August 20, 2026, 6:01 pm | Read time: 5 minutes
Many know melatonin as a supplement that helps with falling asleep. For pain specialist Stefan Wirz, it’s more than that: He successfully uses melatonin for patients suffering from chronic pain who previously saw no alternative to heavy medication.
It’s About Patients Who Can’t Sleep Due to Pain
Those suffering from chronic pain often fear the darkness. As soon as the bedroom becomes quiet, the mind starts racing and the body finds no rest. But insomnia is far more than a bothersome side effect—it acts like an accelerant for the suffering.
Pain specialist Prof. Dr. Stefan Wirz, chief physician at Cura Hospital Bad Honnef, observes this daily in his clinical routine: “Insomnia massively amplifies the pain,” he explains in an interview with FITBOOK. Patients who can’t sleep due to pain wake up exhausted the next morning. The body is in a state of constant stress, drastically lowering the pain threshold, says the specialist in anesthesiology, intensive care, pain therapy, and palliative medicine.
He refers to a fascinating study by pain researcher Emma Hertel. In a clinical study, she showed that pain perception skyrockets in subjects who didn’t sleep for a night.1 Scientists recently deciphered what happens biologically in a mouse model: They identified a ‘pain circuit’ in the brains of mice that essentially turns up the pain during sleep deprivation.2
Melatonin Offers New Hope for Many Patients
A real perspective to break out of this exhausting cycle is offered by a messenger substance that most know only as an over-the-counter supplement to avoid jet lag: melatonin. For Prof. Wirz, the hormone is much more than just a sleep aid. He uses it specifically as a ‘supportive component’ for severely suffering chronic patients.
These are people whose daily lives are severely restricted by nerve pain (neuropathies), the consequences of a herniated disc, or diabetes-related nerve damage (polyneuropathy). For them, life is often no longer about living but merely surviving exhaustion. Prof. Wirz puts it bluntly: If these patients don’t find rest at night, they spend the next day just trying to “survive somehow.” Active measures against the pain are hardly possible in this state of total exhaustion.
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Effects on Three Levels
Melatonin works on three levels, explains Wirz: The key lever for chronic pain patients is the regulation of nighttime rest, the doctor explains. “Chronic pain puts the body in constant stress, lowering the pain threshold. Melatonin helps interrupt this mechanism.” Only when the patient finds rest at night does he have the energy to actively work on his recovery through physical therapy or training during the day, he explains. The pain specialist observes that his patients experience some recovery through melatonin.
But beyond mere sleep promotion, melatonin has an effect: “Melatonin can slightly reduce pain directly by intervening in the internal processes of nerve cells,” Wirz explains. Within nerve cells, there are messenger substances that usually increase nerve activity. Melatonin gently slows this activity, reducing the transmission of pain signals. Thirdly, it has an anti-inflammatory component that supports the body’s own pain-inhibiting systems. It apparently enhances the effect of substances that our body already produces to alleviate pain. This also indirectly counteracts pain amplification.
A Major Advantage Over Ibuprofen and Aspirin
To achieve an effect in his chronic pain patients, Wirz starts inpatient therapy with a dose of four milligrams. Depending on the effect, it is gradually increased to eight to ten milligrams. In his experience, doses over ten milligrams often do not bring additional improvement.
The biggest advantage over traditional painkillers like ibuprofen, aspirin, or Voltaren lies in safety: Stefan Wirz has often treated patients who have taken multiple pain pills daily for years. While these can severely damage the stomach, heart, and kidneys with long-term use, melatonin is harmless to the internal organs and does not cause dependency.
Melatonin Reduced Ibuprofen Use in Study on Osteoarthritis and Back Pain
A new meta-analysis, which evaluated a total of 23 clinical studies with over 2,000 participants, impressively shows this benefit: In people with back pain, osteoarthritis, and fibromyalgia, the administration of melatonin significantly reduced ibuprofen use. Without compromising pain relief.3 However, the authors of the analysis point out that the pain reduction was often not clinically relevant. More research is needed for a final recommendation.
Wirz, in any case, sees in his clinical routine how melatonin helps patients. They are often only able to actively work on their recovery through improved sleep. “If someone is exhausted, they won’t be able to do anything about their chronic pain […] But if they’ve slept and feel refreshed, then melatonin can be a great component for them.”
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Potential Savings on Opioids
According to Wirz, melatonin can also help reduce the dose of strong painkillers. “If you supplement with melatonin, you may need fewer opioids, as the effects can support each other,” the expert explains. He describes the case of a patient who was switched from diclofenac to an opioid after years of use. Through melatonin administration, the opioid dose could be reduced. Caution is needed with drugs like pregabalin or gabapentin, which are used for nerve pain or anxiety disorders (pregabalin): Melatonin can support the effects of these pain medications.
Not a Pain Stopper for Acute Headaches
The doctor emphasizes that melatonin has a slight pain-modulating effect but is not a “real pain stopper.” Melatonin is not suitable as a replacement for pain medication but as a support in pain therapy, says Wirz. “It’s a substance that should be considered, I think.” For everyday complaints, such as occasional headaches, it’s not the right choice.
For tension headaches, for example, acetaminophen helps. When it comes to toothaches, migraines, or rheumatic complaints, ibuprofen is often the more effective choice. Important: Both ibuprofen and acetaminophen should be taken for no more than a week without medical advice.