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
- Overview Pain and Vitamin D
- Overview Fibromyalgia or Chronic Fatigue and vitamin D
- Overview Rheumatoid Arthritis and vitamin D
- Shingles and vitamin D
- Shin splints decrease with vitamin D
- Migraine and Vitamin D
- Headache category
- "musculoskeletal pain" 374 items as of March 2018
- "chronic fatigue" 185 items as of Jan 2017
- Category Back Pain
- "KNEE PAIN" 121 items as of March 2018
- Opioid OR Opiate OR Morphine in the title 10 pages as of June 2021
Pages listed in BOTH the categories Senior and Pain
- Fatigued seniors have lower levels of Vitamin D – Oct 2019
- Muscle problems are both treated and avoided by Vitamin D – April 2018
- Shin pain in elderly men 36 X more likely if low vitamin D – March 2017
- Calcitriol, not inactive vitamin D, associated with pain in seniors – Aug 2014
- If you cannot readily get medical treatment, consider Alternative Med such as vitamin D
- Half of seniors with pain had low levels of vitamin D – April 2012
- Severe chronic disease associated with less than 10 ng vitamin D – July 2011
Pages listed in BOTH the categories Intervention and Pain
- Pain reduced by Vitamin D (60K weekly, then monthly) plus daily Calcium in 3 months – May 2021
- Several Diabetic pains reduced by injection of 300,000 IU of Vitamin D – RCT Feb 2020
- Dysmenorrhea substantially reduced by Ginger, just 1,000 IU Vitamin D also helped – RCT Nov 2019
- Rheumatoid Arthritis pain reduced by monthly 100,000 IU of Vitamin D – Oct 2018
- Fibromyalgia pain substantially reduced by weekly Vitamin D (50,000 IU) – June 2018
- 100,000 IU of vitamin D monthly decreases use of NASIDs by 13 percent if low vitamin D – RCT May 2018
- Fatigue reduced by a single dose of vitamin D (100,000 IU) – RCT Dec 2016
- Knee osteoarthritis pain reduced by 60,000 IU monthly vitamin D following loading dose – RCT Nov 2013
- Fibromyalgia treated with Vitamin D (50,000 IU weekly for 3 months) – 2016, 2017, 2018, 2019
- High dose vitamin reduced pain of fibromyalgia, osteoarthritis, and rheumatoid arthritis - July 2015
- Knee osteoarthritis treated with vitamin D, weekly 50,000 IU – May 2015
- Growing pains reduced 57 percent by vitamin D therapy – May 2015
- Pain of Diabetic Neuropathy reduced with weekly 50,000 IU vitamin D– CT Feb 2015
- Musculoskeletal pain reduced with 4,000 IU of vitamin D – RCT April 2015
- Pain reduced when enough vitamin D was given – review March 2015
- Less use of musculoskeletal pain drugs if get vitamin D – Feb 2015
- Angina dramatically reduced by injections of vitamin D twice a month (300,000 IU) – Jan 2015
- Growing pains reduced 60 percent by monthly Vitamin D – March 2014
- Fibromyalgia pain with trazodone reduced by 50 percent with weekly 50,000 IU of vitamin D – RCT Nov 2014
- 400,000 IU of vitamin D reduced adult pain and improved quality of life – March 2014
- Fibromyalgia pain reduced with vitamin D intervention that achieved 30-48 ng – RCT Feb 2014
- Quality of Life
- Vitamin D injections of a total of 1,800,000 IU reduced shinbone tenderness – Feb 2013
- 150,000 IU vitamin D reduced pain in immigrants – RCT Dec 2012
- Breast Cancer medicine pain reduced with 4300 IU vitamin D – RCT June 2012
- 7 improvements in lives of veterans with chronic pain with 50,000 IU vitamin D weekly – June 2012
- Menstrual Pain reduced by vitamin D – RCT 2012, 2014, 2016
- Raynaud's pain decreased with 600,000 IU monthly vitamin D – RCT May 2012
Pages listed in BOTH the categories Meta-analysis and Pain
- Widespread pain, arthritis pain and muscle pain are associated with low vitamin D – meta-analysis March 2018
- Chronic widespread pain reduced a bit by vitamin D ignored dose sizes - meta-analysis Aug 2017
- Chronic Pain reported 38 percent less often if supplemented with Vitamin D – meta-analysis Sept 2016
- Chronic Widespread Pain associated with Vitamin D under 10 ng – meta-analysis Oct 2015
- Does vitamin D treat pain – still not absolutely, positively sure – meta-analysis April 2015
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. Pain associated with vitamin D deficiency has a special characteristic that it is usually sensed on the bone or the muscle. 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. 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  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.
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. Vitamin D is mediated by vitamin D receptors which are present on skeletal muscle cells, thus proving its function there. 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. Vitamin D deficiency enhances sensitivity to pain due to stimulation of nerve cells. It suppresses proinflammatory cytokines such as Tumor necrosis factor alpha and Macrophage colony-stimulating factor. 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.
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. 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. 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. 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. 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 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.
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.Pain reduced by Vitamin D (60K weekly, then monthly) plus daily Calcium in 3 months – May 2021
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