Vitamin D supplementation for diffuse musculoskeletal pain: results of a before-and-after study

What is known about the effects of vitamin D in neuropsychiatric lupus?

Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect several organs and systems. The central and/or peripheral nervous system can suffer from complications known as neuropsychiatric lupus (NPSLE). Studies have associated the manifestations of SLE or NPSLE with vitamin D deficiency. It has been shown that hypovitaminosis D can lead to cognition deficits and cerebral hypoperfusion in patients with NPSLE. In this review article, we will address the main features related to vitamin D supplementation or serum vitamin D levels with neuropsychiatric manifestations, either in patients or in animal models of NPSLE.

Brain changes in neuroimaging of adult patients with vitamin D deficiency: systematic review protocol

INTRODUCTION

Brain abnormalities detected through neuroimaging are described in patients with vitamin D deficiency, however, it is still not clear which cerebral alterations are more frequent and characteristic in this population. Thus, this review aims to identify and classify which are the main and most frequent brain changes found by neuroimaging in patients with vitamin D deficiency.

METHODS AND ANALYSIS

The study protocol was constructed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and the leading research question was formulated through Population, Intervention, Comparator, Outcome, Setting. The evidence will be researched at the following electronic databases: PubMed, PsycINFO, Scopus, Web of Science and EMBASE. Two researchers will work in the selection, analysis and inclusion phases of the articles. In the case of divergence, a third-party reviewer will be contacted. The following studies will be included: (1) cohort studies, case-control studies and cross-sectional studies; (2) studies carried out on patients with serum 25-hydroxyvitamin D levels below 30 ng/mL; (3) studies conducted with an adult population; (4) studies using neuroimaging methods. Articles considered eligible will be analysed by the Newcastle-Ottawa Quality Assessment Scale/cross-section studies to evaluate study quality. The survey will be conducted from June to December 2022.

ETHICS AND DISSEMINATION

The identification of the main and most frequent brain alterations found through neuroimaging in patients with vitamin D deficiency can guide professionals as to the identification which of the main cerebral pathologies detected through neuroimaging are related to vitamin D deficiency, in choosing more sensitive and specific neuroimaging tests to detect these brain changes, in addition to emphasising the importance of monitoring and maintaining adequate serum levels of vitamin D, in order to reduce possible cognitive sequelae. Results will be announced at national and international conferences.

PROSPERO REGISTRATION NUMBER

CRD42018100074.

Perioperative Serum 25-Hydroxyvitamin D Levels as a Predictor of Postoperative Opioid Use and Opioid Use Disorder: a Cohort Study

IMPORTANCE

Vitamin D deficiency is associated with chronic pain syndromes and higher opioid use among cancer patients, but its association with opioid use among opioid-naïve subjects following a major surgical procedure with acute pain has not been explored.

OBJECTIVE

To determine the association between serum 25-hydroxyvitamin D (25(OH)D) levels, opioid use, and opioid use disorder.

METHODS

We identified commercially insured subjects aged 18-64 years with available perioperative serum 25-hydroxyvitamin D (25D) levels who underwent one of nine major surgical procedures in 2000-2014. Primary outcomes were dose and duration of opioid use measured using pharmacy claims. Secondary outcome was opioid use disorder captured using diagnosis codes. Multivariable negative binomial models with generalized estimating equations were performed examining the association between 25D levels and postoperative opioid use measures, adjusting for age, sex, race/ethnicity, Charlson score, education, income, latitude, and season of blood draw. Adjusted Cox regression was used to examine the association with opioid use disorder.

RESULTS

Among 5446 subjects, serum 25(OH)D was sufficient (≥ 20 ng/mL) among 4349 (79.9%) subjects, whereas 837 (15.4%) had insufficient (12 to < 20 ng/mL) and 260 (4.8%) had deficient (< 12 ng/mL) levels. On multivariable analysis, as compared with subjects with sufficient 25(OH)D levels, subjects with deficient 25(OH)D levels had 1.7 more days (95% CI 0.76, 2.58) of opioid use per year and had 98.7 higher morphine milligram equivalent dose (95% CI 55.7, 141.8) per year. Among 11,713 study cohort, subjects with deficient 25(OH)D levels were more likely to be diagnosed with opioid use disorders (HR 2.41; 95% CI 1.05, 5.52).

