A recent study published in November 2012 found that MSK pain is related to vitamin D deficiency, and replacement of vitamin D improved pain. The researchers found that 95.4 percent of the subjects were vitamin D deficient, and 85.5 percent of the subjects had improvement in pain with vitamin D supplementation (2). Of the subjects that responded to the treatment, post-treatment serum vitamin D levels were significantly higher than in the subjects who did not respond to vitamin D supplementation. The study concluded, “Treatment with vitamin D can relieve the pain in majority of the patients with vitamin D deficiency. Lack of response can be due to insufficient increase in serum vitamin D concentration. Reassessment of serum 25-hydroxyvitamin D concentration is recommended in nonresponsive patients.” (2)
This study confirms the results of a number of other studies that have found the same results (3, 4, 5). The studies found that vitamin D deficiency may be responsible for generalized, non-specific pain especially if it is resistant to manual and conventional treatments. A possible mechanism of why suboptimal levels of vitamin D can cause pain is that there is a reduction in serum calcium since vitamin D is responsible for its absorption from the digestive tract. This in turn stimulates the increase of parathyroid hormone which promotes the excretion of phosphate. Low levels of calcium phosphate lead to the deposition of un-mineralized collagen matrix on bony surfaces. When the collagen matrix hydrates and swells then it causes pain by stimulating nervous endings on the periosteum (5).
Due to the large proportion of the population that experience both chronic pain and vitamin deficiency it would be prudent that healthcare practitioners and patients consider vitamin D levels a possible key-contributing factor. This may be especially useful in clinical settings such as pain clinics and chiropractic offices where there is a larger volume of [back] pain related cases.
The most recent data suggests that less than 50 nmol/L of serum vitamin D is a deficient state. The optimal levels are 100-160nmol/L. The most effective and accurate way to determine what dosage is required to reach optimal levels is to have your serum 25-hydroxyvitamin D assessed. The most recent guidelines from the American Endocrine Society suggest that 500-2000IU daily are effective to maintain adequate levels. For those that are deficient, 50,000 IU once a week for 8 weeks or 6000 IU daily to achieve a blood level of vitamin D above 75 nmol/L is most effective and safe (6). Doses of 2000 IU or less are not able to effectively raise serum levels into the protective range.
Vitamin D can be a simple yet very effective therapy for chronic, non-specific pain if you are deficient. To determine if is may be contributing to your pain, have a qualified healthcare practitioner assess your serum levels and supplement appropriately to restore your optimal levels. Consider liquid formulations to increase the ease of achieving higher dosages. In medicine, sometimes the simplest piece is often the most important. Vitamin D once again forces us to go back to the basics in the quest to achieve pain free function.
1) Andersson HI, Ejlertsson G, Leden I, Rosenberg C. Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization. Clin J Pain. 1993;9(3):174-82
2) Abbasi M, et al. Is vitamin D deficiency associated with non specific musculoskeletal pain? Glob J Health Sci. 2012;1:107-11.
3) Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain.Mayo Clin Proc. 2003 Dec;78(12):1463-70.
4) Al Faraj S, Al Mutairi K. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine (Phila Pa 1976). 2003 Jan 15;28(2):177-9.
5) Holick MF. Vitamin D deficiency: what a pain it is. Mayo Clin Proc. 2003 Dec;78(12):1457-9.
6) Holick et al. Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30.