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How medicine repurposing enables value-based pain management and insomnia therapy

Olumuyiwa Bamgbade, MD
Meds
July 8, 2025
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In today’s evolving health care environment, value-based care is reshaping the future of medicine. The push toward value-based care demands innovative, cost-effective, and patient-centered solutions. A promising yet underutilized strategy is medicine repurposing, the practice of using existing medicines for new therapeutic purposes. Drug repurposing provides a strategic pathway to improving health outcomes while minimizing costs. A compelling example of this approach is the use of clonidine, a long-established cardiovascular drug, for the new application of treating insomnia and chronic pain.

A research publication in the Journal of Clinical Sleep Medicine highlights that clonidine, a traditional cardiovascular medicine, demonstrates better results over zopiclone for insomnia treatment in chronic pain patients. While clonidine has traditionally been used to manage hypertension and cardiovascular disorders, it also works centrally on the nervous system to reduce sympathetic outflow, making it effective for calming heightened arousal states that underlie insomnia and pain. The research showed that clonidine is an effective and reliable alternative to sedative-hypnotic medicine. In contrast to zopiclone, a sedative-hypnotic medicine commonly associated with side effects like hallucinations, falls, and amnesia, clonidine showed a more favorable safety profile.

The prospective observational crossover study included 160 patients undergoing chronic pain management. Each participant used zopiclone or clonidine on alternate nights over three weeks, recording pain levels, sleep quality, and any side effects in daily diaries. The study revealed that clonidine led to quicker sleep onset, longer sleep duration, and better overall sleep quality than zopiclone. Patients reported significantly lower pain scores on nights they took clonidine. Zopiclone was linked with adverse effects such as hallucinations, falls, and amnesia, while clonidine’s primary side effect was dry mouth, mostly at higher doses. Clonidine was associated with fewer adverse effects on the central nervous system. These findings underscore clonidine’s potential as a dual-acting therapy, addressing both pain and insomnia, two deeply interconnected conditions, more safely and effectively than traditional sleep medications.

These outcomes have significant implications for value-based care. From a value-based care perspective, repurposing clonidine represents a high-impact, low-cost solution. Because the drug is already well-known, inexpensive, and widely available, it bypasses the development costs, long timelines, and regulatory hurdles associated with new drug approvals. Its effectiveness in targeting both insomnia and chronic pain also reduces the need for polypharmacy, improving medication adherence and minimizing drug interactions and costs. Furthermore, the improved sleep outcomes and pain relief associated with clonidine may lead to better functional recovery, reduced emergency visits, and enhanced quality of life, key performance metrics in value-based care frameworks.

As the health care system increasingly aligns with value-based principles, policymakers, clinicians, and researchers should invest in evaluating and scaling repurposed therapies. Clonidine’s dual benefit, improving pain and sleep management, aligns with the core principles of value-based care. Indeed, clonidine’s qualities in delivering multi-dimensional insomnia and pain relief make it a value-based therapy in health care integration strategies. This is a promising case of drug repurposing.

Medicine repurposing is more than cost containment; it is about more innovative, safer, and more strategic care. Clonidine’s new role in pain and insomnia therapy shows how aligning science with value can transform outcomes and empower patients. Nonetheless, clonidine may not be the only drug that can be repurposed as an effective pain and sleep treatment. It may just be the beginning of a larger shift.

Olumuyiwa Bamgbade is an accomplished health care leader with a strong focus on value-based health care delivery. A specialist physician with extensive training across Nigeria, the United Kingdom, the United States, and South Korea, Dr. Bamgbade brings a global perspective to clinical practice and health systems innovation.

He serves as an adjunct professor at academic institutions across Africa, Europe, and North America and has published 45 peer-reviewed scientific papers in PubMed-indexed journals. His global research collaborations span more than 20 countries, including Nigeria, Australia, Iran, Mozambique, Rwanda, Kenya, Armenia, South Africa, the U.K., China, Ethiopia, and the U.S.

Dr. Bamgbade is the director of Salem Pain Clinic in Surrey, British Columbia, Canada—a specialist and research-focused clinic. His work at the clinic centers on pain management, health equity, injury rehabilitation, neuropathy, insomnia, societal safety, substance misuse, medical sociology, public health, medicolegal science, and perioperative care.

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