose, and then daily. Analysis was by intention-to-treat and compared the degree of change in pain scores at each period, as well as the total amount of pain relief using the total area under the curve of pain changes. Details on exactly what statistics were used are sketchy, but other aspects of the study were reported in great detail.

At five and 10 minutes, changes from the pain score at baseline after the first dose were significantly different in the patients who received herbal tea than in those who received placebo. The sum of the differences in pain intensity occurring in the first 30 minutes of treatment was approximately twice as good in the treatment group (P =.041). Pain relief also was greater in treated patients 10 minutes after the first dose. By intention-to-treat analysis, however, total pain relief at 30 minutes did not differ between the two groups.

Bottom Line: An herbal tea containing a mixture of traditional demulcents was more effective than a placebo tea in the short-term relief of pain in patients with acute pharyngitis. Because the effect does not last long—less than 30 minutes—frequent tea drinking is required throughout the day. Although I use an analgesic and a topical anesthetic for my own sore throat, herbal tea may be useful in patients who prefer a more active approach and who want to avoid the feeling of a partially anesthetized mouth. (Level of Evidence: 1c)