Sleep and pain are closely linked (poor sleep can make pain feel worse, and pain can make sleep harder)
Melatonin is best known for helping us sleep. But a new study suggests it might have another surprising use: easing muscle and joint pain.
Produced naturally by the pineal gland in the brain at night, melatonin helps regulate the body’s sleep-wake cycle. That’s why this hormone is widely used as a treatment for insomnia and jet lag.
Produced naturally by the pineal gland in the brain at night, melatonin helps regulate the body’s sleep-wake cycle (Getty Images)
Sleep and pain are closely linked (poor sleep can make pain feel worse, and pain can make sleep harder). But melatonin may also reduce pain directly. Researchers believe it dampens pain signals in the brain and spinal cord, reduces inflammation, calms overactive nerves and protects cells from oxidative stress – the cellular wear and tear caused when harmful molecules build up.
In the new study, researchers combined the results of 23 clinical trials involving over 2,000 participants to identify overall patterns. These trials looked at melatonin for long-term muscle and joint pain as well as pain after surgery.
Overall, melatonin reduced both pain and sleep problems in people with chronic muscle and joint pain. But the improvements were modest. On average, pain scores fell by about nine points on a 100-point scale. That’s within the range reported for some anti-inflammatory drugs in similar studies, although the two treatments haven’t been directly compared.
Melatonin’s effects may also depend on whether people already have sleep problems or other long-term health conditions. Most of the chronic pain studies included people who already had poor sleep to begin with, but none of the trials looked at results separately for people with and without sleep issues. Because of this, it’s unclear whether melatonin works better for people who struggle with sleep or whether the effects are similar for everyone.
The findings were much less convincing for pain after surgery. Melatonin did not make a noticeable difference to pain or sleep. One analysis found a tiny improvement (about 2.5 points on a 100-point pain scale), but this is far below what would matter to patients recovering from surgery.
The benefits in chronic muscle and joint pain are modest. Based on the current evidence, melatonin should be seen as a possible add-on treatment rather than a replacement for established therapies. The evidence suggests melatonin could complement treatments such as physiotherapy, exercise and anti-inflammatory medicines rather than replace them.
What we still don’t know
There is also still a lot we don’t know. The trials in this study used a wide range of doses, from 1mg to 10mg, and the researchers couldn’t determine which dose worked best.
There were hints that longer treatment helped more in chronic pain, but this was based on only a few studies. There is also very little evidence on the effectiveness of higher doses, even though they appear safe in other studies.
Melatonin is widely used and generally considered safe for short-term use, but it can cause side-effects, such as daytime sleepiness, dizziness, headaches and nausea.
It is also worth noting that melatonin is regulated very differently around the world. In the US, melatonin is sold as a dietary supplement, meaning people can buy it easily in supermarkets and online without medical advice. But in the UK, melatonin is a prescription-only medicine and is only licensed for short-term sleep problems and jet lag.
For now, the findings suggest melatonin may offer modest relief for some people with chronic muscle and joint pain, particularly if poor sleep is part of the problem. It’s unlikely to replace established treatments, but it could eventually earn a place alongside them. Larger, well-designed trials will be needed before doctors can say with confidence who is most likely to benefit.
A sleep supplement widely used to treat insomnia could help reduce reliance on some of the most common and potentially harmful pain medications, new research from the University of Sydney suggests.
Published in PAIN, the study found melatonin can reduce chronic musculoskeletal pain, with effects in a similar range to medications such as opioids, nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol.
With musculoskeletal pain affecting up to 47% of people globally, the findings point to a low-cost, widely available option that could shift how chronic pain is managed.
Credit: Kindel Media from Pexels
Melatonin for chronic pain
"Melatonin is already in people's homes, it's inexpensive, and we know it's safe," said lead author and Ph.D. student Kangchao Wu from the Musculoskeletal Research Hub at the Charles Perkins Center and the School of Health Sciences.
"What's exciting is that melatonin may also help manage chronic pain, opening the door to reducing reliance on medications that come with more risks."
The research highlights the growing potential of drug repurposing—using existing treatments in new ways to deliver faster, more accessible health benefits.
"We're taking a medication we already understand and applying it to a problem that affects a huge proportion of the global population," said co-author Professor Paulo Ferreira, director of the Musculoskeletal Research Hub.
