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Fibromyalgia patients with low vitamin D have more pain – Dec 2013

Pain Manag Nurs. 2013 Dec;14(4):e156-63. doi: 10.1016/j.pmn.2011.09.006. Epub 2011 Dec 20.
Okumus M, Koybası M, Tuncay F, Ceceli E, Ayhan F, Yorgancioglu R, Borman P.

There are a number of studies that have evaluated the relationship between fibromyalgia (FM) and vitamin D deficiency with conflicting results. The aim of this study was to assess vitamin D deficiency in patients with FM and to evaluate the relationship with the common symptoms of FM and levels of serum vitamin D. Forty premenopausal female fibromyalgia patients and 40 age- and sex-matched control subjects were included in the study. The demographic characteristics of all subjects, including age, sex, and body mass index, were recorded. The number of tender points was recorded, and the intensity of the widespread pain of the subjects was measured by the visual analog scale. The activities of daily living component of the Fibromyalgia Impact Questionnaire (FIQ-ADL), was used to assess physical functional capacity. Serum vitamin D was measured in both groups, and vitamin D levels <37.5 nmol/L were accepted as vitamin D deficiency. The vitamin D levels and clinical and laboratory characteristics of the patient and control groups were comparatively analyzed. The relationship between vitamin D levels and clinical findings of the FM patients were also determined. The mean age was 41.23 ± 4.8 and 39.48 ± 4.08 years for the patient and control groups, respectively.
The pain intensity, number of tender points, and FIQ-ADL scores were higher in FM patients than in control subjects. The mean levels of vitamin D in the patient and control groups were determined to be 31.97 ± 15.50 and 28.97 ± 13.31 nmol/L, respectively (p > .05). The incidence of vitamin D deficiency was similar between the patient and control groups (67.5% vs. 70%). Vitamin D levels significantly correlated with pain intensity (r = -0.653; p = .001) and FIQ-ADL scores in the FM group (r = -0.344; p = .030).
In conclusion, the results of this study indicate that deficiency of vitamin D is not more common in premenopausal female patients with FM than in control subjects without FM. However, the association between pain and vitamin D levels in FM patients emphasizes that hypovitaminosis of vitamin D in the FM syndrome may have an augmenting impact on pain intensity and functional status. Future studies are needed to show the effect of vitamin D supplementation in the reduction of pain intensity and disability in patients suffering from this chronic condition.

Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

PMID: 24315268 PDF cost $14.


