What’s the Best Time of Day to Take Pain Medication?
For acute pain, such as from injuries or after surgery, the answer seems simple: Take pain meds when you have pain! But if you knew that this strategy could prolong your healing by a few days or weeks, would you do it?
The body has a natural rhythm or “clock” called the circadian rhythm that aligns with Earth’s sun and moon cycle. This means that various human metabolic functions, including healing, increase and decrease in their strength and capacity according to signals received from our environment. We know that a disrupted rhythm significantly impacts a person’s risk and progression of various illnesses, including Alzheimer’s, heart disease, mood disorders, and many forms of cancer – so why not explore how drugs support or disrupt this rhythm too?1
Researchers at McGill University explored how administering pain medications (NSAIDs such as Advil) to mice with fractures, improved or impaired healing depending on when in the circadian rhythm medication was administered to the mice.2 They found that mice who received NSAID medication during the day healed the fastest. Mice who received NSAID medication during the resting phase of their rhythm (akin to bedtime for us), healed even more slowly than mice who received no medication at all. If even some of these results can be extrapolated to humans, then we learn at least two important lessons:
- Acute inflammation is a balance between breaking down dead tissue (active or daytime phase) and building up new tissue (resting phase). Both phases are important for healing. This fact may underlie the controversy that still exists regarding whether NSAIDs are okay to use for sports injury, and also the rare side-effects of osteoporosis medications in which the inhibition of breaking down old bone can lead to unusual bone fractures.
- Blocking inflammation during the resting phase (a “healing” phase), can really set us back. We need to be cautious about using anti-inflammatory medications at night. If pain interferes with sleep quality, alternatives might include treatments that are “analgesic” (strictly pain-relieving) and supportive of the circadian rhythm – such as melatonin.3 There are also a few botanicals that, though we refer to them as “anti-inflammatory”, are really more immune-modulating and offer similar pain relief as an NSAID.4
Even with pharmaceuticals designed to oppose normal body processes (i.e. anti-inflammatories), we can still find room to improve their effect by working alongside the body’s inherent healing rhythms. And as Western medical researchers explore the inner workings of this rhythm with relatively new appreciation, naturopathic doctors, Traditional Chinese Medicine practitioners, and Ayurvedic practitioners, can integrate the wisdom of ancient medical systems that never forgot the value of this cycle.
Review our other articles about pain, here.
References:
1. Lyall L., Wyse C., Graham N. et al. Association of Disrupted Circadian Rhythmicity with Mood Disorders, Subjective Wellbeing, and Cognitive Function: A cross-sectional study of 91,105 participants from the UK Biobank. The Lancet Psychiatry. May 2018;5(6):507-514.DOI:https://doi.org/10.1016/S2215-0366(18)30139-1.
2. Al-Waeli H., Nicolau B., Stone L. et al. Chronotherapy of Non-Steroidal Anti-Inflammatory Drugs May Enhance Postoperative Recovery. Sci Rep. 2020;10(468). https://doi.org/10.1038/s41598-019-57215-y.
3. Chen W., Zhang X., Huang W. Pain control by melatonin: Physiological and pharmacological effects (Review). Experimental and Therapeutic Medicine. August 2016;1963 -1968. https://doi.org/10.3892/etm.2016.3565.
4. Shep D., Khanwelkar C., Gade P. et al. Safety and efficacy of curcumin versus diclofenac in knee osteoarthritis: a randomized open-label parallel-arm study. BMC Trials. April 2019;20(214). https://doi.org/10.1186/s13063-019-3327-2.
