Archives of Oral Biology https://doi.org/10.1016/j.archoralbio.2024.106108
Objective
This systematic review evaluates the connection between vitamin D serum levels, deficiency, and temporomandibular disorders (TMD), offering a meta-analysis of the existing evidence in this domain.
Design
The Scopus, ISI Web of Science, and Pubmed databases were searched for human studies concerning the connection between vitamin D and TMD comprising a control group. A random-effect model with forest plots was used for vitamin D serum levels mean difference (MD), vitamin D deficiency odds ratio (OR), and risk difference (RD) between subjects with and without TMD. Subgroup analysis was conducted based on ethnicity, overall risk of bias, TMD diagnosis method, and study designs. A p-value lower than 0.05 was considered significant. The certainty of the meta-evidence was evaluated according to the GRADE approach.
Results
Of the 2621 identified unique records, 15 studies were included in the study, eight of which were considered for the meta-analysis. The meta-analysis revealed a significant vitamin D deficiency OR (3.85; 95% CI: 2.35 – 5.43; Certainty: Low) and RD (22%; 95% CI: 11% - 32%; Certainty: Very low), and vitamin D serum levels MD (-5.03; 95% CI: -9.92 – -0.13; Certainty: Very low) between subjects with and without TMD. Among subgroup analyses, only the difference in vitamin D MD between Middle Eastern and European patients was significant (P < 0.01).
Conclusion
Considering the low to very low certainty of the evidence, vitamin D serum levels are significantly lower, and vitamin D deficiency is significantly more prevalent in TMD patients.
Introduction
Vitamin D is a group of fat-soluble vitamins. It is crucial in maintaining adequate serum calcium and phosphate concentration, which are key to bone health and normal muscle function (Norman, 2008, Straube et al., 2015). The primary natural source of vitamin D is a synthesis of cholecalciferol in the skin through a photochemical reaction with UV radiation from sun exposure. Also, it can be obtained from dietary sources (Bikle, 2014). Vitamin D deficiency mainly arises from insufficient Vitamin D intake through diet and inadequate exposure to sunlight (Holick et al., 2011). Vitamin D deficiency is a global concern prevalent among the elderly, but it persists as a common issue in both children and adults worldwide (Palacios & Gonzalez, 2014). This condition could result in several bone, cartilage, and muscle disorders. Moreover, it is established that vitamin D deficiency is associated with musculoskeletal disorders (e.g., osteoarthritis, rheumatoid arthritis, and osteoporosis) (Amirkhizi et al., 2022, Bolland et al., 2018, Gkekas et al., 2021, Penner et al., 2018).
Temporomandibular disorders (TMDs) include a range of pathological conditions affecting the temporomandibular joints, masticatory muscles, surrounding tissues, and bone structures, individually or in combination (Schiffman et al., 2014). The prevalence of TMDs within the general population is estimated at 5%; however, studies suggest that anywhere from 5% to 60% of individuals may experience at least one symptom associated with TMDs (Gauer and Semidey, 2015, Schiffman et al., 2014). According to the most recent classification for temporomandibular disorders by the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group,
TMDs are categorized into four main groups:
- I) Temporomandibular joint disorders (intra-articular disorders),
- II) Masticatory muscle disorders (extra-articular disorders),
- III) Headache, and IV) Disorders of associated structures (Schiffman et al., 2014).
While the precise etiology of TMD remains uncertain, it is believed to originate from various factors, including mechanical displacement, bruxism, repetitive trauma to the TMJ, and occlusal abnormalities (Cairns, 2010). Systemic diseases such as rheumatoid arthritis, osteoarthritis, inflammatory conditions, ankylosing spondylitis, and immune diseases like lupus are recognized contributors to TMD (Paduano et al., 2020). Furthermore, psychosocial, genetic, hormonal, and environmental factors are thought to trigger this pathology (Ryan et al., 2019).
Although there are available reviews in the literature regarding the association and relationship of vitamin D with TMD, a lack of meta-analysis and a proper consequent conclusion can be sensed. Thus, this systematic review aims to evaluate the connection between vitamin D serum levels and deficiency and TMDs, aiming to offer meta-evidence of the existing evidence in this domain. The results of this study could be beneficial for clinicians in identifying a possible risk factor for TMD to help patients lower the risk of TMD or alleviate their signs and symptoms of TMD.
