Vitamin D and Pain
There is a growing body of both clinical and laboratory evidence pointing to a relationship between low levels of Vitamin D and a variety of chronic pain conditions.
It is recommended to first read the following sections to become familiarized with some of the terms and concepts related here:
Vitamin D and Pain
Vitamin D has been shown to help some patients with chronic pain, especially headaches, low back pain, diabetic peripheral neuropathy and fibromyalgia. In two review articles published in 2015 a number of studies are reviewed, ultimately with mixed results, in which associations between Vitamin D deficiency and various chronic pain conditions were identified along with possible benefits for pain with Vitamin D replacement and supplementation. Significant improvements in assessment of sleep, pain levels, well-being, and various aspects of quality of life with Vitamin D supplementation have been shown.
Muscle Pain and Spine Pain
Different mechanisms have been proposed how Vitamin D can impact pain. It is well established that Vitamin D deficiency results in inadequate bone density that has been shown to contribute to chronic pain. This is especially true in the elderly when osteoporosis results in pathologic fractures, especially in the spine, resulting in severe pain. Low Vitamin D has also been linked to muscle weakness and diffuse muscle pain which sometimes responds to Vitamin D supplementation. Quite a number of studies have identified a link between Vitamin D and muscle pain.
Low Vitamin D has been found to be associated with chronic headaches, including muscle tension headaches. While a definitive cause-effect relationship has not been firmly established, it is known that low Vitamin D causes low magnesium levels, known to contribute to chronic headaches. Some studies indicate a respone to Vitamin D supplements in those with chronic headaches.
Inflammation and Nerve Pain
Vitamin D is known to affect a number of inflammatory pathways associated with the development and persistence of chronic pain. It influences prostaglandins that play a role in inflammation as well as mediate neuropathic pain in the spinal cord.
As a steroid, Vitamin D can modify nerve excitability and alter sensitivity to neurotransmitters and neurotransmitter receptors such as the N-methyl- D-aspartate (NMDA) receptor that is associated with nerve pain, hyperalgesia and opioid tolerance. These actions may be related to the proposed association between low Vitamin D and fibromyalgia and the possible improvement of fibromyalgia pain with Vitamin D supplementation.
Diabetic Peripheral Neuropathy (DPN)
A study just published in 2016 that investigated the use of Vitamin D in DPN found that an intramuscular injection of 600,000 IU of Vitamin D significantly reduced the pain. Another study showed that daily doses of 2,000 IU Vitamin D for 3 months resulted in a 50% decrease in DPN pain. A third study showed that weekly dose of 50,000 IU Vitamin D for 8 weeks significantly reduced DPN disability scores. Interestingly, the benefits of the Vitamin D did not correlate with pretreatment blood levels of Vitamin D. Vitamin D appears to works in DPN by protecting against the breakdown of nerve sheaths and enhancement of nerve regeneration.
There have been a few studies that establish a link between fibromyalgia and low Vitamin D though treatment outcomes have not been consistent. Nevertheless, some FM patients appear to benefit from Vitamin D supplementation for many symptoms of fibromyalgia including the widespread pain, fatigue and sleep. It is advisable to monitor FM patients for low Vitamin D and treat accordingly.
Sleep and Mood
There appears to be considerable overlap in the effects of sleep, pain, depression, and Vitamin D on the immune system. Chronic sleep loss impairs immune function. This results in increases in inflammatory chemicals in the brain that may play a role in headaches as well as depression. Vitamin D is thought to stabilize nerves and inflammatory pathways leading to reduced pain. Vitamin D impacts various neurotramsmitters including serotonin, noradrenaline, substance P, and dopamine, which all affect sleep, mood and pain.
Vitamin D and Central Sensitivity
Another possible underlying mechanism for Vitamin D’s benefit in these chronic pain include it’s role in reducing central sensitivity. Chronic persistent pain leads to chemical, functional, and anatomical changes throughout the nervous system (in the periphery, spinal cord, and brain). These changes lead to hypersensitivity to sensory stimulation, including pain. Pain hypersensitivity can manifest as “hyperalgesia” (an exaggerated and/or prolonged response to a painful stimulus) and “allodynia” (pain that result from a stimulus that is normally not painful).
While the mechanisms behind central sensitivity are not fully understood, it is believed that immune cells present in the cellular matrix around nerves (microglia, astrocytes, and spinal glia) when activated by chronic pain release a variety of neuroexcitatory substances (nitric oxide, excitatory amino acids, proinflammatory cytokines, and mediators) that initiate and maintain the nerve hypersensitivity. Vitamin D has been shown to suppress this neuronal excitability and reduce sensitivity in nerve receptors including the NMDA receptor which is known to plan a role in opioid tolerance and opioid induced hyperalgesia.
Vitamin D – Overview
- Vitamin D – Summary handout
- Vitamin D – NIH
- Vitamin D status and ill health: a systematic review – The Lancet Diabetes & Endocrinology
- Update in Vitamin D – 2010
- Evaluation, treatment, and prevention of vitamin D deficiency – an Endocrine Society clinical practice guideline – 2011
Vitamin D – Central Sensitivity
Vitamin D – Chronic Pain
- Vitamin D and Its Role in the Aetiology and Maintenance of Chronic Pain States and Associated Comorbidities – 2015
- Vitamin D Deficiency and Pain – Clinical Evidence of Low Levels of Vitamin D and Supplementation in Chronic Pain States – 2015
- Vitamin D for Chronic Pain
- Vitamin D status in patients with musculoskeletal pain, fatigue and headache – A cross-sectional descriptive study in a multi-ethnic general practice in Norway – 2010
Vitamin D – Fibromyalgia
- Is Serum Hypovitaminosis D Associated with Chronic Widespread Pain Including Fibromyalgia?
Vitamin D – Headaches
- Interrelationships between chronic tension-type headache, musculoskeletal pain, and vitamin D deficiency: Is osteomalacia responsible for both headache and musculoskeletal pain?
- Vit D levels in pain and headache patients
Vitamin D – Low Back Pain
- High Prevalence of Hypovitaminosis D in Indian Chronic Low Back Patients – 2015
- Improvement of Chronic Back Pain or Failed Back Surgery with Vitamin D Repletion – 2009
- Vitamin D May Be Linked to Spine Disease – in Ophthalmology, Ophthalmology from MedPage Today
Vitamin D – Inflammation
Vitamin D – Optimal Levels
Emphasis on Education
Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.
For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.
Should you wish more information regarding any of the subjects listed – or not listed – here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.
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