Neither ibuprofen nor acetaminophen: a new study points to an alternative for chronic pain

A supplement commonly used to treat insomnia may have a much broader role than previously thought. A systematic review published on June 30 in the journal PAIN – the flagship publication of the International Association for the Study of Pain – concludes that melatonin may reduce chronic musculoskeletal pain with effectiveness comparable to widely used painkillers such as ibuprofen (Advil) and acetaminophen (Tylenol).

The study, led by researchers at the University of Sydney in Australia, analyzed data from 2,028 adults across 23 randomized controlled trials conducted in countries including the United States, Russia, Brazil, Egypt and China. Participants had conditions such as lower back pain, osteoarthritis and fibromyalgia, while others were recovering from hip, knee or spinal surgery.

What researchers found in patients around the world

On average, melatonin reduced pain by about nine points on a 100-point scale. The highest-quality trials found reductions of close to 10 points – a level of improvement similar to that seen with conventional painkillers. The benefits were more consistent for chronic pain than for postoperative pain, where the findings were less conclusive.

The supplement also improved participants’ sleep quality, which researchers say is particularly important given the well-established link between chronic pain and sleep disorders. Pain makes it harder to sleep, while poor sleep can increase the perception of pain.

Dosages varied depending on the condition being treated. For chronic musculoskeletal pain, the most common doses ranged from 3 to 10 mg per day, with 3 mg being the most frequently used. For postoperative pain, doses typically ranged from 5 to 6 mg. In every study, melatonin was taken before bedtime. The researchers caution that the available evidence is not yet sufficient to establish a single optimal dose.

Reported side effects included nausea, dizziness and headaches, all of which were described as mild and temporary, occurring at rates similar to those seen in the placebo groups. No serious adverse events or signs of dependence were identified. The authors conclude that melatonin appears to be safe for short-term use, defined as less than three months.

The researchers stress that their findings do not mean melatonin should replace existing treatments. As lead author Kangchao Wu explained: “The level of pain relief we observed is comparable to that of some conventional treatments, but this does not mean melatonin should replace them. Rather, it may offer a safer additional option as part of a broader pain management plan.”

They also recommend consulting a healthcare professional before taking melatonin, particularly for anyone already using other medications.

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