The study analysed data from 2,028 adults across 23 randomized controlled trials conducted in countries including the United States, Russia, Brazil, Egypt and China. Participants included people with conditions such as low back pain, osteoarthritis and fibromyalgia, as well as those recovering from surgeries including joint replacements and spinal procedures.
On average, the study found that melatonin reduced pain by around 9 points on a 0–100 scale, with the most rigorous trials showing reductions closer to 10 points, a similar magnitude to widely used pain medications.
The supplement also improved sleep quality, reinforcing the well-established link between pain and sleep.
"For many patients, pain doesn't exist in isolation and is closely tied to poor sleep," Wu said.
"Melatonin appears to target both, which makes it particularly useful for people managing chronic pain."
Across the trials, the dose and timing of melatonin varied depending on the condition and setting. For chronic musculoskeletal pain, doses typically ranged from 3 to 10 mg, with 3 mg per day the most commonly used. For postoperative pain, doses ranged from 1 to 10 mg, with 5 to 6 mg most common. Melatonin was generally taken at bedtime or up to one hour before sleep.
The researchers did not find evidence of a clear dose-response relationship, meaning no single "best" dose can be recommended from the current evidence.
Chronic arthritis pain not only limits mobility but also disrupts sleep patterns. This leaves patients feeling exhausted, irritable, and trapped in a vicious cycle
Arthritis affects millions worldwide, but one of its lesser-known consequences is its impact on sleep. Chronic joint pain doesn’t just limit mobility. It can also disrupt sleep patterns, leaving sufferers exhausted, irritable, and stuck in a cycle where pain and insomnia amplify each other. The result is a daily struggle where fatigue worsens discomfort, and discomfort prevents restorative rest, creating a loop that can feel impossible to escape.
Pain And Sleep – Two Sides Of The Same Coin
“Many arthritis patients complain they haven’t had a good night’s sleep in months, sometimes years. The pain keeps them awake, and when they don’t sleep well, their joints hurt even more the next day. It’s a vicious cycle. Our body needs deep sleep to repair tissues and control inflammation, and when you can’t rest, healing never happens," says Dr Ketan Shah, Joint Replacement Surgeon at Prabhukrupa Hospital, Rajkot.
Dr Sanket Diwanji, Robotic Joint Replacement Surgeon at the Knee and Hip Clinic, Surat, adds, “Sleep and pain are closely connected in ways most people don’t realise. When you don’t sleep well, your body becomes more sensitive to pain. It’s like your pain volume gets turned up. Poor sleep makes everything feel worse, affecting mood, energy, and overall quality of life."
Dr Rushay Bhalodia, Senior Joint Replacement Surgeon at Saviour Hospital, Ahmedabad, emphasises, “The first question I ask arthritis patients is, ‘How are you sleeping?’ Because if they’re not, nothing else will get better. Chronic joint pain makes restorative sleep impossible, and that intensifies stiffness, discomfort, and fatigue."
Breaking The Cycle: Treatments And Solutions
Modern medicine offers several ways to disrupt this pain–sleep loop. Medications, physical therapy, and lifestyle interventions can significantly reduce discomfort. “When the joint damage is severe, surgical options can be transformative," notes Dr Bhalodia. Advances in robotics-assisted surgeries and cutting-edge implant technology now allow patients to regain mobility and, importantly, sleep more comfortably.
Dr Shah points out, “The encouraging part is that we have better solutions today than ever before – sometimes it’s the right medication, sometimes lifestyle changes, and in severe cases, modern joint procedures make a huge difference."
Dr Diwanji adds that minimally invasive techniques and improved implant systems mean faster recovery and better outcomes: “When the underlying joint issue is properly treated, patients often experience dramatic improvements in both pain and sleep quality within weeks."
Experts agree that addressing arthritis-related insomnia requires a multi-pronged approach: consistent sleep habits, pain management strategies, and timely medical intervention. Simple adjustments such as supportive pillows, gentle stretches before bed, and following prescribed therapies can complement advanced treatments to improve rest and overall health.
Arthritis doesn’t have to mean sleepless nights. By understanding the connection between joint pain and sleep disruption, patients can take proactive steps to reclaim rest, reduce discomfort, and improve quality of life.
“Painsomnia” may not be an official medical term, but it’s a very real problem that steals precious hours of sleep from millions of Americans every night. Insomnia and chronic pain go hand-in-hand, and it creates a vicious cycle that critically diminishes your physical health and mental well-being. Knowing how to sleep with pain can help you rebuild the foundation necessary for a healthy life.
