Author: Laura Owens, Feb 2, 2010
Chronic Pain & Low D Levels May Be Linked, Research Mixed
In 2008 the online site Pain Treatment Topics released a review of research on the potential benefits of vitamin D for patients with pain conditions, notably musculoskeletal and back issues. Although results varied, researchers agree insufficient vitamin D is an underlying factor in fibromyalgia and other chronic pain conditions.
Chronic Pain and Vitamin D Deficiency Linked Long Ago
Multiple studies link vitamin D deficiency to chronic aches and pains, muscle fatigue or weakness, and other disorders including immunity and some cancers (Holick 2003b; ODS 2008; Plotnikoff and Quigley 2003; Reginster 2005; Tavera-Mendoza and White 2007; Vieth 1999).
A study presented at the American Society of Anesthesiologists 2007 Annual Meeting reported that about one in four patients with chronic pain also have inadequate blood levels of vitamin D. Patients with insufficient vitamin D also needed higher doses of morphine for longer periods of time.
According to study author W. Michael Hooten, MD, medical director and anesthesiologist at the Mayo Comprehensive Pain Rehabilitation Center in Rochester, Minn., researchers have long known that inadequate levels of vitamin D can cause pain and muscle weakness.
The implications are that in chronic pain patients, vitamin D inadequacy is not the principal cause of pain and muscle weakness, said Hooten for a press release, However, it could be a contributing but unrecognized factor.
The jury is still out on the exact connection between vitamin D and chronic pain but scientists believe it may begin with lower levels of circulating calcium (hypocalcemia) due to inadequate vitamin D. A cascade of biochemical reactions then occurs that hinders bone metabolism and health. Low levels of calcium elevates parathyroid hormones which impairs proper bone mineralization causing a spongy matrix to form under periosteal membranes covering the skeleton.
This gelatin-like matrix can absorb fluid, expand, and cause outward pressure on periosteal tissues, which generates pain since these tissues are highly innervated with sensory pain fibers (Holick 2003b; Shinchuk and Holick 2007; Yew and DeMieri 2002).
Fibromyalgia and Vitamin D Deficiency
The association between low levels of 25-hydroxyvitamin D and non-specific musculoskeletal pain, including fibromyalgia syndrome remains controversial.
In one study, Israeli researchers found no association between women with fibromyalgia and low levels of vitamin D (Tandeter et al. 2009).
Yet researches in an earlier study in the Middle East found a significantly greater prevalence of low D concentration in women with fibromyalgia compared to women without fibromyalgia (43% vs 19%). Yet researchers in the Middle East found that 90% of patients diagnosed with fibromyalgia and/or non-specific musculoskeletal pain treated with vitamin D improved.(Badsha et al. 2009).
One reason for the conflicting evidence is researchers have yet to adequately measure patients’ response to different formulations, doses, and durations of vitamin D. In addition, scientists believe vitamin D receptors have different genetic make up and activity so individuals may respond differently to vitamin D therapy. (Kawaguchi et al. 2002; Videman et al. 2001).
Vitamin D Dose For Pain Relief
Dr. Cannell, Executive Director of The Vitamin D Council recommends supplementing with Cholecalciferol (vitamin D3). D3 is the naturally occurring form of vitamin D and is made in large quantities in skin when sunlight strikes it. Dr. Cannell explains that Calcidiol is the only blood test that should be drawn. Doctors can order calcidiol levels although labs will know calcidiol as 25-hydroxyvitamin D.
Take enough vitamin D3 to get 25(OH)D levels above substrate starvation levels, 50 ng/mL or 125 nmol/L. Current recommendationst for adults and children are inadequate to maintain optimal health and certainly to treat chronic pain conditions and illness.
Dr. Cannell suggests people supplement with vitamin D before getting their blood tested, then adjust their dose so their 25(OH)D level is between 5080 ng/ml during both the summer and the winter. These are conservative dosages explains Dr. Cannell. People who avoid the sun, and nearly all dark-skinned people need to increase their dose if their blood levels are still low, even after two months of the above dosage, particularly during the winter months.
Exact levels are difficult to determine because requirements vary by age, body weight, percent of body fat, latitude, skin coloration, season of the year, use of sun block, individual variation in sun exposure, and how sick someone is.
If you use suntan parlors once a week, says Dr. Cannell, or if you live in Florida and sunbathe once a week, year-round, do nothing. However, if you receive very little UVB exposure the Council recommends the following dosing levels of D3 (maintenance level):
- healthy children under the age of two – 1,000 IU per day*
- healthy children over the age of two – 2,000 IU per day*
- adults and adolescents – 5,000 IU per day.
*The American Academy of Pediatrics recommends 400 mg per day for children.
While the exact relationship between vitamin D and chronic pain syndromes like fibromyalgia isn’t fully understood, most researchers agree that vitamin D deficiency contributes to muscuskeletal pain. Patients and practitioners should consider including vitamin D supplementation in their therapy for patients suffering with chronic pain syndromes.
“Vitamin D Inadequacy May Exacerbate Pain,” American Academy of Anesthesiologists, Press Release, October 15, 2007.
Tandeter H, Grynbaum M, Zuili I, Shany S, Shvartzman P., “Serum 25-OH vitamin D levels in patients with fibromyalgia.” Israeli Medical Association Journal, 2009.
Badsha H, Daher M, Ooi Kong K. Myalgias or non-specific muscle pain in Arab or Indo-Pakistani patients may indicate vitamin D deficiency. Clinical Rheumatology. 2009.
Leavitt, Steward, B. MA, PhD., “Vitamin D: A Neglected Analgesic for Chronic Musculoskeletal Pain: An Evidence Based Review and Clinical Practice Guideline,” June 2008, http://Pain-Topics.org/VitaminD.
“Vitamin D for Pain: Update of Research Evidence,” Pain Treatment Topics, Accessed: January 10, 2010.
Arvold DS, et al., “Correlation of symptoms with vitamin D deficiency and symptom response to cholecalciferol treatment: a randomized controlled trial,” Endocrine Practice, 2009 May-Jun.
Armstrong DJ, Meenagh GK, Bickle I, Lee AS, Curran ES, Finch MB., “Vitamin D deficiency is associated with anxiety and depression in fibromyalgia,” Clinical Rheumatology. 2006 Jul 19.