We’ve previously wrote about about melatonin:

❝Melatonin is a hormone normally made in our pineal gland. It helps regulate our circadian rhythm, by making us sleepy.

It has other roles too—it has a part to play in regulating immune function, something that also waxes and wanes as a typical day goes by.

Additionally, since melatonin and cortisol are antagonistic to each other, a sudden increase in either will decrease the other. Our brain takes advantage of this, by giving us a cortisol spike in the morning to help us wake up.

As a supplement, it’s generally enjoyed with the intention of inducing healthy, natural, restorative sleep.❞

Read in full: Melatonin: A Safe, Natural Sleep Aid? ← our research review article that does cover the pros and cons, and yes, there are indeed downsides too, including some contraindications e.g. melatonin helps regulate immune function, so that’s something to bear in mind if you’re on immunosuppressants or otherwise have an autoimmune disorder. It can also interfere with blood pressure medications and blood thinners, and may make epilepsy meds less effective.

We’ve also written about how it can help with specific chronic diseases, such as: Melatonin vs Lupus!

…so, what’s this about melatonin vs chronic pain?

The sleep-pain relationship

This one came to our attention because of a rather eye-catching headline: Melatonin may ease chronic pain, study finds

Which is a fascinating headline to come from a study of 254 adults (mean average age 60.8 years; 87% women) with chronic musculoskeletal (MSK) pain, and whose results were as follows:

❝Sleep disturbances were reported by 73 % of participants, with insomnia most common. Forty percent had previously used melatonin, primarily for sleep, yet 57 % of users were uncertain about its analgesic effects. Willingness to use melatonin was expressed by 79 % of users and 83 % of non-users for pain management. General concerns included side effects, drug interactions, efficacy, and cost.❞

Yes, it was a survey-based study, and the main pain-related finding was “I don’t know”.

Further, if we break down the responses of those with chronic pain and using melatonin, more participants regarded it as “not effective at all” than regarded it as “moderately effective or very effective” (i.e. even if we stack those latter categories on top of each other, they still don’t add up to as many as the responses for “not effective at all”:

Source: Patients’ attitudes toward melatonin for musculoskeletal pain: Insights for rehabilitation practice

However, as anyone with chronic pain will know, chronic pain and poor sleep adversely affect each other (i.e. each being bad makes the other worse), and therefore it is reasonable to infer that the inverse is true—reducing pain can improve sleep, and improving sleep can reduce pain.

And, of course, if you literally just need a break… If you’re asleep, you’re not consciously* in pain and thus not suffering.

^{*Unconsciously, your nerves are still doing their thing and so your body still “knows” that you are in pain and responds accordingly. This is also the main reason that strong painkillers are given to a patient who is about to undergo surgery under general anaesthesia—they won’t be experiencing the pain, the body will still think it’s being eaten by a tiger or something and respond accordingly in terms of heart rate, inflammatory responses, etc.}

So while it’s fair to say “no, the study didn’t at all establish that melatonin can help vs chronic pain”, and nor was that even the question being examined in the study, it doesn’t mean that getting better sleep can’t help you manage chronic pain better, and so there may be an indirect help.

See also:

Want to learn more?

We’ve written quite a bit about pain management, including:

• Before You Reach For That Tylenol…
• How To Stop Pain Spreading
• How To Dial Down Your Pain
• Managing Chronic Pain (Realistically!)
• Get The Right Help For Your Pain
• The 7 Approaches To Pain Management
• Science-Based Alternative Pain Relief (When Painkillers Aren’t Helping, These Things Might)

Take care!

Avoiding/Managing Rheumatoid Arthritis

Arthritis is the umbrella term for a cluster of joint diseases involving inflammation of the joints, hence “arthr-” (joint) “-itis” (suffix used to denote inflammation). These are mostly, but not all, autoimmune diseases, in which the body’s immune system mistakenly attacks our own joints.

Inflammatory vs Non-Inflammatory Arthritis

Arthritis is broadly divided into inflammatory arthritis and non-inflammatory arthritis.

