Postoperative pain relief is crucial for full recovery. With the ongoing opioid epidemic and the insufficient effect of acetaminophen on severe pain; non-steroidal anti-inflammatory drugs (NSAIDs) are heavily used to alleviate this pain. However, NSAIDs are known to inhibit postoperative healing of connective tissues by inhibiting prostaglandin signaling. Pain intensity, inflammatory mediators associated with wound healing and the pharmacological action of NSAIDs vary throughout the day due to the circadian rhythm regulated by the clock genes. According to this rhythm, most of wound healing mediators and connective tissue formation occurs during the resting phase, while pain, inflammation and tissue resorption occur during the active period of the day. Here we show, in a murine tibia fracture surgical model, that NSAIDs are most effective in managing postoperative pain, healing and recovery when drug administration is limited to the active phase of the circadian rhythm. Limiting NSAID treatment to the active phase of the circadian rhythm resulted in overexpression of circadian clock genes, such as Period 2 (Per2) at the healing callus, and increased serum levels of anti-inflammatory cytokines interleukin-13 (IL-13), interleukin-4 (IL-4) and vascular endothelial growth factor. By contrast, NSAID administration during the resting phase resulted in severe bone healing impairment. open Scientific RepoRtS | (2020) 10:468 | https://doi.org/10.1038/s41598-019-57215-y www.nature.com/scientificreports www.nature.com/scientificreports/ and Table S2). For instance, macrophage activity, leukocyte recruitment, and pro-inflammatory mediators such as interleukin-1β (IL-1β), interleukin-6 (IL-6), and interleukin-12 (IL-12) increase at the beginning of daily activity. During this phase, the levels of Tol-Like Receptors TLR9 and TLR4 also increase, leading to the upregulation of CCL2, CXCL1, CCL5, and subsequent leukocyte recruitment and potential tissue damage in injured sites 12-15 ( Fig. 1). By contrast, anti-inflammatory mediators and other growth or angiogenesis factors, such as the vascular endothelial growth factor (VEGF), peak during the resting phase 13,16,17 ( Fig. 1 and Table S2).The circadian rhythm affects many aspects of connective tissue metabolism 18 . A 24-hour oscillation occurs in bone tissue during growth 19 , formation, resorption 20,21 , and in the endochondral ossification during bone fracture healing 21 . Bone formation occurs during the resting period, and resorption occurs mostly during the active period 21 . Experimental studies in rodents and humans reveal that the disruption of sleep and circadian rhythm impairs bone formation 22 . All bone cells such as osteoblasts, osteoclasts, and chondrocytes express clock genes, such as Per or Cry, that influence bone volume regulation 23,24 . Cry2 influences the osteoclastic activity and Per2 regulates osteoblast activity 25 . The circadian clock also affects pain, with sensitivity peaking during the active phase 26 . Part of the pain response oscillation could b...