Melatonin as an Integrative Adjunct in Multimodal Analgesia: Linking Circadian Regulation, Anti-Inflammatory...

Area of Science:

• Pain Management
• Sleep Science
• Neuroendocrinology

Background:

• Postoperative pain and sleep disturbance create a cycle that intensifies pain and hinders recovery.
• Opioid-sparing multimodal analgesia (MMA) is recommended to reduce risks associated with long-term opioid use, such as tolerance and addiction.
• Chronic postoperative pain (CPSP) affects 10-50% of surgical patients, leading to significant functional and psychological distress.

Purpose of the Study:

• To review current analgesics and opioid-sparing strategies for perioperative pain.
• To explore the role of melatonin and circadian rhythm in pain management and sleep.
• To highlight the potential of melatonin and circadian alignment as an integrative approach for pain and sleep.

Main Methods:

• Review of current literature on perioperative pain management, analgesics, and opioid-sparing techniques.
• Analysis of preclinical and clinical studies on melatonin's effects on pain, sleep, and opioid response.
• Examination of the impact of circadian rhythm and light exposure on pain and melatonin secretion.

Main Results:

• Melatonin exhibits anti-nociceptive, anti-inflammatory, and opioid-sparing properties.
• Exogenous melatonin can enhance analgesia and attenuate opioid tolerance.
• Circadian alignment and melatonin supplementation improve sleep quality and modulate pain-related neuroimmune responses.
• Disruption of circadian rhythm (e.g., constant light) accelerates opioid tolerance and increases inflammation.

Conclusions:

• Melatonin and circadian alignment represent a promising integrative strategy for managing perioperative and chronic pain.
• These approaches can enhance sleep health, reduce opioid dependence, and improve patient quality of life.
• Personalized pain and sleep management protocols can be developed using melatonin and circadian-aligned strategies.