CONCLUSION

Patients undergoing common surgical procedures with deficient 25D levels are more likely to have higher opioid use and an increased risk of opioid use disorder compared to those with sufficient levels. Serum 25D levels may serve as a biomarker to identify subjects at increased risk of opioid misuse.

Vitamin D deficiency is associated with tibial bone pain and tenderness. A possible contributive role

BACKGROUND

Vitamin D deficiency is associated with osteomalacia and a variety of musculoskeletal pain. This study aimed to determine the association of vitamin D deficiency with tibial bone pain and tenderness.

METHODS

Patients with leg pain, defined as local pain and tenderness over tibial bones for ≥ 6 weeks were consecutively selected. Secondary causes of pain were excluded by appropriate clinical, radiological and laboratory examinations. Serum 25-hydroxyvitamin D (25-OHD) was assessed by enzyme-linked immunosorbent assay method and levels < 20 ng/mL were considered as deficiency. Age- and sex-matched subjects without leg pain served as controls. Multiple logistic regression analysis was used to determine associations.

RESULTS

One hundred and eighteen patients and 114 controls aged 46.8 ± 14.8 and 44.6 ± 14.1 years, respectively (P = 0.93) were analyzed. Mean 25-OHD level was significantly lower (P = 0.001) and the prevalence of 25-OHD deficiency was significantly higher in the patients as compared with the controls (75.4% vs. 23.6%), odds ratio (OR) = 9.54 (95% CI, 5.22-17.45, P = 0.001). There was a negative dose-response relationship between serum 25-OHD and tibial bone pain by OR = 17.33 (95% CI, 6.48-46.3) in subjects with 25-OHD < 10 ng/mL, and OR = 14.7 (95% CI, 6.35-34.6) in serum 25-OHD levels at 10-19.9 ng/mL, and OR = 2.58 (95% CI, 1.08-6.1) in those with 25-OHD at 20-29.9 ng/mL as compared with 25-OHD ≥ 30 ng/mL. After controlling for demographic and biochemical factors, the association reached a stronger level of 19.8 (6.9-56.3) in subjects with serum 25-OHD < 10 ng/mL and 14.4 (5.8-34.6) in those with serum 25-OHD at levels of 10-19.9 ng/mL and 1.85 (0.73-4.6) in 20-29 ng/mL.

CONCLUSION

These findings indicate a possible contributive role for serum 25-OHD deficiency in the development of pain and tenderness over the tibial bone.

Prevalence of vitamin D deficiency in chronic and subacute low back pain patients in India: a triple-arm controlled study

Vitamin D is vital for musculoskeletal health and may be associated with subacute and chronic low back pain. The objective of this study was to estimate the prevalence of vitamin D deficiency among chronic low back pain (CLBP) and subacute low back pain (SLBP), and compare the same with healthy controls. This study was designed as triple-arm case-control study comprising of CLBP, SLBP, and controls. SLBP and CLBP cases were consecutively enrolled over 3 months of winter season from November 2016 to January 2017. Serum 25- (OH) vitamin D was estimated for the study subjects and categorical comparison of severity of vitamin D deficiency was done for the cases and controls. A total of 250 CLBP, 177 SLBP cases, and 248 controls were included in the study. Mean (± SD) serum vitamin D levels among CLBP, SLBP, and controls were 20.36 (± 12.56), 21.42 (± 13.20), and 20.84 (± 6.93) ng/ml respectively, the difference being statistically insignificant. There was no significant difference in the prevalence of vitamin D deficiency among CLBP, SLBP, and controls which was 53.6, 50.8, and 51.6% respectively, in the three arms. However, the categorical analysis revealed that CLBP and SLBP cases had a significantly higher prevalence of worse categories of vitamin D deficiency. Cases had significantly larger frequency (CLBP vs. controls, 43.6 vs 20.1%, P<0.001; SLBP vs. controls, 43.5 vs 20.1%, P = 0.001) of individuals with vitamin D levels ≤ 16 ng/ml (moderate deficiency upper threshold level). Thus, the severe forms of vitamin D deficiency may be causally associated with CLBP and SLBP. The results of the present study revealed that increasing severity of vitamin D deficiency may have a pathogenetic association with chronic low back pain and subacute low back pain. These results may prove to be of significance in framing of future management guidelines for the above clinical conditions.

