TABLE 3.
Circadian rhythms in different types of chronic pain.
| Author | Type of pain | Study design; Number of participants | Results |
|---|---|---|---|
| van Grootel et al. 15 | Temporomandibular joint pain | Randomized controlled; 133 patients | TMJ pain intensity was highest late in the day (before dinner or bedtime) |
| Bellamy et al. 16 | Fibromyalgia | Observational cohort; 21 female patients | Pain more severe in the morning compared to afternoon |
| Caumo et al. 21 | Fibromyalgia | Cross‐sectional; 18 patients | Negative correlation between pain pressure threshold and aMT6s levels between 6:00–18:00, when fibromyalgia patients' aMT6s is higher than control |
| Bellamy et al. 26 | Rheumatoid arthritis | Cross‐sectional; 13 patients | Lowest pain level occurred around 17:00 |
| Bellamy et al. 27 | Hand osteoarthritis | Observational cohort; 21 patients | Pain severity least at 16:10 |
| Zhang et al. 28 | Knee osteoarthritis | Observational cohort; 241 patients | Lower pain intensity in the afternoon |
| Allen et al. 29 | Hand, hip or knee osteoarthritis | Observational cohort; 157 patients (hand (40), hip (32), and knee (85)) | Pain severity increased during the morning and early afternoon, and declined during the evening. |
| Levi et al. 30 | Hip or knee osteoarthritis | Double‐blind, crossover; 66 patients | Some circadian profiles were unimodal (n = 30), with a single peak between 8 a.m. and 2 p.m. (n = 3), between 2 and 8 p.m. (n = 19), or between 8 p.m. and 8 a.m. (n = 8). Other profiles were bimodal, with both a morning and an evening peak (n = 23). In four series, self‐rated pain intensity varied little throughout the day. |
| Odrcich et al. 49 | Neuropathic pain | Randomized, double‐dummy, crossover; 85 patients | Pain worsened throughout the day from 08:00 to 20:00 pattern maintained even with analgesics |
| Gilron et al. 50 | Neuropathic pain | Randomized, double‐dummy, crossover; 56 patients | Pain score increased throughout the day from 08:00 to 20:00, during the pretrial baseline and also during the treatment with the drugs |
| Tomson et al. 51 | Trigeminal neuralgia | Observational cohort; seven patients taking carbamazepine | The frequency of pain attacks was lowest during night hours (23:00–5:00), and highest during the morning (8:00–11:00). |
| Solomon 52 | Migraine headache | Prospective cohort; 15 patients | Onset of migraine was greatest from 6:00–12:00 |
| Fox and Davis 53 | Migraine headache | Prospective cohort; 1698 patients | Migraine attacks peaked from 4:00–9:00 |
| Alstadhaug et al. 54 | Migraine headache | Retrospective cohort; 58 female patients | Pain was found to peak at 13:40 |
| Soriani et al. 55 | Migraine headache | Prospective cohort; 115 children patients | First peak of in the afternoon (16:48) and second peak in the early morning (06:35) |
| de Tommaso et al. 56 | Migraine headache | Observational cohort; 786 patients | The frequency of migraine attacks is higher throughout the day, with peaks at 10:00 and 22:00. Attacks were less frequently noted at night (3:00). |
| Gori et al. 57 | Migraine headache | Observational cohort; 100 patients | 42% of patients experience more than 75% of their attacks at night and in the early morning hours (3:00–7:00). |
| Packard et al. 58 | Migraine headache | Randomized controlled; 61 patients | No difference in mean pain level between the morning and the afternoon. |
| Park et al. 59 | Migraine headache | Observational cohort; 82 patients | Migrainous headache characteristics presented most frequently at 06:00–12:00, and least frequently at 18:00–00:00 and 00:00–06:00. The same pattern was seen for the occurrence of all headache types (migraine and non‐migraine). |
| van Oosterhout et al. 60 | Migraine headache | Observational cross‐sectional; 2389 patients | Migraine attacks most often began at 04:00–06:00 (15.4% of total) or 06:00–08:00 (11.8% of total). |
| Kikuchi et al. 61 | Tension headache | Prospective cohort; 31 patients | Intensity of tension headaches was significantly lower in the morning and the peak was in the late afternoon (16:00) |
| Rozen and Fishman 62 | Cluster headache | Observational, survey‐based; 1134 patients | Peak between 00:00 and 03:00, most commonly 02:00 |
| de Coo et al. 63 | Cluster headache | Cross‐sectional; 147 headache patients | Attacks occurred most often between 00:00 and 4:00 and least often between 12:00 and 16:00 |
| Lee et al. 64 | Cluster headache | Multicenter, prospective cohort; 175 patients | Nighttime attacks were predominant early in the disease course, while daytime attacks increased with disease progression and decreased in patients with the most advanced disease course |
| Steinberg et al. 65 | Cluster headache | Observational cohort; 475 patients (episodic (421) and chronic (54)) | The most commonly reported time interval for attack was nighttime (2:00–4:00), and the lowest rates were noted around late morning and early afternoon (10:00–14:00). A third of patients noted no rhythmicity. |
| Saini et al. 67 | Breakthrough pain in cancer | Prospective cohort; 123 patients | More breakthrough pain in the morning hours when compared to evening, with a peak between 9:45–10:30 |
| Campagna et al. 68 | Cancer Pain | Prospective longitudinal cohort; 92 patients | Acrophase between 12:15–12:30 |
| Gagnon et al. 69 | Breakthrough pain in cancer patients | Retrospective analysis of prospective cohort study; 104 patients | Patients without delirium needed more analgesia in the morning and patients with delirium required more analgesia in the evening and at night |
| Currow et al. 70 | Cancer pain | Randomized, double‐blind, crossover, placebo‐controlled; 42 patients | No significant difference between the level of pain for patients on morphine in the morning versus in the afternoon |
| Glynn and Lloyd 71 | Cancer Pain | Prospective cohort; 41 patients | Pain increases throughout day and reaches maximum at last time point (22:00) |