![]() All the patients were initially taking prescribed zopiclone 7.5 mg tablet at every bedtime or night as insomnia therapy. Informed consent was obtained from every patient. The study was approved by the local research committee and the pain clinic. This was a quality assurance study of routine clinical practice and patient preference. We conducted a prospective observational crossover study of consecutive adult patients who underwent pain management at a Canadian pain clinic during May 2020 to April 2021. The study also aimed to compare both drugs with respect to tolerability, safety, adverse effects, and impact on chronic pain management outcomes. The study aimed to compare the 2 drugs in terms of sleep quality, onset, duration, efficacy, and reliability. The objective of this prospective observational clinical study was to compare zopiclone and clonidine for insomnia treatment in chronic pain patients. There is no previous clinical study that compares the sleep or other beneficial effects of clonidine and zopiclone in chronic pain patients. 15, 16, 20, 21 Compared to zopiclone, clonidine may afford better sleep, better analgesia, and fewer adverse effects and these outcomes may be particularly beneficial in chronic pain patients. Clonidine provides reliable anxiolysis, analgesia, and sleep but is not commonly employed for these useful qualities. 19 – 21 It produces predictable adverse effects of dry mouth, dizziness, and postural hypotension. 15 – 18 Clonidine provides effective therapy for restless legs, nightmare, and other sleep disorders. 9 – 14Ĭlonidine is an α 2-adrenoreceptor agonist drug that is used to treat hypertension, bruxism, attention-deficit/hyperactivity disorder, drug or substance withdrawal, menopausal hot flush, spasticity, and anxiety. Adverse effects include nausea, residual drowsiness, prolonged tiredness, dry mouth, headache, amnesia, confusion, depression, hallucination, sleepwalking, nightmares, incoordination, collapse, paradoxical excitation, drug dependence, withdrawal, and polysubstance use. Zopiclone use is controversial and associated with unpredictable effects. 9 – 11 Although zopiclone is molecularly different from benzodiazepines, it has a similar mode of action to benzodiazepines by increasing the transmission of the inhibitory neurotransmitter gamma-aminobutyric acid in the central nervous system. Zopiclone is a popular nonbenzodiazepine drug and is categorized as a cyclopyrrolone. 1, 5, 8 Prescription sleep medicines include zolpidem, zopiclone, lemborexant, lorazepam, nitrazepam, trazodone, temazepam, triazolam, flurazepam, and quetiapine. 5, 6, 8 Nonprescription sleep medicines include melatonin, antihistamines, chamomile, valerian, theanine, rhodiola, scutellaria, and passionflower. 4, 5, 7 However, a significant proportion of chronic pain patients may require pharmacologic therapy for insomnia. ![]() 4 – 6 Insomnia should be treated with nonpharmacologic modalities such as diet, psychotherapy, hypnotherapy, and cognitive behavioral therapy. 2, 3 Good sleep hygiene is essential for chronic pain management and improvement. 1, 2 Insomnia is part of the vicious cycle of pain propagation and central pain sensitization syndrome. Chronic pain has negative impacts on sleep and is a major cause of insomnia. ![]()
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