Section snippets
Protocol
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to prepare the protocol for this study (Page et al., 2021). The protocol of this systematic review was prospectively registered in the PROSPERO in March 2024 (CRD42024525658). The available literature was qualitatively and quantitatively analyzed.
PECO Question
Population: Patients diagnosed with TMD
Exposure: Vitamin D serum level
Comparison: Healthy patients without TMD
Outcomes: Different vitamin D serum level
“Is the
Study Selection
Fig. 1 depicts the study's flow diagram. The electronic search identified 4044 records, of which 2621 remained after duplication removal. Twenty-three studies were selected to check their eligibility for inclusion after screening based on their title and abstract. Finally, 15 studies were included in this review, of which eight were selected to be included in the meta-analysis. The features, characteristics, follow-up times, methods, and results of the included studies are summarized in Table 1.
Summary of Findings
The main objective of this study was to evaluate the connection between vitamin D serum levels and vitamin D deficiency with TMDs. The results showed that the prevalence and odds of vitamin D deficiency are significantly higher among TMD patients than among healthy patients. Moreover, vitamin D serum levels are significantly lower in TMD patients. Calcium serum levels showed no significant difference between subjects with and without TMD. Regarding the expression of VDR gene expressions,
Conclusion
Upon considering the limitations of the present study and the high risk of bias of the included studies, the following points can be concluded:
- Vitamin D deficiency is significantly more prevalent among TMD patients than healthy ones.
- Vitamin D serum levels are significantly lower in TMD patients than in healthy subjects, especially in the Middle Eastern population.
- According to the current literature, the calcium serum levels are not significantly different between subjects with and without TMD.
Some of the references
- M.J. Bolland et al. – Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis The Lancet. Diabetes & Endocrinology – (2018)
- S. Yildiz et al.– Relation of vitamin D and BsmI variant with temporomandibular diseases in the Turkish population – British Journal of Oral and Maxillofacial Surgery (2021)
- S. Bashir et al. – Association of VDR gene BsmI polymorphism with temporomandibular joint disorders: A case control study in Kashmiri population – Gene Reports (2022)
- M. Ferrillo et al. – Temporomandibular Disorders and Vitamin D Deficiency: What Is the Linkage between These Conditions? A Systematic Review – Journal of Clinical Medicine (2022)
- A. Gupta et al. – Effectiveness of Vitamin D along with Splint therapy in the Vit D deficient patients with Temporomandibular disorder-A Randomized, double-blind, placebo-controlled clinical trial – Journal of Indian Prosthodontic Society (2022)
Temporomandibular disorders (TMDs) are a group of conditions that affect the jaw joints and surrounding muscles.
Here are the key points about TMDs:
What are TMDs?
Temporomandibular disorders are problems affecting the temporomandibular joints (TMJs) - the joints connecting the lower jaw to the skull - and the muscles that control jaw movement 1 2
. They involve disorders of the jaw muscles, joints, and associated nerves.
