Circadian pain patterns in human pain conditions – A systematic review

Abstract

Background Chronobiology is the science of how physiological processes in the body follow a pattern of time. Pain has been shown to follow a circadian rhythm, with different types of pain having variable expression along this rhythm. Objective This article reviews the nature of diurnal variations in pain along with a discussion of the mechanisms of circadian rhythm of pain. Evidence Review We conducted a literature search on the PubMed and Google Scholar electronic databases, through April 2022. Publications were screened for English language, full‐text availability, and human subjects. Randomized controlled trials and observational trials were included. Data were extracted from studies on patients with acute or chronic pain phenotypes, which provide pain severity data and corresponding diurnal time points. Findings The literature search led to the inclusion of 39 studies. A circadian pattern of pain was found to be present in nociceptive, neuropathic, central, and mixed pain states. Postoperative pain, fibromyalgia, trigeminal neuralgia, and migraines were associated with higher pain scores in the morning. Temporomandibular joint pain, neuropathic pain, labor pain, biliary colic, and cluster headaches increased throughout the day to reach a peak in the evening or night. Arthritis and cancer pain were not associated with any circadian rhythmicity. Furthermore, the circadian rhythm of pain was not found to be altered in patients on analgesics. Conclusion The results of this review suggest that an understanding of diurnal variation may help improve therapeutic strategies in pain management, for instance through analgesic titration.

The Effect of Music on Procedural Analgesia and Anxiety of Patients Undergoing Diagnostic Facet Block for Low Back Pain

“…Pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" [28] Pain may be related to the subjective, primitive protective experiences of the person in the past [29]. The way the pain is perceived and its severity differs between individuals; however, it is quite common for the same person to perceive inconsistency in pain at different instances and to demonstrate variations in response to it [30]. Chronic pain may be nociceptive, neuropathic, or a combination of both.…”

Regulation of headache response and transcriptomic network by the trigeminal ganglion clock

“…We chose to add trigeminal neuralgia because of its direct relationship to trigeminal nerve-mediated pain and because of previously reported daily cycles in trigeminal neuralgia. 26 First, we carried out a systematic review of guideline-recommended medications for migraine, CH, and trigeminal neuralgia. Ultimately 28 studies were included in the qualitative synthesis: 19 migraine, 2 CH, 6 trigeminal neuralgia, and 1 for both migraine and CH (for flow diagram see Figure S7).…”

“…The TG transcriptome has been shown to be highly conserved between mice and humans, and single‐cell analysis at one time point has shown the presence of core clock gene expression in multiple cell types 23,24 . Moreover, preliminary evidence suggests that the TG can cause circadian patterns of pain in humans: trigeminal neuralgia, a facial pain disorder often resulting from vascular compression of the trigeminal nerve, 25 also displays a circadian periodicity of attacks 26 . These observations suggest that the TG may play an important role in the circadian rhythmicity of headaches and facial pain; however, the clock network in the TG has not been characterized, and how it responds to pain remains unclear.…”

The disruptive relationship among circadian rhythms, pain, and opioids

“…Rhythms of pain sensitivity are present in various states of disease and pain syndromes. However, pain rhythms are inconsistently altered in these states ( Knezevic et al, 2022 ). For example, chronic pain conditions such as fibromyalgia and trigeminal neuralgia pain peak in the morning, whereas other neuropathic pain and temporomandibular joint pain peak in the night at 20:00 h ( Knezevic et al, 2022 ).…”

“…Variations in diurnal rhythms of acute pain also exist. For example, biliary colic and labor pain peak at night, whereas post-operative pain peaks in the morning ( Knezevic et al, 2022 ). These variations may reflect differences in the timing of operations or underlying disease biology.…”