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Pain reduced by Vitamin D (60K weekly, then monthly) plus daily Calcium in 3 months – May 2021

Effect of supplementation of vitamin D and calcium on patients suffering from chronic non-specific musculoskeletal pain: A pre-post study

J Family Med Prim Care 2021;10:1839-44 DOI: 10.4103/jfmpc.jfmpc_1699_20
Vrinda Goyal1, Mukta Agrawal2
1 Research Scholar, Department of Home Science, University of Rajasthan, Jaipur, Rajasthan, India
2 Associate Professor, Department of Home Science, University of Rajasthan, Jaipur, Rajasthan, India

All gains were statistically significant

More pain, less gain (those in higher pain could have benefited from higer doses of Vitamin D


It is doubful that the Calcium was needed - as of July 2021 there were no other Pain studies in VitaminDWiki that included Calcium

Pain - chronic category has the following

157 items in category Chronic pain

See also

Pages listed in BOTH the categories Senior and Pain

Pages listed in BOTH the categories Intervention and Pain

Pages listed in BOTH the categories Meta-analysis and Pain

Chronic, Non-Specific Pain Helped with Vitamin D- Grassroots Health on this study


 Download the PDF from VitaminDWiki

Background and Objective: Despite abundant sunshine, India is a country with high prevalence of vitamin D deficiency. It has been suggested that vitamin D deficiency could be a potential cause of chronic non-specific musculoskeletal pain. The study was conducted to evaluate the effect of supplementation of vitamin D and calcium on patients suffering with chronic non-specific musculoskeletal pain.

Methodology: The experimental trial was a pre-post study conducted on 50 hypovitaminosis D patients aged 30–60 years visiting a local orthopedician or physician with complain of chronic non-specific musculoskeletal pain. Oral supplementation with vitamin D and calcium was given for 3 months. Before the intervention trial, pain, physical activity, serum vitamin D, serum calcium, body mass index and waist to hip ratio (WHR) of the respondents were assessed, which was statistically compared with post-intervention data of the same parameters. Assessment of pain was carried out using visual analog scale. Physical activity levels were compared pre and post the intervention. Also, fatigue, mood alteration, and sleep were compared.

Results: Ninety percent of the subjects had vitamin D deficiency.

  • Thirty-six percent of the subjects had severe chronic non-specific musculoskeletal pain, whereas
  • 56% had moderate chronic non-specific musculoskeletal pain.

The mean pain score prior to intervention was 6.22 which significantly decreased to 3.52.
Mean vitamin D levels significantly rose from 17.38 ng/ml to 39.40 ng/ml.
Serum vitamin D, serum calcium, and physical activity levels increased, whereas pain, weight, BMI, and WHR decreased significantly post-intervention.

Conclusions: Supplementation with vitamin D and calcium decreases chronic non-specific musculoskeletal pain.

Clipped from PDF
In the intervention trial of 3 months, the respondents were given an oral therapeutic dose of 60,000 IU of vitamin D orally once weekly for 1 month, and then 60,000 IU once a month for next 2 months. Calcium supplement of 1,000 mg was given twice a day in two divided doses of 500 mg each, every day for 3 months.

Out of 50 respondents, 34 were females and rest males.
Serum vitamin D was found

  • deficient in 68% of the patients.
  • Twenty-two percent had insufficient and
  • 10% had sufficient serum vitamin D levels.

Prior to the treatment, 64% of the patients reported fatigue which decreased to 34% after the treatment.

Before the intervention, 74% of respondents reported a decrease in sleep which could be because of the pain, which decreased to 20% after the supplementation.

More than half of the patients (52%) reported an improvement in their sleep disturbances with relief in pain.

Prior to the intervention, 36 respondents (72%) reported various kind of mood disturbances such as anger, irritability, stress, low confidence, poor concentration, memory loss of crying. After the supplementation, 48 out of the 50 respondents reported an improvement in the mood disturbances after the intervention

Discussion in PDF
Due to the realization of prevalence of high deficiency of vitamin D, many researchers have studied the vitamin, and a lot of skeletal and extra-skeletal symptoms of deficiency have been identified.[27-29]
In our study, incidence of CNMP was found to be 12.33%. In a study, it was shown that patients with persistent, nonspecific musculoskeletal pain were at high risk of vitamin D deficiency which often goes misdiagnosed. It was estimated that among patients suffering with chronic pain, only a quarter of patients suffer with pain at a specific origin, others suffer with pain of unknown origin and unidentified etiology.[16] Pain associated with vitamin D deficiency has a special characteristic that it is usually sensed on the bone or the muscle.[30] Authors have suggested that vitamin D deficiency could be an origin of non-specific musculoskeletal pain including low back pain.[8,31]