Common symptoms
- Pain or tenderness in the jaw, face, neck, and shoulders 1 4
- Clicking, popping, or grating sounds when opening/closing the mouth 1 4
- Limited jaw movement or locking of the jaw 1 4
- Headaches, earaches, dizziness 1 4
- Difficulty chewing or sudden uncomfortable bite 5
See other TMD in VitaminDWiki
138+ VitaminDWiki Chronic Pain pages have VITAMIN D in the title
The list is automatically updated
Items found: 141
Title |
|
Modified |
Pain sources vs. Vitamin D - Jan 2025 |
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22 Jan, 2025 |
Vitamin D may influence pain intensity – review Nov 2024 |
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16 Dec, 2024 |
Jaw joint (TMJ) needs 30-50 ng of Vitamin D and a good VDR – April 2021 |
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17 Oct, 2024 |
Temporomandibular Disorders (superset of TMJ) - 3.8 X more likely to be vitamin D deficient – meta-analysis Oct 2024 |
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17 Oct, 2024 |
Growing pains reduced in 91% of children with a single dose of Vitamin D – July 2024 |
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15 Sep, 2024 |
Growing pains associated with low Vitamin D - many studies |
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03 Aug, 2024 |
Vitamin D reduces 5 types of chronic pain |
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07 Jul, 2024 |
Vitamin D reduces 5 types of pain |
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07 Jul, 2024 |
Willow Bark Extract and Aspirin have many health benefits (Vitamin D might be better) - Dec 2023 |
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28 Dec, 2023 |
Central Nervous System protection by Vitamin D - Dec 2023 |
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21 Dec, 2023 |
Knee osteoarthritis treated by Vitamin D - many studies |
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13 Dec, 2023 |
Fibromyalgia pain, fatigue, etc. reduced by 50,000 IU of Vitamin D for 12 weeks – Sept 2023 |
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04 Oct, 2023 |
Pain relieved by Vitamin D if trial lasted more than 5 months (endometriosis, 50K weekly for 12 months) – Aug 2023 |
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30 Aug, 2023 |
Muscle pain in obese women reduced by aerobic exercise plus 50,000 IU Vitamin D - RCT May 2021 |
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27 Aug, 2023 |
Less morphine recall if preceded by twice a week Vitamin D (400 IU per kg in rats, human weights 80 kg) – Aug 2023 |
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15 Aug, 2023 |
Pain not reduced by 60,000 IU monthly vitamin D (need 50,000 IU weekly) – RCT Aug 2023 |
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22 Jul, 2023 |
Raynaud's pain decreased with 600,000 IU monthly vitamin D – RCT May 2012 |
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17 Jul, 2023 |
Vitamin D at CureTogether: Fibromyalgia, MS, Psoriasis, etc - Dec 2013 |
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11 Jul, 2023 |
Overview Fibromyalgia or Chronic Fatigue and vitamin D |
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11 Jul, 2023 |
Carpal tunnel syndrome and low vitamin D - many studies |
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08 May, 2023 |
Large dose Vitamin D before surgery was found to help by 35 studies |
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08 May, 2023 |
Neuropathy treated by vitamin D - many studies |
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24 Mar, 2023 |
More post-operative pain if low vitamin D before ( 2.4 X for Thoracoscopic) – Oct 2022 |
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19 Oct, 2022 |
Opioid addiction related to low vitamin D in many ways (in both mice and men) – June 2021 |
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13 Oct, 2022 |
Fibromyalgia Syndrome correlated with poor Vitamin D Receptor (less D to cells) in a small study – July 2022 |
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24 Aug, 2022 |
Fibromyalgia and Musculoskeletal Pain treated by raised Vitamin D levels – July 2022 |
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23 Jul, 2022 |
Overview Pain and Vitamin D |
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15 May, 2022 |
Ageing faster and more knee pain are associated with low vitamin D – March 2022 |
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08 Mar, 2022 |
Low Level Laser Therapy greatly increased Vitamin D and Magnesium (for diabetics with nephropathy) – March 2019 |
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28 Nov, 2021 |
Nightmares associated with low Vitamin D and low Calcium – Aug 2021 |
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21 Nov, 2021 |
Menstrual Pain (PMS) reduced by vitamin D – RCT 2012, 2014, 2016 |
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23 Sep, 2021 |
Less labor pain if higher level of vitamin D – August 2021 |
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10 Aug, 2021 |
Pain reduced by Vitamin D (60K weekly, then monthly) plus daily Calcium in 3 months – May 2021 |
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16 Jul, 2021 |
15,000 US death per year from NSAIDs (0 deaths from Vitamin D) |
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10 Jun, 2021 |
