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Benefits of maintaining adequate levels of vitamin D Symptoms in blood are well known and have been described in many clinical conditions. In addition to being essential for bone metabolism, among other aspects, studies have been published in recent years that link the potential value of vitamin D in patients. chronic pain, “There is evidence for a role in nociception, as well as a role in controlling inflammation”points to iSanidad Dr. Luis Miguel TorresHead of the Anesthesia-Resuscitation and Pain Treatment Service, and Director of the Department of Surgery at the Puerta del Mar Hospital in Cadiz.
The President of the Spanish Multidisciplinary Pain Society (Semador) also confirms that clinical evidence also shows “Potential benefit of vitamin D in the control of various types of pain” and explains how it works and what the risks of having low levels of this substance are.
What is the connection between vitamin D and chronic pain?
Vitamin D is a hormone that has fundamental functions at the level of bone metabolism. But there is growing evidence about its effects on chronic pain patients. Virtually all tissues and cells in the human body contain receptors for vitamin D. Immune cells, neurons or inflammatory cells produce vitamin D locally.
“There is evidence that vitamin D acts as an immunomodulator or regulates the production of anti-inflammatory cytokines”
Is there evidence that vitamin D may play a role in pain management? What is that role?
There is evidence that vitamin D acts as an immunomodulator or regulates the production of anti-inflammatory cytokines. Its deficiency has a very negative impact on chronic pain patients due to its effects on tissues such as the central nervous system, endocrine system, immune system, production of anti-inflammatory cytokines, and protection against autoimmune or inflammatory diseases. , There is also evidence that low levels of vitamin D are associated with a higher risk of mortality. All this, and especially its beneficial effects at the level of the central nervous system (CNS), together with its anti-inflammatory potential, suggest its role in the treatment of pain.
This vitamin regulates the production of anti-inflammatory cytokines, which is why it has a relevant role in inflammatory pathologies that cause pain. The antinociceptive mechanism has been described at three levels: regulation of inflammatory pathways with upregulation of TGF alpha, IL-4 and TNF alpha, effects on postglandins, inhibiting COX-2, stimulating PEGDH and inhibiting PEG2, and Acting on neuroprotective mechanisms, regulating the synthesis of neurotrophins and inhibiting iNOS.
In which type of pain has the most beneficial effect of vitamin D been seen?
The mechanism of action in fibromyalgia is one of the most studied. Pain pathways involving cortical, immunological, hormonal and neuronal changes in chronic pain are thought to be potentially influenced by vitamin D levels.
Vitamin D has been shown to have anti-inflammatory properties that may alter sensitivity to peripheral pain. It has also been shown that vitamin D deficiency (<50 mmol/l) and 25(OH)D deficiency are strongly correlated with the degree of pain sensitivity.
“Pain pathways associated with cortical, immunological, hormonal and neuronal changes in chronic pain are potentially influenced by vitamin D levels”
The use of vitamin D in chronic pain is supported by recent publications, such as that of Wu et al., where 3,436 participants were included and demonstrated that in groups with supplementation of this hormone compared to placebo There was a significant reduction in pain. The effect of vitamin D was comparable in non-specific generalized pain and local pain pathologies. The authors concluded that there was a significantly greater reduction in vitamin D compared to placebo.
Recent meta-analyses have shown that the association between vitamin D deficiency and low back pain is greater in young women. Back pain was more severe and more likely to occur in patients with vitamin D deficiency or low concentrations. The association between low levels of vitamin D and back pain was especially clear in patients under 60 years of age.
There is also evidence of other types of pain, particularly those related to osteoarticular pathology. Vitamin D can reduce complications in these types of patients, so it should be given to deficient patients to prevent musculoskeletal complications.
“Recent meta-analyses have shown that the association between vitamin D deficiency and low back pain is greater in young women”
There are several studies and reviews on the potential benefits of vitamin D in migraine or headache patients. Some observational studies have established an inverse relationship between vitamin D levels and headaches, both migraine and tension headache. In 2020, in the study Fallah et al. 57 children and adolescents suffering from migraine were randomly divided into two groups. Topiramate 2 mg/kg per day with vitamin D 3,500,000 IU per week for 2 months versus topiramate monotherapy. Efficacy in reducing headache frequency, severity, duration and disability was observed in both groups. But the combination of topiramate plus vitamin D was more effective than topiramate alone.
Are patients with vitamin D deficiency more likely to suffer from chronic pain?
In patients with chronic widespread pain, a very heterogeneous pathology that is difficult to treat, there is evidence of the potential benefit of vitamin D in these patients. It is known that patients with low levels of vitamin D in the blood (<15.6 ng/mL) have a higher risk of developing chronic pain than patients with levels greater than 36.3 ng/mL.
In the case of osteoarthritis, there is abundant evidence of the benefits of vitamin D at the musculoskeletal level, as well as the importance of maintaining adequate levels of 25(OH)D in the blood. Vitamin D’s effects on osteoarthritis are not limited to its musculoskeletal benefits. There is evidence of its effectiveness in reducing pain, improving function and reducing disease progression over six months of treatment.
“In patients with deficiency, it may be beneficial to normalize the levels of this hormone in the blood, through supplementation. The benefits will be pain reduction and potential functional improvement.
Would it be advisable to give Vitamin D supplements in all cases in which there is any kind of chronic pain?
Natural sources of vitamin D are sunlight and foods that provide vitamin D; The latter are rare and the quantities are usually low for normal daily intake rations. Both sources are increasingly compromised not only in the general population, but also to a greater extent in patients with chronic pain. They get less sunlight because many of them cannot go outside and, in addition, they often have diets low in vitamin D-rich foods.
In patients with deficiency of this vitamin, normalizing blood levels of this hormone through supplementation may be beneficial. The benefits will be pain reduction and potential functional improvement. Considering this potential benefit of vitamin D and its excellent margins of safety, it can be suggested that vitamin D supplementation could be added to standard therapeutic pain management.
What dosage of vitamin D would be recommended for these patients?
Patients with vitamin D deficiency and pain benefit from normalizing blood 25(OH)D levels, especially those who are obese or overweight. It is also known that obese or overweight people are more likely to be deficient in this substance.
Adequate levels are determined by measuring the 25(OH)D level in the blood, which is accepted as a reference. Although it is not the active form of vitamin D, it is an intermediate metabolite that is easy to measure in routine analysis.
The dosage depends on the type of vitamin D. In the case of hydropherol, the dosage varies depending on the individual and the indications. The doctor should monitor calcium and vitamin D levels before starting treatment and periodically for 3 months after starting treatment. In general, the dose will be reduced or given a break once the vitamin D deficiency is corrected. The recommended dose in adults is one drinkable ampoule (0.266 mg calcifediol) every 15–30 days. In case of Vitamin D3 (cholecalciferol) 1000-2000 units per day.