Vitamin D Deficiency and Chronic Pain

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Recent research has shown that vitamin D plays an extremely important role in chronic pain and that many people are at high risk for vitamin D deficiency. Levels of the vitamin can be measured with a simple blood test. Levels below 20 ng/mL (50 nmol/L) are generally considered deficient in conventional medicine. Others have defined deficiency as below 32 ng/mL, with the optimum range 50 to 70 ng/mL.(1)

Vitamin D is produced naturally in the body when the skin is exposed to ultraviolet rays from sunlight. Using sunscreen blocks the body’s ability to produce vitamin D. People with dark skin synthesize 99% less vitamin D because melanin, the substance responsible for dark skin pigmentation, absorbs the UVB rays. Our bodies also become less able to synthesize vitamin D as we age. People living in the northern United States, where the sun is less direct and winters are longer, are also less likely to synthesize enough of the vitamin.(2) Many drugs also block the synthesis of vitamin D or reduce absorption, including some antacids, barbiturates, anticonvulsants, antirejection drugs, antiviral drugs, nicotine, blood thinners, cholesterol-lowering medication, and steroids.(3)

Food sources of this critical vitamin include fortified milk, egg yolk, cod liver oil, oysters, fatty fish, fortified soy milk, and fortified cereal.(4) These foods, however, are rarely consumed in sufficient quantities to maintain vitamin D at optimum levels. For instance, to obtain a target dose of 4000 to 8000 IU of vitamin D a day, a person would need to consume ¼ cup of cod-liver oil daily or 18 to 36 capsules.(5) Fortunately, vitamin D is inexpensive and readily available in supplement form. Vitamin D3, the natural form of vitamin D, is absorbed more readily than the synthetic form, vitamin D2.(6), (7)

Research Results

A study at the University of Minnesota of people with nonspecific musculoskeletal pain (pain without evidence of injury, disease, or anatomical or neurological defect) found that 93% of participants were deficient in vitamin D.(8) Another study, this one including participants with nonspecific musculoskeletal pain from diverse age groups and ethnicities, found that 100% of African American, Hispanics, and Native Americans were vitamin D deficient. All subjects younger than 30 were also deficient, with 55% severely so and five patients so deficient that their vitamin D levels were undetectable.(9)

Other studies in adults have shown that an inadequate level of vitamin D is associated with many other types of pain:(10)

  • Nonspecific bone and joint pain
  • Fatigue
  • Muscle weakness
  • Fibromyalgia
  • Osteoarthritis
  • Rheumatoid disorders
  • Headaches
  • Immune disorders
  • Depression
  • Chronic fatigue syndrome

A 2014 review of vitamin D status and ill health found that low vitamin D concentrations were associated with the following:(11)

  • Cardiovascular disease
  • High cholesterol levels
  • Inflammation
  • Diabetes
  • Weight gain
  • Infectious diseases
  • Multiple sclerosis
  • Mood disorders
  • Declining cognitive function
  • Physical functional impairment
  • Colorectal cancer
  • Mortality from all causes

Many studies have documented a reduction in pain when vitamin D supplements have been given to people in chronic pain. An article published in Archives of Internal Medicine reported that five patients who had chronic pain and low vitamin D levels had resolution of their pain in five to seven days after they were given vitamin D2 supplements. These patients had been hypersensitive to pain stimuli, and the pain did not improve with the use of any pain medications, including narcotics and tricyclic antidepressants. One of the patients had a decline in vitamin D level and a return of pain after several months; the pain was again resolved with vitamin D supplementation.(12)

A randomized controlled trial in the Netherlands of vitamin D3 supplementation of nonspecific musculoskeletal pain in non-Western (Arab and African) immigrants found that patients receiving a single dose of 150,000 IU of vitamin D3 were more likely, after six weeks, to report pain relief and an improvement in ability to climb stairs than those in the placebo group. Those receiving a second dose of vitamin D3 at six weeks were more likely to report improvements than the group that didn’t receive a second dose.(13)