Vitamin D deficiency: an unrecognized cause of flank pain – Nov 2017 |
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24 Jan, 2021 |
Vitamin D interplay with pain - May 2020 |
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27 Nov, 2020 |
Vitamin D injections of a total of 1,800,000 IU reduced shinbone tenderness – Feb 2013 |
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25 Jul, 2020 |
Several Diabetic pains reduced by injection of 300,000 IU of Vitamin D – RCT Feb 2020 |
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25 Jul, 2020 |
Opiate addiction 2.4 X more likely if vitamin D deficient before surgery – June 2020 |
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26 Jun, 2020 |
Chronic pain if osteoporosis and low vitamin D – June 2020 |
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18 Jun, 2020 |
3X less Septic Shock in children with sepsis getting 150,000 IU of Vitamin D - RCT June 2020 |
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03 Jun, 2020 |
Dysmenorrhea substantially reduced by Ginger, just 1,000 IU Vitamin D also helped – RCT Nov 2019 |
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02 Dec, 2019 |
Fatigued seniors have lower levels of Vitamin D – Oct 2019 |
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20 Oct, 2019 |
Fibromyalgia treated with Vitamin D (50,000 IU weekly for 3 months) – 2016, 2017, 2018, 2019 |
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19 Oct, 2019 |
Vitality recaptured with Vitamin D (stories of Swedish immigrant women in this case) – Dec 2019 |
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14 Oct, 2019 |
Long-term neck and back pains greatly reduced by 50,000 IU of Vitamin D – 4 cases – Sept 2019 |
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14 Sep, 2019 |
8 Signs of Low Vitamin D - sweating, bones ache, muscle pain, poor immune, fatigue, slow healing etc. – YouTube Dec 2018 |
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05 Aug, 2019 |
Fibromyalgia severity associated with serotonin but not Vitamin D (almost all were insufficient) – May 2019 |
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27 May, 2019 |
Growing pains reduced 60 percent by monthly Vitamin D – March 2014 |
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19 May, 2019 |
Off topic: Transcutaneous enhancers (DMSO, etc) for Vitamin D, Vitamin C, Resveratrol, Magnesium, etc. |
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30 Apr, 2019 |
100,000 IU of vitamin D monthly decreases use of NASIDs by 13 percent if low vitamin D – RCT May 2018 |
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25 Dec, 2018 |
Rheumatoid Arthritis pain reduced by monthly 100,000 IU of Vitamin D – Oct 2018 |
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05 Oct, 2018 |
Musculoskeletal pain was 5.9 X more likely to be associated with depression if low vitamin D – Aug 2018 |
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07 Aug, 2018 |
Muscle problems are both treated and avoided by Vitamin D – April 2018 |
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03 Jul, 2018 |
Fibromyalgia pain substantially reduced by weekly Vitamin D (50,000 IU) – June 2018 |
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23 Jun, 2018 |
Muscle pain (Low Magnesium) plus Low Vitamin D associated with 10X more Cancer, etc (San Francisco) – Aug 2017 |
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13 Apr, 2018 |
Widespread pain, arthritis pain and muscle pain are associated with low vitamin D – meta-analysis March 2018 |
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08 Apr, 2018 |
Hospice and palliative care – Vitamin D, CBD, and Medical Cannabis |
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14 Mar, 2018 |
Fibromyalgia associated with lower Vitamin D – meta-analysis Oct 2017 |
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10 Feb, 2018 |
Trigger points (myofascial pain) may be associated with low Vitamin D and low Magnesium – Jan 2018 |
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16 Jan, 2018 |
Opioid dependency associated with vitamin D levels which are 8 % higher initially – Jan 2018 |
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15 Jan, 2018 |
Tibia pain (long term) is 20X more likely if low vitamin D (under 10 ng) – Jan 2018 |
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05 Jan, 2018 |
Jaw joint pain (Temporomandibular) is associated with low vitamin D in young adults – Nov 2017 |
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16 Dec, 2017 |
Australians tested for Vitamin D – 40 percent deficient and 60 percent taking vitamin D – Nov 2017 |
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03 Nov, 2017 |
Chronic widespread pain reduced a bit by vitamin D ignored dose sizes - meta-analysis Aug 2017 |
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17 Aug, 2017 |
Vitamin D improves sleep and reduces pain – review of studies - July 2017 |
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04 Aug, 2017 |
Off Topic: 4X increase in Americans taking morphine-type drugs in last decade (consider Vitamin D instead) – Aug 2014 |
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04 Aug, 2017 |
Shin pain in elderly men 36 X more likely if low vitamin D – March 2017 |
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30 Jul, 2017 |
