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4 Articles in this Series
Introduction
Diagnosing and Treating Sjogren's Syndrome More than Meets the Eye
Retaining Mobility May Lead to Pain Reduction
Treatment Uncertainty Remains for Asymptomatic Hyperuricemia
Vitamin D Supplementation May Improve Chronic Widespread Pain

Vitamin D Supplementation May Improve Chronic Widespread Pain

With Wai Chung Yong, MD, and Michael Atwell, FNP-C 

Chronic widespread non-specific pain in patients with fibromyalgia and other conditions is marked by reduced pain thresholds, multiple tender points, and decreased quality of life. Findings presented at the American College of Rheumatology 2017 Annual Meeting in San Diego suggests that paying attention to Vitamin D levels, and supplementing when needed, may provide bring more relief from generalized pain-inducing symptoms.

“We can perhaps improve pain,” Wai Chung Yong, MD, told Practical Pain Management. A primary care physician at Baystate Medical Practice in Massachusetts, Dr. Yong conducted a meta-analysis and systematic review of Vitamin D deficiencies while working at Bassett Medical Center in New York.1 Specifically, he researched the Central, Medline, and Embase databases from inception through January 2017.  

Dr. Yong found four randomized clinical trials including 287 patients in which the patients' vitamin D levels were evaluated for any effects of vitamin D supplementation on treatment results versus placebo in adults with chronic systemic pain, or fibromyalgia.1 Chronic widespread, non-specific pain, in this case, was defined as long-term, recurrent musculoskeletal pain without any evident secondary cause. Fibromyalgia diagnoses met the definition of the American College of Rheumatology criteria for the condition.

The study outcomes were derived from data obtained using the visual analog scale (VAS) to evaluate pain levels.1 Dr. Yong then used a meta-regression analysis, applying a random effects model, to explore the effect of a change in vitamin D in the treated group on the difference in mean VAS.

The studies were published from 2008 through 2014, and the amounts of vitamin D supplementation used in the studies varied widely.1

Vitamin DPaying attention to Vitamin D levels, and supplementing when needed, may provide some relief from pain symptoms.

 Supplemental Vitamin D May Elicit Pain Relief 

The pooled results found a significantly lower VAS in CWP patients who received the vitamin D treatment compared to those given placebo (MD=0.46, 96% CI:0.09-0.83, P = 0.02).1 However, meta-regression found no significant change in VAS after increasing vitamin D levels, said Dr. Yong. “I want to emphasize that my study showed a statistically significant improvement of the visual analog scale, but the difference is minimal,” he explained.

Dr. Yong recommended that future studies on vitamin D supplementation focus on any links with other chronic, wide-spread pain patient outcomes, such as functional status, quality of life, and pathophysiological changes.

Role of Vitamin D in the Central Nervous System and Brain

"The association between vitamin D and pain is not easily explained," Dr. Yong told Practical Pain Management. However, there is growing evidence of “vitamin D receptors in the central nervous system and hydroxylation of vitamin D in the brain.”

Vitamin D may help to modulate pain through an influence on the  regulation of dopamine, serotonin, and acetylcholine, he said, “but the pathophysiology of fibromyalgia or chronic widespread pain itself is full of uncertainty.”

Serum 25-Hydroxyvitamin D (25(OH)D) levels below 30 nmol/L (12 ng/mL) have been associated with deficiency based on data from the National Institutes of Health, while levels of between 30 nmol/L to 50 nmol/L (12 mg/nL to below 20 ng/mL) are considered inadequate for bone and overall health in uncompromised individuals.2

Although the role of vitamin D in the maintenance of skeletal health is well established, more recent investigations have focused on the impact that a deficiency in this vitamin may have in the pathogenesis of autoimmune diseases.3,4

In Practice

This newest analysis by Dr. Yong “has practical applications,” agreed Michael Atwell, FNP-C, a family nurse practitioner at Reid Health in Indiana who reviewed the poster following an oral presentation.

“There has been a lot more emphasis on checking the vitamin D status of our patients,” he said, particularly for patients who present with pain conditions that have responded poorly to standard treatments.

Going forward, Dr. Yong advised practitioners to screen patients for vitamin D levels if fibromyalgia or other long-term systemic pain conditions are suspected. For patients who demonstrate a deficiency of vitamin D, a trial of supplementation to normalize levels may be warranted.

Dr. Yong had no conflicts of interest to report

References

  1. Yong WC, Sanguankeo A, Upala S. Effect of Vitamin D Supplementation in Chronic Widespread Pain: A Systematic Review and Meta-Analysis. Poster presented at: The American College of Rheumatology 2017 Annual Meeting, Nov. 3-8, 2017. Available at: http://acrabstracts.org/abstract/effect-of-vitamin-d-supplementation-in-chronic-widespread-pain-a-systematic-review-and-meta-analysis/ Accessed Nov.ember 5, 2017.
  2. National Institutes of Health. Vitamin D Fact Sheet. Available at http://ods.od.nih.gov/factsheets/VitaminD-Consumer/. Accessed November 9, 2017.
  3. Aranow C. Vitamin D and the Immune System. J Investig Med. 2011;59(6): 881–886.

  4. Prietl B, Treiber G, Pieber TR, Amrein KVitamin D and immune function. Nutrients. 2013; 5;5(7):2502-21. 

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