A wide range of nutrients are
required to lead a healthy and active life free from chronic pain. Vitamin D, a
fat soluble vitamin, is naturally present in very few foods and is available as
a dietary supplement.
Vitamin D is formed in the skin
when exposed to UV-B rays of the sunlight. It can also be obtained from the
diet through plant sources as vitamin D2 or through animal sources as vitamin
D3 or cholecalciferol.
Vitamin D enters the circulation
and undergoes metabolic reactions in the liver and kidney to activate hormones
that increase calcium absorption thus increasing the availability of calcium.
In the liver, vitamin D is converted to 25-hydroxy cholecalciferol or 25(OH)D,
which is then converted in the kidney to 1, 25(OH)D.
Phosphorus absorbed in the
intestine and parathyroid hormone regulate the production of 1, 25(OH)D in the
kidney which in turn regulates calcium metabolism by increasing calcium
absorption and thus normalizing blood calcium.
The Institute of Medicine of the
National Academies recommends the daily allowance of vitamin D to be 600 - 800
IU daily, with a maximum intake of 4,000 IU per day. In India, however, only 10
percent of vitamin D is available through dietary sources and ICMR (Indian
Council of Medical Research) recommends a daily supplement of 400 IU in adults.
Researchers from Sri Venkateswara
Institute of Medical Sciences, Andhra Pradesh, India, have pointed out that the
levels of 25(OH)D is uniformly low among the Indian population despite abundant
Vitamin D deficiency is
associated with a number of disorders such as metabolic syndrome, type-1
diabetes, heart disease, fragile bones, and even cancer. A number of evidence
now shows that low levels of vitamin D are also responsible for diverse chronic
pain syndromes including pain in the legs in older adults, post-herpetic pain,
pain with sickle cell disease, headaches, joint pain, chronic back pain,
diffuse bone and muscle pain.
A review of case studies on
vitamin D deficiency done by Colleen Nadolski and published in the journal U.S.
Pharmacist, revealed the following -
• A 16-year-old girl with sickle cell disease having
chronic pain, headache and nausea and very low vitamin D level, and unrelieved
with NSAIDs, when treated with 50,000 IU of vitamin D twice weekly, with 1,000
mg calcium carbonate (TUMS) added at week 4, was resolved of all pain symptoms
by week 14.
• An elderly woman with
persistent diffuse muscular aching pain and with 25(OH)D level of 15 ng/mL,
unrelieved with OTC medications, showed significant reduction in pain when
treated with 50,000 IU of ergocalciferol for 8 weeks.
• Eight patients with tension
headache and 25(OH)D levels of less than10 ng/mL when treated with 1,000 to
1,500 IU of D3 and 1,000 mg calcium daily, showed complete
resolution of headache within 4 to 8 weeks.
• Treatment with vitamin D and
calcium over time resolved the symptoms of osteomalacia myopathy (weakening of
muscles and softening of bone due to loss of minerals) characterized by
fatigue, muscle aches, bone pain, and muscle weakness and frequently found in
patients who have undergone bariatric surgery.
• 1,000 to 4,000 IU of
cholecalciferol daily for 3 to 6 weeks improved or completely resolved severe
or disabling back pain in seven patients.
Sometimes, patients who were
thought to have a metastatic malignancy were eventually found to have vitamin D
deficiency which could be resolved with vitamin D and calcium treatment.
However, cases of post-herpetic
neuralgia (PHN), a painful condition affecting the nerve fibers and skin, and
joint pain (arthralgia) in breast cancer patients treated with aromatase
inhibitor (AI), when treated with vitamin D showed inadequate results requiring
Colleen Nadolski suggested the
following areas of investigation regarding vitamin D:
• Dosing required for vitamin D
repletion based on initial vitamin D levels needs to be investigated and
• Treatment targets for achieving
pain relief in multifarious pain syndromes along with dosing guidelines require
• Types of pain syndromes that do
not respond to vitamin D treatment.
The researcher has advised
primary care providers to screen for vitamin D levels in their patients who
report chronic pain, especially when there is poor response to routine
treatment. She has also advised the pharmacists to consider these relationships
in counseling patients who report inadequate or diminished efficacy of pain
Source: Nadolski, C. E. Vitamin D and Chronic Pain: Promising
Correlates. US Pharm. 2012;37(7):42-44.