Back and leg pain lasts a year longer if low vitamin D – April 2017 |
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30 Jul, 2017 |
Chronic Pain reported 38 percent less often if supplemented with Vitamin D – meta-analysis Sept 2016 |
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25 Jul, 2017 |
Knee osteoarthritis treated with vitamin D, weekly 50,000 IU – May 2015 |
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20 Jul, 2017 |
Opioid use in palliative cancer patients far less if high level of vitamin D – May 2015 |
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11 May, 2017 |
Angina dramatically reduced by injections of vitamin D twice a month (300,000 IU) – Jan 2015 |
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05 Apr, 2017 |
Fatigue reduced by a single dose of vitamin D (100,000 IU) – RCT Dec 2016 |
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27 Feb, 2017 |
Addictive pain relievers Oxycodone and Percocet (not needed as much if have enough vitamin D?) – July 2014 |
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27 Feb, 2017 |
Fibromyalgia helped by Vitamin D – still not sure how much, and why - June 2016 |
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31 Dec, 2016 |
Acute Rehab. patients 2.3X more likely to have musculoskeletal pain if low vitamin D – Oct 2014 |
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29 Dec, 2016 |
Knee osteoarthritis pain reduced by 60,000 IU monthly vitamin D following loading dose – RCT Nov 2013 |
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24 Dec, 2016 |
Less use of musculoskeletal pain drugs if get vitamin D – Feb 2015 |
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20 Nov, 2016 |
Calcitriol, not inactive vitamin D, associated with pain in seniors – Aug 2014 |
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30 Oct, 2016 |
Chronic Widespread Pain - 2 times more likely to be developed if low vitamin D – Jan 2016 |
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10 Oct, 2016 |
Vitamin D deficiency 4X more likely if illiterate or have bone pain – Lahore Pakistan – Oct 2015 |
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09 Jul, 2016 |
Reduced palliative cancer pain after Vitamin D supplementation – April 2016 |
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19 Apr, 2016 |
Fibromyalgia development 1.9 X more likely if low vitamin D – Jan 2016 |
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20 Jan, 2016 |
If you cannot readily get medical treatment, consider Alternative Med such as vitamin D |
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24 Dec, 2015 |
Chronic Widespread Pain associated with Vitamin D under 10 ng – meta-analysis Oct 2015 |
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12 Dec, 2015 |
Fibromyalgia pain reduced with vitamin D intervention that achieved 30-48 ng – RCT Feb 2014 |
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05 Nov, 2015 |
Musculoskeletal pain reduced with 4,000 IU of vitamin D – RCT April 2015 |
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05 Nov, 2015 |
Knee pain in seniors predicted by low vitamin D 5 years before – Feb 2014 |
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27 Oct, 2015 |
Pain of Diabetic Neuropathy reduced with weekly 50,000 IU vitamin D– CT Feb 2015 |
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22 Oct, 2015 |
2000 IU of vitamin D reduced fatigue of advanced cancer – RCT May 2012 |
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03 Sep, 2015 |
Growing pains associated with low vitamin D - Sept 2015 |
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11 Aug, 2015 |
Pain not reduced by vitamin D (only used 1,000 IU) - RCT Dec 2014 |
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16 Jul, 2015 |
Pain and Vitamin D - Review April 2015 |
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24 Jun, 2015 |
Growing pains reduced 57 percent by vitamin D therapy – May 2015 |
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28 May, 2015 |
Breast Cancer medicine pain reduced with 4300 IU vitamin D – RCT June 2012 |
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24 May, 2015 |
Does vitamin D treat pain – still not absolutely, positively sure – meta-analysis April 2015 |
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30 Apr, 2015 |
400,000 IU of vitamin D reduced adult pain and improved quality of life – March 2014 |
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28 Apr, 2015 |
Knee osteoarthritis more painful if low vitamin D, especially among obese – Jan 2015 |
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12 Apr, 2015 |
Pain following auto accident is worse if low vitamin D (for African Americans) – April 2015 |
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27 Mar, 2015 |
Pain reduced when enough vitamin D was given – review March 2015 |
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19 Mar, 2015 |
Severe chronic disease associated with less than 10 ng vitamin D – July 2011 |
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11 Mar, 2015 |
Poor sleep strongly associated with pain in seniors (both associated with low vitamin D) – March 2015 |
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07 Mar, 2015 |
Sleep disorder and nonspecific pain implies low vitamin D, especially if dark skin – March 2013 |
