Low Vitamin D and Chronic Pain – What is the Evidence?

In 2006, My Daughter, Janice Montbriand, published a poster called Commonly Missed Factors in Chronic Pain. Vitamin D deficiency was one of them. Since the there have been a variety of confirmatory studies – with some negative ones as well. I will review some of the positive ones.

Among Africans, this has been found previously to be an issue:
Female asylum seekers with musculoskeletal pain: the importance of diagnosis and treatment of hypovitaminosis D
G de Torrenté de la Jara*, A Pécoud and B Favrat
BMC Family Practice 2006, 7:4 free article here

• 67% African asylum seeker were found to be profoundly low in Vitamin D and
• In these cases, 2/3 became painfree on high dose vitamin D

In an arabian study,

Faraj SA, Mutairi KA.
Vitamin D deficiency and chronic low back pain in saudi arabia.
Epidemiol Spine. 2003;28:177–179.
https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=2ac365a5fd46b6033a43d138c6797f64b977eeeb

• all cases of low vitamin D and back pain recovered with high dose Vitamin D supplementation (299 cases)
• in “placebo” group with normal vitamin D levels, 69% got better (42/61)

In a European study,

McBeth J, Pye SR, O’Neill TW, et al.
Musculoskeletal pain is associated with very low levels of vitamin D in men: results from the European Male Ageing Study.
Ann Rheum Dis. 2010;69:1448–1452  abstract here

• Having Chronic  widespread pain increased chances of being Vit D deficient by 50%

An Alberta, Canada study highlighted cases of chronic back pain and failed back that responded to Vitamin D therapy:
Improvement of Chronic Back Pain or Failed Back Surgery with Vitamin D Repletion: A Case Series
Gerry Schwalfenberg, MD
J Am Board Fam Med January-February 2009 vol. 22 no. 1 69-74  free article here

In an Egyptian study:

Clinical Rheumatology Volume 26, Number 11, 1895-1901, 2007
Hypovitaminosis D in female patients with chronic low back pain
Ahmed Lotfi, Ahmed M. Abdel-Nasser, Ahmed Hamdy, Ahmed A. Omran and Mahmoud A. El-Rehany  abstract here

• In female low back pains, 60% had low vitamin D versus 40% in control group  = 1.5 X risk

In a Turkey German study:
High prevalence of vitamin D deficiency, secondary hyperparathyroidism and generalized bone pain in Turkish immigrants in Germany: identification of risk factors
M. Z. Erkal, J. Wilde, Y. Bilgin, A. Akinci, E. Demir, R. H. Bödeker, M. Mann, R. G. Bretzel, H. Stracke and M. F. Holick
Osteoporosis International  Volume 17, Number 8, 1133-1140, 2006  abstract here

• 30 % of Turkish females and 8% turkish males had vitamin D levels < 20 nmol/l
• 19% of turkish german females and 6% turkish german males were vitamin d Deficient
• Overall Turkish subjects 1.45 times more likely to be vitamin D deficient versus turkish germans
• Turkish subjects were 60% likely to have widespread pain versus 15% turkish germans and women were more represented in this.  – 4 X risk widespread pains

In a British study widespread pains and low vitamin D levels associated in women:

Vitamin D and chronic widespread pain in a white middle-aged British population: evidence from a cross-sectional population survey
K Atherton,1 D J Berry,1 T Parsons,1 G J Macfarlane,2 C Power,1 E Hyppo¨nen
Ann Rheum Dis 2009;68:817–822.  free article here

• OR risk factor 1.45 if under 75 nmol/l versus over 75
• I suspect they didn’t have enough subjects profoundly deficit (under 20 nmol/l) to get valid stats there, like they did in african and arabian studies to get males
• they adjusted for other risk factors however

In an Asian Study, Low Vitamin D and widespread pain was associated:
An excess of widespread pain among South Asians: are low levels of vitamin D implicated?
G J Macfarlane1,2, B Palmer1, D Roy1, C Afzal1, A J Silman1, T O’Neill1
Ann Rheum Dis 2005;64:1217-1219  free article here

