Could vitamin D be the key to recovery?
Research finds link between healthy levels and chronic widespread pain
Not getting enough vitamin D in your system may be linked to chronic pain. Over the past two decades, several researchers have found an association between very low vitamin D levels and chronic, general pain that doesn’t respond to treatment.
The New England Journal of Medicine in 2018 termed vitamin D deficiency (which affects an estimated 6 per cent of the population) a pandemic. Some clinicians estimate that nearly 100 per cent of their patients with chronic pain are also vitamin D deficient. But does not having enough vitamin D cause pain? “Yes, there is a definite link,” says Dr Pradeep Ingale, Orthopaedic Surgeon, Zulekha Hospital, Sharjah. “In observational studies, low vitamin D levels have been associated with increased pain and higher opioid doses.”
Cross sectional studies indicate that people with chronic widespread pain (CWP) and other pain had increased odds of lower (25 OH) vitamin D levels when compared to those without pain; even after adjusting for age and lifestyle factors.
Severe and prolonged vitamin D deficiency is known to cause bone mineralisation disorders such as rickets in children and osteomalacia in adults. These conditions can lead to soft bones, aching muscles, painful movement and fractures, and may also contribute to osteoporosis.
“Cross sectional studies indicate that people with chronic widespread pain (CWP) and other pain had increased odds of lower (25 OH) vitamin D levels when compared to those without pain; even after adjusting for age and lifestyle factors,” says Dr. Somshekhar, Specialist Orthopaedic Surgeon, Aster Clinic, Al Warqa.
While the vitamin is important in the internal metabolism of the body, Dr Zaineb Sabri, Specialist Internal Medicine, Medcare Hospital Sharjah, says its role in chronic pain is still not well researched. “It is vital for maintaining the normal physiological function in the body and should be within the normal levels in many patients having chronic diseases like diabetes, thyroid disorders and obesity,” she says.
It is vital for maintaining the normal physiological function in the body and should be within the normal levels in many patients having chronic diseases like diabetes, thyroid disorders and obesity
Higher doses
Although most people take vitamin D supplements without any problems, it is possible to take too much. Vitamin D toxicity is usually caused by megadoses — not by diet or sun exposure.
“It is advisable to consult your doctor to find out the exact cause of pain and if advised, take recommended doses,” says Dr Ingale. “An upper level of 4,000 international units (IU) supplement per day is considered safe. In general, adults should consume 600 IU of vitamin D a day. That goes up to 800 IU a day for those over 70.”
Individuals at risk of deficiency, who are obese or taking medications are additionally encouraged to take at least two to three times more vitamin D as recommended for their age group, with a tolerable upper intake of 10,000 IU per day
In general, the use of vitamin D poses a low risk, is largely well accepted, and is inexpensive. “Individuals at risk of deficiency, who are obese or taking medications are additionally encouraged to take at least two to three times more vitamin D as recommended for their age group, with a tolerable upper intake of 10,000 IU per day,” says Dr Somshekhar.
Dr Sabri says that there is no concrete evidence that replenishing vitamin D levels with high doses will cure chronic pain, but explains that a deficiency can be fixed. “If your level is scarce it should treated,” she says. “To treat deficient levels we need to conduct initial tests, then start the treatment over a two-to-three-month period and after that maintenance for six months to one year.”
The most affected
People who spend most of their time indoors generally have low levels of vitamin D. Conditions that affect your absorption or processing can affect circulating levels of the vitamin. For example, having conditions such as inflammatory bowel disease or celiac disease, or having undergone bariatric surgery can affect your intestine’s ability to absorb vitamin D. Chronic kidney or liver problems can also interfere with the conversion of vitamin D into its active circulating forms.
“People with darker skin are at greater risk of deficiency because larger amounts of melanin in the skin reduces its ability to produce vitamin D from sunlight,” explains Dr Ingale. “Aging also decreases the efficiency of vitamin D synthesis. Sunscreen, clothing and other UV protective measures that block skin’s exposure to sun although help prevent skin cancer, reduces the production of vitamin D.”
Dr Somshekhar warns that people with musculoskeletal conditions need to be concerned about an underlying scarcity. “Patients who are suffering from inflammatory joint disease, connective tissue disease, soft tissue rheumatoid, osteoarthritis, non-specific musculoskeletal back pain, and osteoporosis should be more concerned,” he says.
Vitamin D is probably only one of many common factors in pain; it’s usually caused by a stew of issues that eat away at people for many years. Trying to solve the problem by fixing one thing — if indeed vitamin D is even a problem — may not be the only solution. As Dr Sabri says, “Deficiency should be corrected in all patients for better metabolic effect and function of the body organ, but we should not forget to control the main medical problems like high blood sugar.”
Pain treatment
There is no doubt that Vitamin D plays a vital physiological role in the human body, but it doesn’t necessarily mean that taking it is going to actually help the pain.
“If the cause of pain is related to deficiency, it will help,” says Dr Ingale. “A recent systematic review of published RCTs in Pain Physician 2016 concluded that taking vitamin D leads to a significantly greater mean decrease in pain score compared to placebo in patients with chronic pain.”
Given the prevalence of deficiency in chronic pain patients, supplementation may offer some health benefits, reiterates Dr Somshekhar. “In light of the current lack of evidence, vitamin D supplementation cannot be considered an efficacious, independent treatment for chronic pain, at this time.”
Dr Sabri says, “Vitamin D itself does not treat pain as acute pain, but it helps in some complaints of fatigue and general feeling of being ill as well as muscle pains.”
Can a diet help?
Supplements are usually the main sources of getting the vitamin, but that doesn’t mean you shouldn’t try to get as much as you can from food.
“A vitamin-D-rich diet is very safe to take and will definitely help alleviate the symptoms related to deficiency,” says Dr Ingale. “Fatty fish such as salmon, trout, tuna and halibut, offer higher amounts. Eggs, milk and yoghurt are also rich. Three ounces (84g) of salmon contains about 480 to 640 IU of vitamin D, three ounces of mackerel contains 400 IU, three ounces tuna — 220 IU, one cup milk — 120 IU, and a boiled egg — 44 IU.”
Vitamin D is the only nutrient your body produces when exposed to the sun, but 50 per cent of the world’s population may not get enough exposure to natural sunlight. “This is in part due to people preferring to spend more time indoors, wearing sunblock, and eating a diet low in natural vitamin D sources,” says Dr Somshekhar.
As much as supplements and diet can help you, a bit of physical activity will also go a long way in dealing with deficiency. “Along with the diet, exercising regularly will be very effective in maintaining a good level of vitamin D as well preventing osteoporosis,” says Dr Sabri.