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07 Mar, 2015 |
Is there a role for vitamin D in the treatment of chronic pain – Oct 2014 |
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09 Jan, 2015 |
Fatigue substantially reduced by 450,000 IU Vitamin D2 spread over 5 weeks – Aug 2014 |
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06 Jan, 2015 |
Back pain cured with vitamin D – Book May 2014 |
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21 Dec, 2014 |
Fibromyalgia pain with trazodone reduced by 50 percent with weekly 50,000 IU of vitamin D – RCT Nov 2014 |
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22 Nov, 2014 |
Dark skinned in Norway: 1000 IU vitamin D not enough to reduce pain – RCT Sept 2014 |
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28 Sep, 2014 |
150,000 IU vitamin D reduced pain in immigrants – RCT Dec 2012 |
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17 Sep, 2014 |
7 improvements in lives of veterans with chronic pain with 50,000 IU vitamin D weekly – June 2012 |
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20 Aug, 2014 |
Low vitamin D associated with chronic widespread pain for women |
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06 Aug, 2014 |
Pain subjectively and objectively lower in people with higher levels of vitamin D – Aug 2014 |
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03 Aug, 2014 |
More likely to have Chronic Widespread Pain when have less than 15 ng of vitamin D – May 2010 |
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03 Aug, 2014 |
20,000 IU weekly did not get 43 percent of Scottish Cancer patients to a level of 30 ng of vitamin D – April 2014 |
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29 Jul, 2014 |
Back pain gone and grew 3 inches with vitamin D - Dec 2010 |
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14 Jul, 2014 |
Vitamin D reduced skeletal pain in 85 percent of the patients – Nov 2012 |
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29 May, 2014 |
After back surgery failure, vitamin D greatly reduced the pain of every person |
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29 May, 2014 |
Blacks had lower vitamin D and more quantifiable pain than whites with knee osteoarthritis – Nov 2012 |
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11 May, 2014 |
Chronic pain 40 percent less intense associated with 10 nanogram more vitamin D – April 2014 |
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11 May, 2014 |
Poor sleep and lack of vitamin D - Nov 2011 |
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08 Mar, 2014 |
7100 IU vitamin D (50,000 weekly) significantly reduced fibromyalgia – 2009 |
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20 Jan, 2014 |
Chronic Fatigue and Vitamin D insight – Jan 2014 |
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12 Jan, 2014 |
Literature review of Fibromyalgia and vitamin D – Sept 2011 |
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18 Dec, 2013 |
Fibromyalgia patients with low vitamin D have more pain – Dec 2013 |
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18 Dec, 2013 |
Pain reduction with 600,000 IU Vitamin D: RCT announced Dec 2013 |
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06 Dec, 2013 |
Daily headaches and musculoskeletal pain may be due to low vitamin D – Oct 2013 |
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29 Nov, 2013 |
Leg pain 7X more prevalent when vitamin D lower than 20 ng – Oct 2010 |
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24 Sep, 2013 |
No rise in vitamin D levels of fibromyalgia patients in the summer – Sept 2013 |
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08 Sep, 2013 |
Most immigrant women in Sweden had little vitamin D and lots of muscle pain – May 2013 |
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22 May, 2013 |
Vitamin D and Chronic Pain: Promising Correlates - July 2012 |
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12 May, 2013 |
RADICAL discussion of vitamin D and Nonspecific Musculoskeletal Pain– Nov 2012 |
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16 Jan, 2013 |
Half of seniors with pain had low levels of vitamin D – April 2012 |
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08 Nov, 2012 |
Discover the Pain of Vitamin D Deficiency |
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17 Mar, 2012 |
Vitamin D relieves pain – 2008 2010 |
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29 Feb, 2012 |
Fibromalgia reduced with 50,000 IU weekly vitamin D2 – Sept 2011 |
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14 Dec, 2011 |
More Arab leg pain when less than 20 ng of vitamin D – Aug 2010 |
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30 Aug, 2010 |
Patients like me survey found vitamin D to be number one supplement |
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27 Jun, 2010 |
Chronic Pain not proven to be helped by Vitamin D – June 2010 |
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02 Jun, 2010 |
Pain 'linked with low vitamin D' BBC Aug 2008 |
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13 Apr, 2010 |
Tenuous link between vitamin D and chronic pain - April 2009 |
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13 Apr, 2010 |