A randomized controlled study of patients with knee pain and vitamin D insufficiency, who received either vitamin D supplementation or a placebo for a year, found that the treatment group experienced significantly less pain and better knee function than the placebo group.(14) US veterans with multiple areas of chronic pain and low vitamin D levels who were given vitamin D supplementation had less pain, better sleep, and better quality of life.(15)

A randomized double-blind study of children and adolescents with sickle cell disease given a six week course of high-dose vitamin D found that the treatment group had fewer pain days per week and higher physical quality of life scores over a period of 6 months.(16)

A small study of women with diabetes who had neuropathic pain, tingling, and numbness found that six months of weekly vitamin D2 supplementation reduced pain and depression.(17)

A 2011 editorial in the Scandinavian Journal of Primary Health Care stated that vitamin D supplementation in patients with chronic pain seems reasonable, as the treatment is cheap and relatively safe, and evidence indicates that vitamin D supplementation has overall positive effects on health. The editorial recommended a daily dose of 2000 IU for chronic pain patients.(18) Others have documented a vitamin D requirement of 4000 to 8000 IU daily, or 35 IU per pound of body weight.(19) A more individualized approach, based on testing of vitamin D levels along with follow-up testing to determine the level of supplementation needed to maintain adequate blood serum levels, would probably yield the most effective results.

Despite the plethora of evidence accumulating on widespread vitamin D deficiency, the large number of chronic and life-threatening conditions preventable and treatable with vitamin D supplementation, and the safety and low cost of vitamin D testing and supplementation, in June 2014, the US Preventive Services Task Force declined to endorse screening for vitamin D deficiency in healthy adults. In its report, the task force cited insufficient evidence of benefit.(20)

Dr. Joseph Mercola, a well-known holistic physician, recommends also supplementing with vitamin K2 if you are taking vitamin D supplements. Vitamin K2 helps keep calcium where it belongs in the body. The only known toxicity from excessive vitamin D intake is related to excessive calcium in the bloodstream.(21)

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[1] http://articles.mercola.com/sites/articles/archive/2014/02/17/vitamin-d-supplements.aspx accessed on 5/31/14.

[2] Birkner, K. (2010). Chronic Pain and Vitamin D. HER-92. Pain and Stress Publications.

[3] Birkner. (2010). Chronic Pain and Vitamin D.

[4] Sulindo-Ma & Isenhart. (2008). Nutrition and Supplements for Pain Management, 421.

[5] Vasquez, A. (2004). Vitamin D supplementation in the treatment of musculoskeletal pain. The Original Internist, 07.

[6] Trang, H. M, Cole, D. E, Rubin, L. A, Pierratos, A., Siu, S., Vieth, R. (1998). Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. American Journal of Clinical Nutrition, 68, 854-8.

[7] Amas, L. A., Hollis, B. W., & Heaney, R. P. (2004). Vitamin D2 is much less effective than Vitamin D3 in humans. Journal of Clinical Endocrimology Metabolism, 89, 5387-91.

[8] People with undetermined muscle/bone pain tend to be severely vitamin D deficient. Public release: December 9, 2003, Minneapolis, St. Paul. Contact: ashleyb@umn.edu, University of Minnesota.

[9] Plotnikoff, G. A. & Quigley, J. M. (2003). Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc, 78, 1463-1470.

[10] Birkner. (2010). Chronic Pain and Vitamin D.

[11] Autler, P., Boniol, M., Pizot, C., & Mullie, P. (2014). Vitamin D status and ill health: a systematic review. The Lancet Diabetes & Endocrinology, 2(1):76-89.

[12] Gloth, F. M. 3rd, Lindsay, J. M., Zelesnick, L. B., & Greenough, W. B. 3rd. (1991) Can vitamin D deficiency produce an unusual pain syndrome? Archives of Internal Medicine, 151(8), 1662-4.