The interfaces between vitamin D, sleep and pain

The role of vitamin D in osteomineral metabolism is well known. Several studies have suggested its action on different biological mechanisms, such as nociceptive sensitivity and sleep-wake cycle modulation. Sleep is an important biological process regulated by different regions of the central nervous system, mainly the hypothalamus, in combination with several neurotransmitters. Pain, which can be classified as nociceptive, neuropathic and psychological, is regulated by both the central and peripheral nervous systems. In the peripheral nervous system, the immune system participates in the inflammatory process that contributes to hyperalgesia. Sleep deprivation is an important condition related to hyperalgesia, and recently it has also been associated with vitamin D. Poor sleep efficiency and sleep disorders have been shown to have an important role in hyperalgesia, and be associated with different vitamin D values. Vitamin D has been inversely correlated with painful manifestations, such as fibromyalgia and rheumatic diseases. Studies have demonstrated a possible action of vitamin D in the regulatory mechanisms of both sleep and pain. The supplementation of vitamin D associated with good sleep hygiene may have a therapeutic role, not only in sleep disorders but also in the prevention and treatment of chronic pain conditions.

The effect of vitamin D supplementation on pain, quality of life, and nerve conduction studies in women with chronic widespread pain

The aim of this study was to investigate the effects of vitamin D supplementation on pain, quality of life, and nerve conduction studies (NCSs) in women with chronic widespread pain (CWP) diagnosed with Vitamin D insufficiency. Thirty-three female participants with CWP and vitamin D insufficiency were included in this open-label trial. They were evaluated by routine NCSs in upper and lower limbs, pain scales, and the Nottingham Health Profile before and 8 weeks after starting vitamin D supplementation therapy. The P-value was adjusted to account for the number of comparisons performed in each assessment. After 8 weeks of treatment, participants reported significantly lower pain scores (P=0.000). The total Nottingham Health Profile score and subscores for pain, emotional reactions, and physical activity domains were significantly lower (0.000≤P≤0.008). However, no statistically significant changes in NCSs were detected, except trends toward increases in the amplitudes of left median and ulnar sensory nerve potentials and a decrease in the distal latency of the right median sensory potential (0.01≤P≤0.04). Vitamin D supplementation therapy decreased pain and increased quality of life without significantly affecting nerve conduction in patients with CWP.

Association of circulating 25-hydroxyvitamin D with mental well-being in a population-based, nationally representative sample of German adolescents

OBJECTIVE

Numerous studies have linked vitamin D to health-related quality of life (hrQoL) in chronically ill adults or elderly subjects. The aim of this study was to evaluate the association between 25-hydroxyvitamin D (25(OH)D) and hrQoL in a population-based sample of German adolescents.

METHODS

A total of n = 5066 study participants from the nationwide, representative German Health Interview and Examination Survey for Children and Adolescents (Kinder- und Jugendgesundheitssurvey) aged 11-17 years were included in this post hoc analysis. HrQoL was measured using the well-validated self- and parent-rated Children's Quality of Life questionnaires (KINDL-R), while the level of distress was assessed using the self- and proxy version of the Strengths and Difficulties Questionnaire (SDQ). Serum 25(OH)D concentrations were determined using a commercially available chemiluminescence immunoassay.

RESULTS

Bivariate analyses demonstrated a significant positive association between 25(OH)D and hrQoL for both self- [estimate (E) = 0.82, 95 % confidence interval (95 % CI) 0.35-1.30, p = 0.001] and parent ratings (E = 1.33, 95 % CI 0.83-1.83, p < 0.001). In addition, we found negative correlations between 25(OH)D and self- (E = -0.34, 95 % CI -0.58 to -0.11, p = 0.005) and parent-reported total SDQ scores (E = -0.70, 95 % CI -1.03 to -0.37, p < 0.001). Generalized linear models adjusted for age, sex, body mass index, systolic blood pressure, migration background, socio-economic status, and sedentary screen time confirmed that 25(OH)D independently and significantly predicted better hrQoL (p ≤ 0.004).

CONCLUSIONS

These findings linking 25(OH)D to better well-being in a nationally representative sample of German children and adolescents suggest beneficial effects of vitamin D on mental health. However, recommendations for vitamin supplementation in healthy children and adolescents are not warranted from our data.