  • Alagol F, Shihadeh Y, Boztepe H, Tanakol R, Yarman S, Azizlerli H, et al. Sunlight exposure and vitamin D in Turkish women. Journal of Endocrinological Investigation. 2000;23:173–177
  • Al-Allaf AW, Mole PA, Paterson CR, Pullar T. Bone health in patients with fibromyalgia. Rheumatology. 2003;42:1202–1206
  • Al Faraj S, Al Muttairi K. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine. 2003;28:177–179
  • Armstrong DJ, Meenagh GK, Bickle I, Lee AS, Curran ES, Finch MB. Vitamin D deficiency is associated with anxiety and depression in fibromyalgia. Clinical Rheumatology. 2007;26(4):551–554
  • Arnson Y, Amital D, Amital H. The diverse world of vitamin D:Does it also modulate pain sensation?. The Israel Medical Association Journal. 2009;11(6):371–372
  • Atherton K, Berry DJ, Parsons T, Macfarlane GJ, Power C, Hypponen E. Vitamin D and chronic widespread pain in a white middle-aged British population: Evidence from a cross-sectional population study. Annals of the Rheumatic Diseases. 2009;68:817–822
  • Atli T, Gullu S, Uysal AR, Erdogan G. The prevalence of vitamin D deficiency and effects of ultraviolet light on vitamin D levels in elderly Turkish population. Archives of Gerontology and Geriatrics. 2005;40(1):53–60
  • Badsha H, Daher M, Ooi Kong K. Myalgia or nonspecific muscle pain in Arab or Indo-Pakistani patients may indicate vitamin D deficiency. Clinical Rheumatology. 2009;28(8):971–973
  • Bhatty SA, Shaikh NA, Irfan M, Kashif SM, Vaswani AS, Sumbhai A, et al. Vitamin D deficiency in fibromyalgia. Journal of the Pakistan Medical Association. 2010;60(11):949–951
  • Block SR. Vitamin D deficiency is not associated with nonspecific muskuloskeletal pain syndromes including fibromyalgia. Mayo Clinic Proceedings. 2004;79(12):1585–1587
  • Borman P, Celiker R. A comparative analysis of quality of life in rheumatoid arthritis and fibromyalgia. Journal of Musculoskeletal Pain. 1999;7(4):5–14
  • Boullion R. Vitamin D: Photosynthesis, metabolism and action to clinical applications. In: Degroot L, Jameson JL, Burger HG editor. Endocrinology. Philadelphia: Saunders; 2001;p. 1009–1028
  • Brannon PM, Picciano MF. Vitamin D in pregnancy and lactation in humans. Annual Review of Nutrition. 2011;31:89–115
  • Burckhardt CS, Clark SR, Bennett RM. The Fibromyalgia Impact Questionnaire: Development and validation. The Journal of Rheumatology. 1991;18:728–733
  • de Rezende Pena C, Grillo LP, das Chagas Medeiros MM. Evaluation of 25-hydroxyvitamin D serum levels in patients with fibromyalgia. Journal of Clinical Rheumatology. 2010;16(8):365–369
  • Fischer AA. Pressure algometry over normal muscle. Standard values, validity and reproducibility of pressure threshold. Pain. 1987;30:115–126
  • Gannage-Yared MH, Chemali R, Yaacoub N, Halaby G. Hypovitaminosis D in a sunny country: Relation to lifestyle and bone markers. Journal of Bone and Mineral Research. 2000;15:1856–1862
  • Ghannam NN, Hammami MM, Bakheet SM, Khan BA. Bone mineral density of the spine and femur in healthy Saudi females: Relation to vitamin D status, pregnancy and lactation. Calcified Tissue International. 1999;65(1):23–28
  • Gloth FM, Lindsay JM, Zelesnick LB, Greenough WB. Can vitamin D deficiency produce an anusual pain syndrome?. Archives of Internal Medicine. 1991;151:1662–1664
  • Grootjans-Geerts I, Wielders JP. A pilot study of hypovitaminosis D in appearently healthy, veiled, Turkish women: Severe vitamin D deficiency in 82%. Nederlands J Med. 2002;146:1100–1101
  • Hashemipour S, Larijani B, Adibi H, Javadi E, Sedaghat M, Pajoouhi M, et al. Vitamin D deficiency and causative factors in the population of Tehran. BMC Public Health. 2004;4:38–44
  • Heidari B, Shirvani JS, Firouziahi A, Heidari P, Hajian-Tilaki KO. Association between nonspesific skeletal pain and vitamin D deficiency. International Journal of Rheumatic Diseases1. 2010;3(4):340–346
  • Hollis BW, Wagner CL. The vitamin D requirement during human lactation: The facts and IOM's “utter” failure. Public Health Nutrition. 2011;14:748–749
  • Jensen B, Wittrup IH, Bliddal H, Danneskiold-Samsoe B, Faber J. Bone mineral density in fibromyalgia patients—Correlation to disease activity. Scandinavian Journal of Rheumatology. 2003;32:146–150
  • Johnson DD, Wagner CL, Hulsey TC, McNeil RB, Ebeling M, Hollis BW. Vitamin D deficiency and insufficiency is common during pregnancy. American Journal of Perinatology. 2011;28:7–12
  • Macfarlane GJ, Palmer B, Roy D, Afzal C, Silman AJ, O'Neill T. An excess of widespread pain among South Asians: Are low levels of vitamin D implicated?. Annals of the Rheumatic Diseases. 2005;64:1217–1219
  • Mannerkorpi K, Ekdahl C. Assessment of functional limitation and disability in patient with fibromyalgia. Scandinavian Journal of Rheumatology. 1997;26:4–13
  • Meddeb N, Sahli H, Chahed M, Abdelmoula J, Feki M, Salah H, et al. Vitamin D deficiency in Tunusia. Osteoporos International. 2005;16:180–183
  • Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clinic Proceedings. 2003;78:1463–1470
  • Preece MA, McIntosh WB, Tomlinson S, Ford JA, Dunnigan MG, O'Riordan JL. Vitamin D deficiency among Asian immigrants to Britain. Lancet. 1973;1:907–910
  • Reginato AJ, Falasca GF, Pappu R, McKnight B, Agha A. Musculoskeletal manisfestations of osteomalacia: Report of, 26 cases and literature review. Seminars in Arthritis and Rheumatism. 1999;28:287–304
  • Serhan E, Newton P, Ali HA, Walford S, Singh BM. Prevalence of hypovitaminosis D in Indo-Asian patients attending a rheumatology clinic. Bone. 1999;25:609–611
  • Straube S, Moore RA, Derry S, McQuay HJ. Vitamin D and chronic pain. Pain. 2009;141:10–13
  • Swezey RL, Adams J. Fibromyalgia: A risk factor for osteoporosis. The Journal of Rheumatology. 1999;26:2642–2644
  • Tandeter H, Grynbaum M, Zuili I, Shany S, Shyartzman P. Serum 25-OH vitamin D levels in patients with fibromyalgia. The Israel Medical Association Journal. 2009;11(6):339–342
  • Thomas MK, Lloyd-Jones DM, Thadhani RI, Shaw AC, Deraska DJ, Kitch BT, et al. Hypovitaminosis D in medical inpatients. New England Journal of Medicine. 1998;338:777–783
  • Ulusoy H, Sarica N, Arslan S, Ozyurt H, Cetin I, Bırgul OE, et al. Serum vitamin D status and bone mineral density in fibromyalgia. Bratisl Med J. 2010;111(11):604–609
  • Villamor E, Marin C, Mora-Plazas M, Baylin A. Vitamin D deficiency and age at menarche: A prospective study. The American Journal of Clinical Nutrition. 2011;94(4):1020–1025
  • Warner AE, Arnspiger SA. Diffuse musculoskeletal pain is not associated with low vitamin D levels or improved by treatment with vitamin D. Journal of Clinical Rheumatology. 2008;14:12–16
  • Wolfe F, Ross K, Anderson J, Russel IJ, Herbert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis and Rheumatism. 1995;38:19–28
  • Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: Report of the multi-center criteria commitee. Arthritis and Rheumatism. 1990;33:160–172

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