The sleep-regulating hormone melatonin reduces chronic musculoskeletal pain to a degree comparable with common non-steroidal anti-inflammatory drugs and paracetamol, according to a systematic review of 23 clinical trials involving 2,028 participants across multiple countries. Researchers at the University of Sydney found that, on a 0–100 scale, melatonin lowered pain scores by an average of roughly nine points in patients with conditions such as low back pain, osteoarthritis and fibromyalgia. The effect size, they note, is similar to that of aspirin, naproxen and paracetamol, though the review did not directly compare the hormone against opioids.

The mechanism is thought to be dual-action: melatonin not only modulates sleep—disordered sleep being a near-universal companion of chronic pain—but also appears to exert independent analgesic effects through chemical signalling in the brain. The hormone, produced naturally by the pineal gland and widely available as a low-cost synthetic supplement, was well tolerated over the short-term study periods, typically one to two months. Doses ranged from 3 mg to 10 mg daily, with 3 mg most common for chronic pain and 5–6 mg for post-surgical pain, though the review found no significant benefit in post-operative cohorts. Lead researcher Kangchao Wu cautioned that melatonin is not a replacement for existing analgesics but could serve as a safer adjunct, particularly for patients who also struggle with sleep.

Viewed alongside other non-pharmacological lines of inquiry, the finding adds to a growing body of work seeking to reduce dependence on medications that carry higher risks. At the University of Queensland, a pilot physiotherapy programme targeting upper cervical rotation has shown early promise for migraine prevention, with eight in ten participants reporting fewer attacks and some able to abort an episode. The trial, now recruiting for a formal clinical study, focuses on patients whose migraines are accompanied by neck pain—a symptom reported by 80–90 per cent of sufferers. Separately, mental health specialists in Latin America and Indonesia stress that chronic stress, if unmanaged, elevates cortisol and degrades sleep, concentration and immune function, creating a feedback loop that amplifies pain perception. Techniques such as regular moderate exercise, sleep hygiene, mindfulness and dietary balance are recommended to help regulate the body's stress response.

The Sydney team emphasises that larger, longer-term trials are required to confirm melatonin's analgesic potential and to establish optimal dosing protocols. For now, the researchers advise that anyone considering melatonin for pain should do so only after consulting a physician, and as part of a broader management plan. The next factual milestone will be the publication of results from the University of Queensland's full clinical trial on neck exercises for migraine, which could offer a drug-free option for a condition affecting over a billion people worldwide.