Louisiana State University School of Medicine, Shreveport, LA.
John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX.
Pain Physician. 2024 Jul;27(5):273-282.
Melatonin, one of the most versatile hormones in the body, is well appreciated in managing circadian rhythm and for antioxidant properties. Produced in the pineal gland and within mitochondria, melatonin influences many physiologic processes through receptor mediated and direct effects.
The present investigation explores the evolving pharmacologic properties of melatonin, as well as current therapeutic uses in areas where mitigating oxidative stress, inflammation, and cellular senescence. This review also delves into novel therapeutic potential of melatonin and how current research is revealing a wide array of therapeutic promise in pain medicine.
A systematic review of randomized controlled trials (RCTs) and observational studies was performed using various search engines focused on melatonin and its role in pain medicine.
The available literature on melatonin and pain medicine was reviewed. A comprehensive literature search of multiple databases from 1966 to July 2024, including manual searches of the bibliography of known review articles was performed. Quality assessment of the included studies and best evidence synthesis were incorporated into qualitative and quantitative evidence synthesis.
The primary outcome measure was the proportion of patients receiving melatonin with significant relief and functional improvement of greater than 50% of at least 3 months. Duration of relief was categorized as short-term (less than 6 months) and long-term (greater than 6 months).
Melatonin can affect intervertebral disc (IVD) health through the enhancement of survival and function of nucleus pulposus cells, primarily through activation of the ERK1/2 signaling pathway. Melatonin also influences the biochemical environment of the IVD by modulating inflammation and oxidative stress, crucial factors in the pathogenesis of disc degeneration. Melatonin has been shown to reduce senescence and promote autophagy within disc cells, vital for clearing out damaged cellular components, preserving cellular function and preventing deterioration associated with aging and degenerative diseases.
Despite the availability of multiple studies, the paucity of clinical pain related literature is considered as the major drawback.
Based on the present systematic review, melatonin plays a critical role in sleep, but evolving studies have demonstrated substantive roles in mitigating degenerative conditions in various tissues, including IVD degeneration. Ongoing studies will better clarify the role of melatonin as a potential therapeutic agent, including the targeted delivery to various body regions.
褪黑素是体内最具多功能性的激素之一，其在调节昼夜节律和抗氧化方面的作用已得到广泛认可。褪黑素由松果体和线粒体产生，通过受体介导和直接作用影响许多生理过程。
本研究探讨了褪黑素不断发展的药理学特性，以及在减轻氧化应激、炎症和细胞衰老等领域的当前治疗用途。本文还探讨了褪黑素的新治疗潜力，以及当前研究如何揭示出在疼痛医学领域广泛的治疗前景。
使用各种专注于褪黑素及其在疼痛医学中作用的搜索引擎，对随机对照试验 (RCT) 和观察性研究进行了系统回顾。
对褪黑素与疼痛医学相关的文献进行了综述。对 1966 年至 2024 年 7 月的多个数据库进行了全面的文献检索，并对已知综述文章的参考文献进行了手动检索。将纳入研究的质量评估和最佳证据综合纳入定性和定量证据综合。
主要观察指标是接受褪黑素治疗的患者中，至少 3 个月内疼痛缓解且功能改善大于 50%的比例。缓解持续时间分为短期（<6 个月）和长期（>6 个月）。
褪黑素可以通过激活 ERK1/2 信号通路，增强核髓核细胞的存活和功能，从而影响椎间盘 (IVD) 的健康。褪黑素还通过调节炎症和氧化应激来影响 IVD 的生化环境，这是椎间盘退变发病机制中的关键因素。褪黑素已被证明可以减少椎间盘细胞的衰老和促进自噬，这对于清除受损的细胞成分、保持细胞功能以及防止与衰老和退行性疾病相关的恶化至关重要。
尽管有多项研究，但临床疼痛相关文献的缺乏被认为是主要的缺点。
基于本系统回顾，褪黑素在睡眠中起着关键作用，但不断发展的研究表明，它在减轻包括 IVD 退变在内的各种组织的退行性疾病方面具有重要作用。正在进行的研究将更好地阐明褪黑素作为潜在治疗剂的作用，包括针对身体各个部位的靶向递送。