When the mean serum levels of vitamin D of patients with non-specific pain were compared with the control group, it was observed that there was a positive relation between vitamin D deficiency and skeletal pain. This association was greater in women than men. A similar study proved the same.[32] In patients with chronic back pain, mean level of serum vitamin D assessed was 18.4 ng/mL (19.6 ng/ml for women, 17.3 ng/ml for men), which was insufficient [33] In a study conducted on adult OPD patients suffering with non-specific complaints of general body pain, back pain, tiredness, and weakness, it was revealed that 40.2% male and 37% females were deficient in vitamin D.[34]

There are several mechanisms to show that vitamin D deficiency could be involved in causing pain. Vitamin D deficiency can cause loss of anti-inflammatory, anti-apoptotic, or anti-fibrotic effects.[35] Vitamin D is mediated by vitamin D receptors which are present on skeletal muscle cells, thus proving its function there.[36] Vitamin D causes increased activity of bone deforming cells (osteoclasts) and decreases activity of bone forming cells (osteoblasts) and results in low bone mineralization producing bone pain.[37] Vitamin D deficiency enhances sensitivity to pain due to stimulation of nerve cells.[38] It suppresses proinflammatory cytokines such as Tumor necrosis factor alpha and Macrophage colony-stimulating factor.[39] Vitamin D upregulates the synthesis of neurotrophins such as nerve growth factor, neurotrophin 3, and glial cell line-derived neurotrophic factor, whereas it downregulates neurotrophin-4.[40]

Vitamin D could be involved in metabolism of muscles and nerves. It was found in our study that supplementation therapy caused a significant increase in the serum levels of calcium and vitamin D and a significant reduction in pain scores. Pain score was negatively associated with serum levels of vitamin D. There was a highly significant rise in the physical activity levels after the intervention. The shift in PAL could be attributed to the relief in pain which initially might be causing hindrance in performing physical activities. There was also an evidence of improvement in mood disorders of the patients after the intervention. Thus, vitamin D could also have an anti-depressive effect.[41] Intervention trial bought about a highly significant fall in weight, BMI, and WHR. There was a decrease in the number of respondents with morbid obesity. The decrease in BMI could be attributed to increase in ability or willingness to perform physical activity.

In a study conducted on 28 US veterans suffering with chronic pain it was revealed that all of them reported difficulty in sleep and that when these patients were supplemented with vitamin D for 3 months, there was improvement in efficacy of sleep.[42] Other authors have also reported that there is betterment in sleep, mood, wellbeing, and various aspects of quality of life with vitamin D supplementation.[43,44]
Vitamin D supplementation in suitable doses must be encouraged in those who are deficient and the “at-risk” population. Vitamin D supplementation must be accompanied with appropriate age-related calcium intake.[45] Vitamin D supplementation in individuals with a normal serum vitamin D could have an impact of limited duration, but could be of greater benefits to individuals with low levels of serum vitamin D.[46] Vitamin D supplementation could be beneficial in the treatment regime of primary care physicians. Many patients visit general practitioners for various kinds of pain. Findings of this study could help physicians treat patients with persistent vague pains. Physicians may discuss the possibility of vitamin D deficiency in patients suffering from chronic nonspecific musculoskeletal pain.

There are such diverse functions of vitamin D that it could be potentially beneficial in pharmaceutical applications,7] Serum variations in the vitamin D status of the individuals could arise because of genetic differences in the vitamin D related enzymes. It could also be varied because of the underlying conditions of the patients especially those suffering with chronic pains. Also, there is difference in perception of pain person to person. To determine the pain-relaxing effect of vitamin D, it is important to consider the variations in the expression and assessment of pain by the patients[48] Vitamin D clearly cannot be a solution to cure various skeletal and extra skeletal diseases, but could be a feasible, economical, and a safe accessory-therapy for some disease conditions.[49]

It could be said that more women than men were found to be suffering with CNMP. A huge number of individuals do not have a sufficient vitamin D status and many of them suffer with CNMP. Supplementation with vitamin D and calcium to vitamin D deficient patients suffering with CNMP might bring about a considerable relief in the painful conditions. It may also enhance the physical activity capacity. Relieving the painful conditions improves the physical, mental, and social wellbeing of the individual.

Attached files

ID Name Comment Uploaded Size Downloads
15905 Pain GRH.jpg admin 13 Jul, 2021 12:07 65.09 Kb 407
15866 More pain, less gain.jpg admin 01 Jul, 2021 18:53 10.38 Kb 322
15865 pain intervention.jpg admin 01 Jul, 2021 18:53 36.91 Kb 371
15864 Vitamin D reduced pain RCT.pdf PDF 2021 admin 01 Jul, 2021 18:32 566.89 Kb 258