• Among young women with Vit D <10 nmol/l widespread pain was 3.5 times more common
• in general , young women had only 1.8 times risk of widespread pain versus  total asian group – so low vitamin D doubled risk of widespread pains

Another Asian study:

Unexplained musculo skeletal pain in people of South Asian ethnic group referred to a rheumatology clinic : relationship to bio chemical osteomalacia, persistence over time and response to treatment with calcium and vitamin D
HELLIWELL P. S. (1 2) ; IBRAHIM G. H. (1) ; KARIM Z. (1) ; SOKOLL K. (1) ; JOHNSON H.
Clinical and Experimental Rheumatology,2006, vol. 24, no4, pp. 424-427  abstract here

• Found high levels of widespread pain in Vitamin D deficient group and 57% showed high parathyroid levels suggesting actual osteomalacia (rickets)

A Pakistan study:
Myalgias or non-specific muscle pain in Arab or Indo-Pakistani patients may indicate vitamin D deficiency
Humeira Badsha & Mirna Daher & Kok Ooi Kong
Clin Rheumatol (2009) 28:971–973  free article here

• among those with non-specific muscle pains , 70% are vitamin D deficient (<20nmol/l) and supplementation helps 90% of them.

A newer Egyptian study found low vitamin D related to Fibromyalgia:
Rheumatol Int. 2013 Jan;33(1):185-92.
Serum vitamin D level and bone mineral density in premenopausal Egyptian women
with fibromyalgia.
Olama SM, Senna MK, Elarman MM, Elhawary G.
FM patients had lower vitamin D levels.
“Serum level of the 25-OHD is inversely correlated with visual analogue scale (VAS) of pain (p = 0.016)”. “The lumbar BMD inversely correlated with VAS of pain (p = 0.013).”

One negative  study, took Osteoarthrtic patients with low Vitamin D and found supplementation did not get rid of pain – Well, excuse me, but Vitamin D is NOT a treatment for Osteoarthritis – I call these MORON studies: JCR: Journal of Clinical Rheumatology:  February 2008 – Volume 14 – Issue 1 – pp 12-16
Diffuse Musculoskeletal Pain Is Not Associated With Low Vitamin D Levels or Improved by Treatment With Vitamin D [should have added “in Osteoarthritis Patients”]
Warner, Ann E. MD*; Arnspiger, Sarah A.  abstract here
– Vitamin D deficiency not a major cause of osteoarthritis and vitamin D does not help it even if levels low. Having said that the Framingham study showed that people with high vit D levels had 1/3 the OA rates:

McAlindon, Timothy E., David T. Felson, Yuqing Zhang, Marian T. Hannan, Piran Aliabadi, Barbara Weissman, David Rush, Peter WF Wilson, and Paul Jacques.
Relation of dietary intake and serum levels of vitamin D to progression of osteoarthritis of the knee among participants in the Framingham Study.
Annals of Internal Medicine 125, no. 5 (1996): 353-359.
http://billnordt.com/DIETSUPPLEMENTS/RelationofDietaryIntakeandSerum.HTM

I am left with a suspcious feeling that widespread pain susceptiblity to low Vitamin D might be racial in nature. Asian Indians have alterned vitamin D metabolisms that could make things worse:
Vitamin D Metabolism Is Altered in Asian Indians in the Southern United States: A Clinical Research Center Study1
Emmanuel M. K. Awumey, Devashis A. Mitra, Bruce W. Hollis, Rajiv Kumar and Norman H. Bell
The Journal of Clinical Endocrinology & Metabolism January 1, 1998 vol. 83 no. 1 169-173  free article here

Comment – immigrant cases appear to be at high risk and parathyroid levels could be checked to see if frank osteomalacia rickets.  Back, widespread pains and post-laminectomy cases should be checked though uncetain if would help osteoarthrtic cases…