New Study Alert: Pain Rhythms Could Help Understand Why Some People with Chronic Low Back Pain Use Opioids

KINGSTON, ON – A new Canadian study has uncovered an important link between the body’s internal clock and opioid use in people with chronic low back pain, a condition that affects millions of Canadians. Supported by the Chronic Pain Network as part of the Canadian Institutes of Health Research Strategy for Patient-Oriented Research, the study led by Dr. Nader Ghasemlou and his team found that people whose pain followed a daily rhythm were less likely to use opioids and reported better overall sleep and mood.

The study was among the first from their research group to be co-led by patient partners, in alignment with the Chronic Pain Network’s mandate to embed people with lived experience as core members of research teams and not just as participants. Their insights shaped the design and direction of the research, contributing to its real-world relevance. The team followed 62 adults with chronic low back pain, asking them to track their symptoms in real time over several days, using an electronic diary the team developed. The research team also analyzed blood samples taken at different times of day to see if individuals’ biology mirrored their reported pain. They found that about one out of four participants had what is described as “rhythmic pain” that consistently increased throughout the day. Most participants, however, had consistent or variable pain scores over the course of the study.

Surprisingly, these individuals with rhythmic pain patterns were not using opioids, showed fewer symptoms of depression and sleep disruption, and had a distinct immune profile. In particular, there was a different gene signature in their blood for a process called neutrophil degranulation – an immune system response that is known to be influenced by circadian rhythms (the body’s 24-hour clock). To further validate their findings, the team assessed this in another population of people with chronic pain who transitioned from acute to persistent pain, supporting that opioid use is linked to this immune response. Neutrophils make up a majority of white blood cells in our blood, and have been implicated across diseases. Dr. Ghasemlou’s lab recently showed an important role for these cells in the transition from acute to chronic low back pain with an international team of scientists. Their team is now working to better understand the implications of rhythms across all immune cells in chronic pain and other diseases.

As Canada continues to grapple with the opioid crisis and unmet needs in pain care, the study opens new directions for treatment innovation. The findings point to the potential for personalized pain management strategies that could reduce reliance on opioids and improve quality of life. The Ghasemlou team is now starting a clinical trial that seeks to use circadian rhythm modifying therapies as a way to improve pain. This new work, also funded by the Canadian Institutes of Health Research Strategy for Patient-Oriented Research, includes people with lived experience as key interest holders. The ongoing work also aligns with priorities in Canada’s Action Plan for Pain, which calls for more personalized, equitable, and evidence-based approaches to pain care.

About the Chronic Pain Network:
The Chronic Pain Network is a pan-Canadian research initiative funded through the Canadian Institutes for Health Research Strategy for Patient-Oriented Research. It brings together researchers, clinicians, and patient partners to advance pain research and improve outcomes for people living with pain. This study highlights the network’s commitment to cutting-edge, collaborative, and patient-informed science. The network continues to support research like Dr. Ghasemlou’s CircaPain project, which is currently recruiting participants to better understand how their pain patterns change over time.

Quotes:

“This opens the door to more personalized, time-based approaches to treating pain. Instead of treating pain like a flat line, we need to look at how it changes over the day and how treatments can be tailored to those changes.” – Dr. Nader Ghasemlou, senior author of the study.

“Pain that follows a pattern may tell us something important about how the body is working or trying to cope. It’s not just the intensity of pain that matters, but when it happens.” – Dr. Norm Buckley, clinician-scientist involved in the study and nominated principal applicant of Chronic Pain Network.

“As someone who lives with chronic pain, I know how unpredictable and exhausting it can feel. What I appreciate about this study is that it validates what many of us have noticed — that pain can shift with the time of day — and shows how those patterns can hold real clinical value. Being part of this research means we’re not just the subjects of the study; we’re helping to shape questions and findings that could make pain care more personal and more effective for people like me.” – Jennifer Daly-Cyr, patient partner on the study.

Full Article Link:
Taccardi, D. et al. Circadian rhythmicity and biopsychosocial characteristics influence opioid use in chronic low back pain. https://pubmed.ncbi.nlm.nih.gov/41031896/