The Chronobiology, Chronopharmacology, and Chronotherapeutics of Pain

Abstract

Data for this review of chronobiology, chronopharmacology, chronotherapeutics and pain were derived from electronic searches of the medical literature (Medline) utilizing both Silver Platter and OVID search engines. Further information was obtained from personal conversations with members of the International Society for Chronobiology involved in chronopharmacology and pain research and reviews of non-Medline-referenced materials and journals such as Chronobiologia and the Annual Review of Chronopharmacology. A variety of data from proceedings were available, but was not utilized because of their nonrefereed status and the relative unavailability of such sources; however, peer-reviewed, published proceedings have been included in this review.A total of 62 studies were identified as relevant to this review of biological rhythms and pain; of these, only 6 were conducted by nurses. Studies were broadly categorized by purpose as experimental chronobiology in humans (9), experimental chronobiology in animals (12), clinical chronobiology (25), chronopharmacology in animals (6), chronopharmacology in humans (6), and chronotherapeutic interventions (4). All statistically significant findings were reported at the p < 0.05 level.

Morphine administration and abrupt cessation alter the behavioral diurnal activity pattern

“…Studies indicate that the master clock that regulate the circadian activity rhythm is located in the hypothalamus i.e., in the suprachiasmatic nucleus (SCN) which regulates and controls the circadian activity and other circadian rhythms (Reppert et al , 2002; Herzog and Schwartz, 2002). It is known that medications as well as opioid can have different effects when administered at the morning compared to night administration (Auvil-Novak, 1999; Bruguerolle et al , 2007; Li et al , 2010). Opioids work through interaction with one of several receptors in the brain, specifically the μ (mu) type receptors, to produce analgesia (Smith et al , 1995).…”

The Chronotherapeutic Boost: Using Natural Cycles to Schedule Medications

“…2 Current research shows an association in the timing of migraine headaches as preceding or coinciding with the onset of menstruation. 3 Ongoing research examines associations between the menstrual cycle and irritable bowel syndrome. 2 New research examines the associations between menstruation and pain.…”

“…Susan E. Auvil-Novak, R.N., Ph.D., while on the facul ty a t T he Fr ance s Payn e Bo lt o n School of Nursing, Case Western Reserve University, Cleveland, Ohio, was a lead investigator for several clinical studies on pain management. After revie wing 62 research studies on cycles and pain, 3 Dr. Auvil-Novak suggested that the traditional setting of 24-hour nursing care coverage provides a unique opportunity for clinical nursing research on biorhythms and pain. Asthma has a cyclic relation to the menstrual cycle.…”

Making a Case for Programmable Pumps Over Fixed Rate Pumps for the Management of Fluctuations in Chronic Pain and Spasticity: A Literature Review

“…Circadian control of biologic events results in predictable daily patterns that characterize the function of most organ systems (e.g., pulmonary, cardiovascular, renal, hematologic, immunologic, cognitive, and motor function) and integrative physiologic functions (e.g., body temperature, blood flow) (3,4). Circadian rhythms also have been shown to influence the timing of disease processes.…”

“…Conventional drug administration paradigms of flat infusions are not ideal to treat symptoms that fluctuate due to circadian rhythms or other causes. Instead, pulsed programmed drug delivery is required such that the desired amount of drug is delivered at different times to meet varying biologic needs (3). Within the last 30 years, the administration of drugs based on circadian rhythm patterns and other fluctuations has emerged as a possible way to improve treatment and reduce unwanted side effects for a number of diseases, including arthritis, ulcer disease, asthma, hypertension, and cancer (4).…”