A randomized double-blind placebo-controlled study adding high dose vitamin D to analgesic regimens in patients with musculoskeletal pain

BACKGROUND

The current mode of therapy for many patients with musculoskeletal pain is unsatisfactory.

PURPOSE

We aimed to assess the impact of adding 4000 IU of vitamin D on pain and serological parameters in patients with musculoskeletal pain.

MATERIALS AND METHODS

This was a randomized, double-blinded and placebo-controlled study assessing the effect of 4000 IU of orally given vitamin D3 (cholecalciferol) (four gel capsules of 1000 IU, (SupHerb, Israel) vs. placebo on different parameters of pain. Eighty patients were enrolled and therapy was given for 3 months. Parameters were scored at three time points: prior to intervention, at week 6 and week 12. Visual analogue scale (VAS) scores of pain perception were recorded following 6 and 12 weeks. We also measured serum levels of leukotriene B4 (LTB4), interleukin 6 (IL-6), tumor necrosis factor alpha (TNFα) and prostaglandin E2 (PGE2) by ELISA.

RESULTS

The group receiving vitamin D achieved a statistically significant larger decline of their VAS measurement throughout the study compared with the placebo group. The need for analgesic 'rescue therapy' was significantly lower among the vitamin D-treated group. TNFα levels decreased by 54.3% in the group treated with vitamin D and increased by 16.1% in the placebo group. PGE2 decreased by39.2% in the group treated with vitamin D and increased by 16% in the placebo group. LTB4 levels decreased in both groups by 24% (p < 0.05).

CONCLUSION

Adding 4000 IU of vitamin D for patients with musculoskeletal pain may lead to a faster decline of consecutive VAS scores and to a decrease in the levels of inflammatory and pain-related cytokines.

Emphasizing the health benefits of vitamin D for those with neurodevelopmental disorders and intellectual disabilities

People with neurodevelopmental disorders and intellectual disabilities have much greater health care needs. Mainly staying indoors, such people generally have low 25-hydroxyvitamin D (25(OH)D) concentrations. The Vitamin D Task Force of the American Academy of Developmental Medicine and Dentistry (AADMD) reviewed the evidence of 25(OH)D concentrations that benefit the health of persons with developmental disabilities. Maintaining recommended optimal serum 25(OH)D concentrations year long will benefit skeletal development in infants, children, and adolescents, and benefit musculoskeletal health and neuromuscular coordination in adult patients, and decrease risk of falls. Maintaining optimal concentrations decreases risks and severities of autoimmune diseases, cardiovascular disease, many types of cancer, dementia, types 1 and 2 diabetes mellitus, and respiratory tract infections. Other benefits include improved dental and oral health and improved physical performance. The Task Force recommends that 25(OH)D concentrations for optimal health to be in the range of 75 to 125 nmol/L, which can be achieved using between 800 and 4000 IU/day vitamin D3 and sensible exposure to solar UVB radiation. The paper also discusses the potential risks of higher 25(OH)D concentrations, the evidence from and limitations of randomized controlled trials, and the recommendations by various groups and agencies.

Vitamin D supplementation and health-related quality of life: a systematic review of the literature

Vitamin D deficiency and insufficiency are highly prevalent worldwide and thought to potentiate a variety of chronic disease states, including diabetes, cancer, and depression. Routine vitamin D supplementation is often needed to meet vitamin D requirements. Little is known regarding the effect of vitamin D supplementation on quality of life. The purpose of this article was to systematically review the literature regarding quality-of-life outcomes from vitamin D supplementation in healthy and clinical populations. Clinical trials of vitamin D supplementation, where quality-of-life outcomes were reported, were selected from Medline and Web of Science databases. Inclusion criteria were English language articles available online (published between 1950 and May 2014), primary research articles, studies conducted on human beings, and treatment/supplementation with vitamin D. Articles were excluded if they involved topical vitamin D application or implicit cotreatment with other vitamins (eg, multivitamins). Articles selected for review were examined for process and methodologic quality using validated methodologies. A total of 15 articles met the inclusion criteria for review. Interventions were highly variable in terms of study population (eg, healthy/diseased, children/elderly, and baseline vitamin D status) vitamin D dose, and duration of follow-up. Vitamin D supplementation ranged from 400 IU/day for an average of 7.1 years, to a single 300, 000 IU dose. The main tools used to capture quality of life were adaptations of validated, questionnaires (Medical Outcomes Study Short Form 36-item questionnaire and EuroQOL five dimension questionnaire). Vitamin D supplementation was not associated with significant changes in quality of life. Studies that reported changes in quality of life as a result of vitamin D supplementation were in clinical populations on short-term vitamin D. Most articles reviewed displayed poor methodologic quality (eg, no randomization/blinding, dropout description, or vitamin D assessment). Current evidence indicates that vitamin D supplementation may have a small to moderate effect on quality of life when used on a short-term basis in diseased populations. However, the evidence for a beneficial effect of long-term vitamin D supplementation on health-related quality of life is lacking.

