Vitamin D for the treatment of chronic painful conditions in adults

Department of Occupational and Social Medicine, University of Göttingen, Waldweg 37 B, Göttingen, Germany, D-37073.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 01/2010; 5(1):CD007771. DOI: 10.1002/14651858.CD007771.pub2
Source: PubMed


Vitamin D is produced in the skin after sun-light exposure and can also be obtained through food. Vitamin D deficiency has recently been linked with a range of diseases including chronic pain. Observational and circumstantial evidence suggests that there may be a role for vitamin D deficiency in the aetiology of chronic pain conditions.
To assess the efficacy and adverse events of vitamin D supplementation in chronic painful conditions.
We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to September 2009. This was supplemented by searching the reference lists of retrieved articles, textbooks and reviews.
Studies were included if they were randomised double blind trials of vitamin D supplementation compared with placebo or with active comparators for the treatment of chronic pain conditions in adults.
Two review authors independently selected the studies for inclusion, assessed methodological quality, and extracted data. Pooled analysis was not undertaken due to paucity and heterogeneity of data.
Four studies, with a total of 294 participants, were included. The studies were heterogeneous with regard to study quality, the chronic painful conditions that were investigated, and the outcome measures reported. Only one study reported a beneficial effect, the others found no benefit of vitamin D over placebo in treating chronic pain.
The evidence base for the use of vitamin D for chronic pain in adults is poor at present. This is due to low quality and insufficient randomised controlled trials in this area of research.

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    • "The discussion was not meant to be exhaustive, but rather to provide the reader with what we considered to be the most likely factors involved in the relationship. We did not include vitamin D as a potential explanatory mechanism because there is currently a lack of definitive data to support the role of vitamin D in chronic pain (Straube et al., 2010) or CVD (Bjelakovic et al., 2014). However, in light of the comments of Grant et al., there may be a need for additional research on the role of vitamin D and its association with CMP and CVD. "

    No preview · Article · Jul 2014 · European journal of pain (London, England)
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    • "To our knowledge, this systematic review and meta-analysis is the first to evaluate the efficacy of vitamin D supplementation in depression in RCTs. Summarizing the available RCT evidence on the efficacy of vitamin D will be very useful, because there is a positive public perception of oral vitamin D supplementation, which could lead to high rates of patient adherence [61]. Furthermore, vitamin D supplementation may be cost-effective with rare adverse effects [16] in preventing development of depression or treating depressive symptoms. "
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    ABSTRACT: The role of vitamin D in management of depression is unclear. Results from observational and emerging randomized controlled trials (RCTs) investigating the efficacy of vitamin D in depression lack consistency - with some suggesting a positive association while others show a negative or inconclusive association. The primary aim of this study is to conduct a systematic review of RCTs to assess the effect of oral vitamin D supplementation versus placebo on depression symptoms measured by scales and the proportion of patients with symptomatic improvement according to the authors' original definition. Secondary aims include assessing the change in quality of life, adverse events and treatment discontinuation. We will conduct the systematic review and meta-analysis according to the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. We will search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to present), EMBASE (1980 to present), CINAHL (1982 to present), PsychINFO (1967 to present) and Unpublished work will be identified by searching two major conferences: the International Vitamin Conference, the Anxiety Disorders and Depression Conference, while grey literature will be acquired by contacting authors of included studies. We will use the random-effects meta-analysis to synthesize the data by pooling the results of included studies. The results of this systematic review will be helpful in clarifying the efficacy of vitamin D supplementation and providing evidence to establish guidelines for implementation of vitamin D for depression in general practice and other relevant settings.Study registration: Unique identifier: CRD42013003849.
    Full-text · Article · Aug 2013 · Systematic Reviews
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    • "Our study does not support an identifiable sub-group of people with LBP and Vitamin D deficiency who could benefit from treatment with Vitamin D. This is in line with a Cochrane review that concludes that there is not sufficient evidence to support treatment of chronic pain with Vitamin D [35]. The study had a cross-sectional design. "
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    ABSTRACT: Background Hypovitaminosis D has previously been reported in both the general population, in people with chronic musculoskeletal pain, and in people with low back pain (LBP). Myopathy-related symptoms such as diffuse bone and muscle pain, weakness and paresthesia in the legs, have also been observed in people with non-specific LBP and associations with low levels of Vitamin D have been suggested. The objectives of this study were to investigate (1) Vitamin D levels in patients seeking care for LBP in a Danish out-patient secondary care setting, and (2) their possible relationship with myopathy-related symptoms, Body Mass Index (BMI), and Modic changes. Methods A total of 152 consecutive patients with non-specific LBP participated in a cross-sectional study. Participants were recruited at The Spine Centre of Southern Denmark during springtime 2011. Individual serum levels of 25-Hydroxyvitamin-D were determined using Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS). Information about symptoms, height, and weight were collected from electronic questionnaires completed by the participants. All patients had an MRI from which Modic changes were identified. Correlations between Vitamin D level and pain, paresthesia, weakness in the legs, BMI or Modic changes were described using correlation coefficients and odds ratios obtained from logistic regression. Results Two-thirds of the included patients with LBP had normal Vitamin D levels of >50 nmol/L. No correlations were seen between Vitamin D deficiency and gender, age, back pain intensity, leg pain intensity, and duration of pain. Statistically significant, but low, correlation coefficients were found between Vitamin D levels and BMI as well as Modic changes. Low Vitamin D levels and Modic changes were statistically significantly associated with an odds ratio of 0.30 (95% CI 0.12; 0.75) while weakness, paresthesia and widespread pain were not. Conclusions In patients seeking care for low back pain in a Danish outpatient clinic, Vitamin D deficiency was not common. Whether patients who are overweight or who have Modic changes might represent subgroups of people for whom their LBP may be associated with Vitamin D levels, needs further investigation.
    Full-text · Article · Mar 2013 · BMC Musculoskeletal Disorders
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