[13] Schreuder, F., Bernsen, R. M., vn der Wouden, J. C. (2012). Vitamin D supplementation for nonspecific musculoskeletal pain in non-Western immigrants: a randomized controlled trial. Annals of Family Medicine, 10(6):547-55.

[14] Sanghi, D., Mishra, A., Sharma, A. C., Singh, A., Natu, S. M., Agarwal, S., & Srivastava, R. N. (2013). Does Vitamin D improve osteoarthritis of the knee: a randomized controlled pilot trial. Clinical Orthopedics and Related Research, (11), 3556-62.

[15] Huaang, W., Shah, S., Long, Q., Crankshaw, A. K., & Tangpricha, V. (2013). The Clinical Journal of Pain, (4), 341-7.

[16] Osunkwo, I., Ziegler, T. R., McCracken, C., Cherry, K., Osunkwo, C. E., Ofori-Acquah, S. F., Ghosh, S., Ogungobode, A., Eckman, J. R., Dampier, C., & Tangprich, V. (2012) British Jouranl of Haematology, 159(2), 211-5.

[17] Jancin, B. (2013). Vitamin D promising in women with diabetic pain. Internal Medicine News, 46(13), 35.

[18] Kragstrup, T. W. (2011). Vitamin D supplementation for patients with chronic pain. Scandinavian Journal of Primary Health Care, (29), 4-5.

[19] http://articles.mercola.com/sites/articles/archive/2014/02/17/vitamin-d-supplements.aspx accessed on 5/31/14.

[20] O’Connor, A. (2014). Vitamin D screening not backed by expert panel New York Times.

[21] http://articles.mercola.com/sites/articles/archive/2014/02/17/vitamin-d-supplements.aspx

[22] Birkner. (2010). Chronic Pain and Vitamin D.

[23] Autler, P., Boniol, M., Pizot, C., & Mullie, P. (2014). Vitamin D status and ill health: a systematic review. The Lancet Diabetes & Endocrinology, 2(1):76-89.

[24] Gloth, F. M. 3rd, Lindsay, J. M., Zelesnick, L. B., & Greenough, W. B. 3rd. (1991) Can vitamin D deficiency produce an unusual pain syndrome? Archives of Internal Medicine, 151(8), 1662-4.

[25] Schreuder, F., Bernsen, R. M., vn der Wouden, J. C. (2012). Vitamin D supplementation for nonspecific musculoskeletal pain in non-Western immigrants: a randomized controlled trial. Annals of Family Medicine, 10(6):547-55.

[26] Sanghi, D., Mishra, A., Sharma, A. C., Singh, A., Natu, S. M., Agarwal, S., & Srivastava, R. N. (2013). Does Vitamin D improve osteoarthritis of the knee: a randomized controlled pilot trial. Clinical Orthopedics and Related Research, (11), 3556-62.

[27] Huaang, W., Shah, S., Long, Q., Crankshaw, A. K., & Tangpricha, V. (2013). The Clinical Journal of Pain, (4), 341-7.

[28] Jancin, B. (2013). Vitamin D promising in women with diabetic pain. Internal Medicine News, 46(13), 35.

[29] Kragstrup, T. W. (2011). Vitamin D supplementation for patients with chronic pain. Scandinavian Journal of Primary Health Care, (29), 4-5.

[30] http://articles.mercola.com/sites/articles/archive/2014/02/17/vitamin-d-supplements.aspx accessed on 5/31/14.

[31] O’Connor, A. (2014). Vitamin D screening not backed by expert panel New York Times.

[32] http://articles.mercola.com/sites/articles/archive/2014/02/17/vitamin-d-supplements.aspx

12 Responses to "Vitamin D Deficiency and Chronic Pain"
  1. Donna Oliver says:

    Vitamin D3 is not covered by insurance companies.
    A one month supply of 50,000 iu’s cost $35.00 in the U.S. For people living on Social Security, the cost of six months of the Vitamin is not affordable.

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