Effectiveness Not Established


for Mucositis

Payayor is an herb that has been used in Thailand for burns, insect bites, rashes, herpes simplex and herpes zoster wounds, and varicella zoster infection. The scientific name is Clinacanthus nutans (Burm. f.). Payayor was evaluated for use in managing mucositis in patients with cancer.

Research Evidence Summaries

Putwatana, P., Sanmanowong, P., Oonprasertpong, L., Junda, T., Pitiporn, S., & Narkwong, L. (2009). Relief of radiation-induced oral mucositis in head and neck cancer. Cancer Nursing, 32(1), 82-87.

Study Purpose

Explore the effectiveness of payayor compared with benzydamine for the prevention and relief of radiation induced mucositis.

Intervention Characteristics/Basic Study Process

Patients were randomized to receive either benzydamine (BZD) hydrochloride (Difflam, 3M, Australia) 15 ml, rinse 3 times daily or glycerin payayor 3 drops, 3-5 times daily. Payayor is an herb that was prepared in a standardized preparation that contains flavinoids and glycosides with sulfur compounds. A single research assistant instructed participants in oral hygiene care, how to use the product, and avoidance of tobacco, alcohol, or other oral products. All patients received normal saline as a mouth cleaning solution. Oral examinations were done weekly until two weeks after treatment.

Sample Characteristics

The sample was comprised of 30 patients. The mean age was 55.66, with a range of 32-62 years. Females 25%, Males 75%.

Diagnosis Information: Cancer of the nasopharnyx, larynx, oral cavity and tonsils. All were scheduled to receive radiation therapy daily 5 times per week, up to 6,000cGy.

Other Key Characteristics: Over 50% had concomitant chemotherapy.


Single site

Outpatient setting: Bangkok, Thailand

Study Design

Prospective, single, blind, randomized controlled trial

Measurement Instruments/Methods

Oral examination 0-4 scale for symptom grading by the patient World Health Organization grading system for oral mucositis. Patient satisfaction 5 point scale.


All patients developed oral mucositis. Time to onset was 1.24 weeks with payayor versus 0.44 weeks with BZD (p < 0.001). Total radiation dose to onset was higher in the payayor group, but was not significantly different from BZD. Mean mucositis severity scores were lower in the payayor group (p < 0.001). There were more treatment delays in the BZD group, with 30% of these due to oral pain. No treatment delays due to oral symptoms were reported for the payayor group. The mean satisfaction score in the payayor group was significantly higher (p < 0.01). Patients in the payayor group described a feeling of increased saliva in the mouth with alleviation of xerostomia symptoms. All symptoms were mild to moderate.


Results support the protective and relief effects of BZD and payayor in patients receiving radiation therapy for head and neck cancer. Payayor was well tolerated and potentially can be more effective for mucositis prophylaxis.


Small sample <100

No discussion of other medications provided for oral pain relief. The sample size was too small to provide appropriate subgroup analysis by radiation dosage or between those who had concomitant chemotherapy or not.

Nursing Implications

Payayor and BZD are shown to be at least somewhat effective for the prevention of mucositis in patients receiving radiation therapy, prone to oral complications. Findings here warrant further investigation of efficacy in other patient groups and in comparison to other standard treatments in this area. BZD is not yet approved for this use in the United States.