Vitamin D for the treatment of chronic painful conditions in adults

ArticleinCochrane database of systematic reviews (Online) 5(1):CD007771 · January 2010with22 Reads
DOI: 10.1002/14651858.CD007771.pub2 · Source: PubMed
Abstract
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.
    • "No significant association was observed between 1,25 (OH) 2 D and the new occurrence of CWP. Some previous observational and experimental studies have suggested that low levels of vitamin D may have a causal role in the development of chronic pain, though the evidence is conflicting [20]. We however observed, after adjustment, no independent association between vitamin D at baseline and CWP at follow up in our male, and largely Caucasian, population and our results are in keeping with previous studies which have found no association either at all or not in men [8, 15, 18], though a significant association has been reported previously in women [8] . "
    [Show abstract] [Hide abstract] ABSTRACT: Background: The association between low levels of vitamin D and the occurrence of chronic widespread pain (CWP) remains unclear. The aim of our analysis was to determine the relationship between low vitamin D levels and the risk of developing CWP in a population sample of middle age and elderly men. Methods: Three thousand three hundred sixty nine men aged 40-79 were recruited from 8 European centres for a longitudinal study of male ageing, the European Male Ageing Study. At baseline participants underwent assessment of lifestyle, health factors, physical characteristics and gave a fasting blood sample. The occurrence of pain was assessed at baseline and follow up (a mean of 4.3 years later) by shading painful sites on a body manikin. The presence of CWP was determined using the ACR criteria for fibromyalgia. Serum 25-hydroxyvitamin D (25-(OH) D) was assessed by radioimmunoassay. Logistic regression was used to determine the relationship between baseline vitamin D levels and the new occurrence of CWP. Results: Two thousand three hundred thirteen men, mean age 58.8 years (SD = 10.6), had complete pain and vitamin data available and contributed to this analysis. 151 (6.5 %) developed new CWP at follow up and 577 (24.9 %) were pain free at both time points, the comparator group. After adjustment for age and centre, physical performance and number of comorbidities, compared to those in upper quintile of 25-(OH) D ( ≥36.3 ng/mL), those in the lowest quintile (<15.6 ng/mL) were more likely to develop CWP (Odds Ratio [OR] = 1.93; 95 % CI = 1.0-3.6). Further adjustment for BMI (OR = 1.67; 95 % CI = 0.93-3.02) or depression (OR = 1.77; 95 % CI = 0.98-3.21), however rendered the association non-significant. Conclusions: Low vitamin D is linked with the new occurrence of CWP, although this may be explained by underlying adverse health factors, particularly obesity and depression.
    Full-text · Article · Dec 2016
    • "Another important factor is to recognize and assess the psychological variables differentiating various subgroups and thus better identify patients' characteristics and needs to provide holistic, multidisciplinary and personalized health care (de Rooij et al. 2013 ). Increasing patients' participation in the pain management process, enabling them to play a proactive role in their own health care and providing the necessary tools for a healthy lifestyle to be adopted (Scascighini et al. 2008, Engers et al. 2008, Straube et al. 2010), so that they can direct and control the management of the illness, in an environment of shared decision-making, are all key factors in the successful treatment of chronic non-cancer pain (Consejer ıa de Salud. Junta de Andaluc ıa 2010). "
    [Show abstract] [Hide abstract] ABSTRACT: Aim: To determine the effect of a nurse-led intervention programme for patients with chronic non-cancer pain. Background: Chronic non-cancer pain is a widespread health problem and one that is insufficiently controlled. Nurses can play a vital role in pain management, using best practices in the assessment and management of pain under a holistic approach where the patient plays a proactive role in addressing the disease process. Improving the quality of life, reducing disability, achieving acceptance of health status, coping and breaking the vicious circle of pain should be the prime objectives of our care management programme. Design: Open randomized parallel controlled study. Methods: The experimental group will undertake one single initial session, followed by six group sessions led by nurses, aimed at empowering patients for the self-management of pain. Healthy behaviours will be encouraged, such as sleep and postural hygiene, promotion of physical activity and healthy eating. Educational interventions on self-esteem, pain-awareness, communication and relaxing techniques will be carried out. As primary end points, quality of life, perceived level of pain, anxiety and depression will be evaluated. Secondary end points will be coping and satisfaction. Follow-up will be performed at 12 and 24 weeks. The study was approved by the Ethics and Research Committee Costa del Sol. Discussion: If significant effects were detected, impact on quality of life through a nurse-led programme would offer a complementary service to existing pain clinics for a group of patients with frequent unmet needs.
    Article · Feb 2016
    • "On closer appraisal, the participants in their study did not satisfy the ACR criteria for fibromyalgia but did satisfy criteria for CNMP. The strengths of this study are its focus on CNMP and inclusion of meta-analysis, as was recommended in a recent Cochrane review [19]; the absence of language or publication restrictions, giving confidence that we did not miss important studies; and the confinement of included studies to those that used a RCT design, because they provide the most rigorous method of verifying if a cause-effect relationship exists between the intervention and outcome [47]. We used SMD score to evaluate the clinical relevance and CI for inference because it focuses on the probability and significance of the intervention and helps to establish the clinical and statistical significance of the findings [48]. "
    [Show abstract] [Hide abstract] ABSTRACT: Chronic nonspecific musculoskeletal pain (CNMP) is an idiopathic condition often seen in general practice and rheumatology clinics, the aetiology of which may include vitamin D deficiency. The objective of the present study is to evaluate the effectiveness of vitamin D supplementation in the management of CNMP through a systematic review and meta-analysis. According to PRISMA guidelines, PubMed, Embase, Web of Science, Cochrane and Scopus electronic databases were searched for randomised controlled trials comparing vitamin D supplementation to a control or placebo in CNMP patients; the search was not limited by language or date. Meta-analysis was performed using the mean and standardised mean difference which was computed with 95 % confidence intervals, and overall effect size was calculated. Both fixed and random effects models were used in meta-analysis to account for heterogeneity in the studies. The initial search identified 107 studies, of which 10 were potentially relevant, with 7 studies excluded because they did not meet selection criteria. Three studies were included in the meta-analysis. We found no effect of vitamin D supplementation (standardised mean difference (SMD) 0.004; 95 % confidence interval (CI) −0.248 to 0.256) on pain in CNMP patients. Forest plot is used to present the results from meta-analysis. Contrary to a widespread clinical view, there is a moderate level of evidence that vitamin D supplementation is not helpful for treating CNMP patients.
    Full-text · Article · Feb 2016
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