Learn how to sleep with pain using pain-relieving props, meditation, and or cognitive therapy.
ILLUSTRATION: FORBES / PHOTO: GETTY
We consulted several medical and wellness experts for their tips on how to manage pain so you can sleep comfortably. Keep in mind that this is general advice they’re offering. All of the experts we reached out to emphasized the importance of visiting your health care provider for a proper diagnosis of your pain.
Tips For How To Sleep With Pain
1) Use Distraction Techniques To Lessen The Intensity Of The Pain
According to Jeff Kahn, CEO and founder of Rise Science, meditation and breathwork are scientifically proven distraction techniques that can help sleepers manage their pain. “There’s evidence the more mentally engaging the distraction, the more effective it is at managing pain,” he says. Techniques you can try include mindfulness meditation, cognitive reframing and guided imagery.
Kahn says ACT (acceptance and commitment therapy) can be helpful for more severe pain. One randomized control trial found that those who practiced deep breathing exercises and progressive muscle relaxation reported less intense pain and better sleep quality after 12 weeks. Studies also show that CBT (cognitive behavioural therapy) combined with sleep-specific strategies for reducing insomnia (CBT-I) can help with pain in the short term.
Sound can also distract you, and put your mind at ease before bedtime. If you can’t afford a $10,000 sound cocoon that emits healing frequencies, pick up at Hatch Restore 2 sleep machine instead. It plays everything from guided meditations to ambient noise, allowing you to fall asleep to whatever soothes you.
2) Eat Foods That Reduce Inflammation And Promote Sleep
Salmon, pumpkin seeds and certain nuts are high in omega-3 fatty acids and magnesium.
GETTY
“Believe it or not, [your] diet can have a huge impact on inflammation and pain,” says Dave Asprey, founder of Bulletproof Coffee and Upgrade Labs. Oxalates—which are found in plant-based foods—can accumulate and crystallize in soft tissue, causing joint pain, migraines and other ailments. One study shows a link between obstructive sleep apnoea and high levels of urinary oxalate, which can lead to kidney stones.
Dr. Bethany Tennant, a naturopathic physician and certified nutrition specialist, says a diet rich in omega-3 fatty acids, magnesium and vitamin D can promote musculoskeletal health, decrease pain sensitivity and reduce inflammation. She also recommends cutting out processed foods and excessive sugars, which have been linked to low-grade inflammation.
To induce sleep, Tennant says to seek foods rich in melatonin, the sleep hormone. Some examples are tart cherries, pistachios and bananas. To ease inflammation, try a golden milk latte with ginger, turmeric and black pepper infused in water with your milk of choice. Tennant recommends almond or coconut milk because they have the most anti-inflammatory benefits.
Be sure to refill your Stanley Cup (or other water bottle of choice) regularly, too. “An often overlooked part of nutrition is hydration, which can help with healing, reducing inflammation and alleviating pain,” says Tennant.
If you’re considering a significant change to your diet, speak with a doctor or dietitian first. “The best diet for reducing pain and improving sleep looks different for everyone depending on an individual’s general health status, intolerances and nutritional needs,“ says Kahn.
3) Move Daily For Restful, Pain-Free Sleep
Incorporating gentle yoga stretches into your bedtime routine can help relieve tension in the body GETTY
Exercise might seem counterintuitive if you’re in pain, but a study from Norway shows that regular physical activity can be useful for managing chronic pain—which, in turn, can improve your sleep quality.
“Exercise routines for those experiencing chronic pain can include consistent activity that is not exacerbating the pain of concern,” says Tennant. If your hips or knees are the source of your discomfort, try walking or cycling with a recumbent bike. Low-impact cardio, yoga, pilates, tai chi and water exercises are other great ways to stay active while sparing your joints from strain.
If possible, Tennant suggests strength training, which has been proven to help with pain management and longevity. You don’t need equipment to perform these exercises, although they can be helpful for developing proper form and stability. Push-ups, planks and squats are popular ways to build strength by just using your body weight. Remember to listen to your body and modify movements as needed.
Resistance bands are a convenient way build strength and increase your range of motion.