You may be wondering: how does one get non-inflammatory inflammation of the joints?

The answer is, in “non-inflammatory” arthritis, such as osteoarthritis, the damage comes first (by general wear-and-tear) and inflammation generally follows as part of the symptoms, rather than the cause. So the name can be a little confusing. In the case of osteo- and other “non-inflammatory” forms of arthritis, you definitely still want to keep your inflammation at bay as best you can, but it’s not as absolutely critical a deal as it is for “inflammatory” forms of arthritis.

We’ll tackle the beast that is osteoarthritis another day, however.

Today we’re going to focus on…

Rheumatoid Arthritis

This is the most common of the autoimmune forms of arthritis. Some quick facts:

• It affects a little under 1% of the global population, but the older we get, the more likely it becomes
• Early onset of rheumatoid arthritis is most likely to show up around the age of 50 (but it can show up at any age)
• However, incidence (not onset) of rheumatoid arthritis peaks in the 70s age bracket
• It is 2–4 times more common in women than in men
• Approximately one third of people stop work within two years of its onset, and this increases thereafter.

Well, that sounds gloomy.

Indeed it’s not fun. There’s a lot of stiffness and aching of joints (often with swelling too), loss of joint function can be common, and then there are knock-on effects like fatigue, weakness, and loss of appetite.

Beyond that it’s an autoimmune disorder, its cause is not known, and there is no known cure.

Is there any good news?

If you don’t have rheumatoid arthritis at the present time, you can reduce your risk factors in several ways:

• Having an anti-inflammatory diet. Get plenty of fiber, greens, and berries. Fatty fish is great too, as are oily nuts. On the other side of things, high consumption of salt, sugar, alcohol, and red meat are associated with a greater risk of developing rheumatoid arthritis.
• Not smoking. Smoking is bad for pretty much everything, including your chances of developing rheumatoid arthritis.
• Not being obese. This one may be more a matter of correlation than causation, because of the dietary factors (if one eats an anti-inflammatory diet, obesity is less likely), but the association is there.

There are other risk factors that are harder to control, such as genetics, age, sex, and having a mother who smoked.

See: Genetic and environmental risk factors for rheumatoid arthritis

What if I already have rheumatoid arthritis?

If you already have rheumatoid arthritis, it becomes a matter of symptom management.

First, reduce inflammation any (reasonable) way you can. We did a main feature on this before, so we’ll just drop that again here:

Keep Inflammation At Bay

Next, consider the available medications. Your doctor may or may not have discussed all of the options with you, so be aware that there are more things available than just pain relief. To talk about them all would require a whole main feature, so instead, here’s a really well-compiled list, along with explanations about each of them, up to date as of this year:

Rheumatoid Arthritis Medication List (And What They Do, And How)

Finally, consider other lifestyle adjustments to manage your symptoms. These include:

• Exercise—gently, though! You do not want to provoke a flare-up, but you do want to maintain your mobility as best you can. There’s a use-it-or-lose-it factor here. Swimming and yoga are great options, as is tai chi. You may want to avoid exercises that involve repetitive impacts to your joints, like running.
• Rest—while keeping mobility going. Get good sleep at night (this is important), but don’t make your bed your new home, or your mobility will quickly deteriorate.
• Hot & cold—both can help, and alternating them can reduce inflammation and stiffness by improving your body’s ability to respond appropriately to these stimuli rather than getting stuck in an inappropriate-response state of inflammation.
• Mobility aids—if it helps, it helps. Maybe you only need something during a flare-up, but when that’s the case, you want to be as gentle on your body as possible while keeping moving, so if crutches, handrails etc help, then by all means get them and use them.
• Go easy on the use of braces, splints, etc—these can offer short-term relief, but at a long term cost of loss of mobility. Only you can decide where to draw the line when it comes to that trade-off.

You can also check out our previous article:

Managing Chronic Pain (Realistically!)

Take good care of yourself!