Are Growing Pains Related to Vitamin D Deficiency? Efficacy of Vitamin D Therapy for Resolution of Symptoms

OBJECTIVES

The aim of this study was to investigate the 25-hydroxyvitamin D [25(OH)D] status of children with growing pains and to evaluate the efficacy of vitamin D treatment on the resolution of pain symptoms.

SUBJECTS AND METHODS

One hundred and twenty children with growing pains were included in a prospective cohort study. Serum 25(OH)D and bone mineral levels were measured in all subjects at the time of enrollment. The pain intensity of those with vitamin D deficiency was measured using a pain visual analog scale (VAS). After a single oral dose of vitamin D, the pain intensity was remeasured by means of the VAS at 3 months. The 25(OH)D levels and VAS scores before and after oral vitamin D administration were compared by means of a paired Student's t test.

RESULTS

In the 120 children with growing pains, vitamin D insufficiency was noted in 104 (86.6%). Following vitamin D supplementation, the mean 25(OH)D levels increased from 13.4 ± 7.2 to 44.5 ± 16.4 ng/ml, the mean pain VAS score decreased from 6.8 ± 1.9 to 2.9 ± 2.5 cm (a mean reduction of -3.8 ± 2.1, p < 0.001) and the difference was statistically significant.

CONCLUSION

Supplementation with oral vitamin D resulted in a significant reduction in pain intensity among these children with growing pains who had hypovitaminosis D.

Vitamin D in Children's Health

Knowledge of vitamin D in the health of children has grown greatly over the years, extending past the importance for calcium homeostasis and bone growth. There is growing recognition of the role vitamin D plays in health impacting the innate immune system to prevent infections and the adaptive immune system to modulate autoimmunity. Other studies are starting to reveal the neurohormonal effects of vitamin D on brain development and behavior, with a link to mental health disorders. Many of these effects start well before the birth of the child, so it is important that each pregnant woman be assessed for vitamin D deficiency and supplemented for the best possible health outcome of the child. It is recommended that targeting a 25(OH)D level of 40–70 ng/mL for each individual would provide optimal health benefits and reduce health care costs. Current recommended doses of vitamin D supplementation fall short of what is needed to obtain ideal serum levels. A vitamin D supplementation program to prevent disease, much like the current vaccination program, could potentially have a dramatic impact on overall health worldwide.

Hypovitaminosis D in widespread pain: its effect on pain perception, quality of life and nerve conduction studies

The aim of the study was to investigate the effects of hypovitaminosis D on pain, quality of life (QoL) and nerve conduction studies (NCSs) in patients with chronic widespread pain (CWP). We randomly selected 83 female patients with CWP according to their vitamin D levels in this cross-sectional study. Patients were divided into two groups as sufficient vitamin D level (above 20 ng/ml) and deficient vitamin D level (below 20 ng/ml, hypovitaminosis D). Various pain scales and Nottingham Health Profile (NHP) were used. NCSs were also done. In patients with hypovitaminosis D, there were significantly higher pain scores for all scales (p value range 0.002-0.027). The subscale and total NHP scores were significantly higher in hypovitaminosis D group (p = 0.048-0.001) except social isolation subscale (p = 0.553). Vitamin D levels were in negative correlation with right and left median and/or ulnar motor nerve amplitudes, left tibial motor amplitude. This study confirm that hypovitaminosis D is related with higher pain intensity and lower QoL scores in patients with CWP when compared with control group. Additionally, we identified for the first time that there were negative correlations between vitamin D levels and some findings of NCSs.