4) Biohack Your Pain Away
“Biohacking” is when you optimize your body for peak performance through biology, genetics, neuroscience and nutrition. If you want to adopt a biohacking pain management strategy to help sleep better, Dave “Father of Biohacking” Asprey suggests the following:
Red Light Therapy: “Red and near-infrared light reduce inflammation and promote tissue healing,” says Asprey, who recommends using this treatment before bedtime. (Red light therapy devices are available to purchase for home use, but do your research first.)
Infrared Sauna: “Infrared light promotes tissue healing and the heat promotes circulation. The better your circulation, the more oxygen and nutrients are delivered to the site of injury, which is crucial for healing,” says Asprey. If you lack the space or funds to build an infrared sauna at home, check your nearest wellness spa.
Cryotherapy: Asprey calls cryotherapy “a great way to tame inflammation,” and research shows that it can also improve sleep quality. Alternatively, if a cryotherapy chamber isn’t in your budget, pick up a cold plunge tub for similar results.
Note that these methods are generally deemed safe but they’re not suitable for everyone, particularly those with certain health conditions or sensitivities. Always consult your healthcare provider before you practice biohacking methods.
5) Talk To Your Doctor About Sleep Aids
If lifestyle changes alone aren’t improving your pain, consider an over-the-counter sleep aid before resorting to prescription medication. Non-prescription sleep aids usually contain “natural” ingredients like melatonin, valerian, chamomile and cannabidiol (CBD), or antihistamines like diphenhydramine and doxylamine. You can consume OTC sleep aids in pill form or as a tea.
Before going this route, discuss it with your doctor first, especially since supplements don’t require FDA approval before entering the market. Your doctor could recommend a brand they know and trust.
Sleeping Positions To Help Reduce Pain
How you lay at night can impact your pain levels. “[The] ideal sleeping position keeps you comfortable and your neck and spine aligned,” says Dr. Mark Aloia, Head of Sleep and Behavioural Sciences at Sleep Number. Depending on where the pain is, you might need to change your sleeping position or add a prop for support and relief.
Back Sleeping
If you place a pillow under your knees when resting on your back, it can help relieve pressure and ease pain. Try a supportive wedge pillow with an incline that’s steep enough to alleviate pressure from your lumbar spine.
“Back sleeping is the most universally recommended for a variety of pain,” says Dr. John Gallucci, CEO at JAG-ONE Physical Therapy. Sleeping this way can target various pain points:
Lower Back Pain: Gallucci says to place a supportive pillow under your knees to “help maintain the natural curvature of your spine, potentially reducing strain on your lower back.” An adjustable bed can also help here.
Shoulder Pain: “Back sleeping can be beneficial for shoulder pain, especially if you use a supportive pillow that keeps your shoulders aligned with the rest of your body,” says Gallucci.
Neck Pain:Gallucci sayssleeping on your back with a supportive pillow under your neck and head can relieve pressure from your neck muscles.
Hip Pain: For some people with hip pain, Gallucci says that sleeping on your back may reduce pressure build-up in that area.
Side Sleeping
Remember that side sleepers generally fare best with a softer mattress to cradle their joints. If your current mattress is too firm, a mattress topper can add a touch of plushness to make your bed side sleeper-friendly.
“Sleeping on your side with your knees drawn up toward your chest or placing a pillow between your knees can help align your spine and reduce stress on your hips and lower back,” says Aloia.
Stomach Sleeping
Aloia says stomach sleeping is a “reason behind neck and back pain,” and can also “put more pressure on your muscles and joints.” Thus, sleeping on your stomach is generally discouraged by experts, but there are exceptions. Gallucci says that “some people with lower back pain or sciatica may find that lying on their stomach temporarily eases their discomfort by taking pressure off the lumbar spine,” but he adds that consistently sleeping this way can lead to “discomfort and potential long-term issues.”
Final Thoughts On Sleeping With Pain
Making changes to your diet, lifestyle and sleep habits can do a lot to ease pain, but the experts we spoke to for this story emphasize finding (and properly treating) the root cause of your discomfort. Don’t try to push through or underestimate the severity of your pain. If it’s bad enough to disrupt your sleep, get it checked out.
“Pain can be very difficult to live with and many of us feel like maybe it is not bad enough to warrant visiting a specialist,” says Aloia. “I would encourage everyone to set their own threshold for pain, and to seek support once that threshold is met.”
Produced naturally by the pineal gland in the brain at night, melatonin helps regulate the body’s sleep-wake cycle (Getty Images)
