Link between Vitamine D deficiency and Pain…
We’re usually told that we get all the Vitamin-D we need from the sun. I’ve heard that 10-15 minutes a day in the sun is enough to give you your full daily requirements. However, now-a-days most of us avoid the sun and if we do go out we make sure to put on sunscreen and/or wear a hat. We worry about skin cancer and, since it is on the rise as atmospheric ozone decreases, it’s a legitimate worry.
You can also get Vitamin-D from dietary sources: fish (Salmon, Herring, Sardines, Mackerel), eggs (yolks), milk (fortified), cod liver oil, and probably some other food I’m just not remembering. Most of the times we just never think of Vitamin-D as being a problem.
It was recently brought to my attention that researchers have found a connection between Vitamin-D deficiency and pain. In a BBC New article, scientists found that low levels of Vitamin D, may contribute to chronic pain among women — since this finding is more prevalent among women they believe it may also be related to hormones. Lower levels of Vitamin-D are also linked to osteomalacia but they did not believe that accounted for the link to pain. Dr. Hyppönen said:
“Work was needed to evaluate whether vitamin D supplements could help prevent chronic pain.
In the meantime, she advised: “If I had chronic pain I would certainly check I was getting enough vitamin D.”
However, on the flip side, Kate Maclver of the Pain Research Institute cautioned:
“Taking too high a dose of Vitamin D supplements as a means of preventing or treating chronic pain could result in Vitamin D toxicity and high blood calcium levels.”
An earlier article on WebMD cited another study that also found a link between Vitamin D deficiency and chronic pain:
In a study involving 150 children and adults with unexplained muscle and bone pain, almost all were found to be vitamin D deficient; many were severely deficient with extremely low levels of vitamin D in their bodies.
About the reality of getting enough sun to satisfy your Vitamin D needs, it was stated:
The amount of sun exposure needed to get the proper dose of vitamin D depends on a person’s skin type, where they live, and time of year, and time of day the exposure occurs. Holick says it is difficult for people living in northern climates to get the vitamin D they need from the sun in the winter, but in the summer a light-skinned person at the beach should get all the vitamin D they need in about five minutes.
“The trick is getting just enough sun to satisfy your body’s vitamin D requirement, without damaging the skin,” he says. “It is difficult to believe that this kind of limited exposure significantly increases a person’s risk of skin cancer.”
A further study, Back Pain and Osteoporosis Special Report: The Bone-Protecting Benefits of Vitamin D in a Johns Hopkins Health Alert found the same relationship between Vitamin D deficiency and pain as the other studies. Again they talk about the difficulty of getting sufficient Vitamin D from sunshine:
When it comes to vitamin D, a few minutes in the sun is all you need, correct? Well, that depends. As it turns out, that is easier said than done for many of us. Draw a rough line across the country from San Francisco to Richmond, Virginia. If you live north of that line, it’s impossible to get enough sun exposure during the winter months to maintain adequate blood levels of vitamin D. And even during the summer, you may not be getting enough vitamin D. That’s especially true if you spend a great deal of time inside, out of the heat—or, ironically, if you’re particularly meticulous about using sunscreen, covering up, and seeking the shade when you’re outside.
Aging and racial background also affect vitamin D status. As we age, our skin doesn’t synthesize vitamin D as efficiently, and our kidneys are less able to convert vitamin D to its active hormone form. As for ethnicity, melanin—the pigment that gives skin its color—reduces the efficiency of vitamin D synthesis from sunlight; therefore dark-skinned individuals require even more sunlight to maintain adequate vitamin D levels.
Medscape Today in the article, Vitamin-D deficiency increases pain of knee OA by Zosia Chustecka from December 23, 2004 pretty had found the same connection as the previously mentioned more recent studies.
Vitamin-D deficiency has become a major health problem in the US, and all physicians should be alert to it, an editorial in the Mayo Clinic Proceedings cautioned last year [3]. It was prompted by a study that found most patients presenting with persistent nonspecific musculoskeletal pain were vitamin-D deficient, many severely so, as reported at the time by rheumawire. “The take-home message . . . is that when patients with nonspecific skeletomuscular pain are evaluated, their serum 25-hydroxyvitamin-D levels should be obtained,” says the editorialist, Dr Michael Holick (Boston University). “Physicians should discard the laboratory-reported lower limit of the normal range. A serum 25-hydroxyvitamin-D level of at least 20 ng/mL is necessary to minimally satisfy the body’s vitamin-D requirement. Maintenance of a serum level of 25-hydroxyvitamin D of 30 to 50 ng/mL is preferred.”
However, Chustecka also goes on to talk about the problem of measuring Vitamine-D level in clinical practice:
Laster cautions, however, that the assays used by different laboratories can show significant variability—for example, 1 commonly used lab assay (from Nichols) significantly underestimates the amount of vitamin D2 derived from dietary and pharmaceutical sources (while D3 is mainly derived from the action of ultraviolet light on the skin).
“I use a vitamin-D assay that accurately identifies both D2 and D3 components of 25-hydroxyvitamin D,” Laster tells rheumawire. “When a level below 30 ng/mL is identified, I recommend ergocalciferol (vitamin D2) 50 000 IU once a week for approximately 8 weeks. I then repeat a level. If it has normalized I then go on to 50 000 IU once or twice a month. If levels remain low, I evaluate for possible malabsorption, etc.”
Some practitioners recommend taking 800 IU of vitamin D each day and suggest taking 2 multivitamin tablets every day (many over-the-counter multivitamin products contain 400 IU vitamin D2). However, it has been pointed out that this also increases the dose of vitamin A, and higher levels of vitamin A have been associated with an increase in the risk of fractures, Laster comments. He adds: “What has not been proven, to my knowledge, however, is that supplementing vitamin D to therapeutic levels alleviates pain.”
So, it looks to me, a layperson with chronic pain from fibromyalgia, that maybe I need to get my Vitamin-D levels checked and should talk to my primary care physician during my next visit. But, in the meantime, I’m going to check the amount of Vitamin-D in my daily vitamin and maybe plan to spend just a bit of time each day doing yard work. That’s assuming I have enough spoons to get outside — even if it’s just to sit with a cup of tea. Sunshine may not be all that effective but who knows it may be a boost to the daily vitamin until I can find out if my Vitamin-D levels are deficient.
Hope springs eternal and all that….