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Are Low Vitamin D Levels Associated with Nonspecific Pain?

The results of two studies argue against any simple relation between diffuse pain and vitamin D deficiency.

Observational data have suggested that vitamin D deficiency might be a common cause of otherwise unexplained musculoskeletal pain (Journal Watch Jan 9 2004). In two new studies, researchers addressed this problem.

In a cross-sectional population-based study, researchers examined the relation between vitamin D status and pain in the back, hips, knees, and feet in 958 randomly selected older adults (age, 65) in Italy. Women with low levels of 25-hydroxyvitamin D (<25 nmol/L, equivalent to 10 ng/mL) were somewhat more likely than those with higher levels to have isolated back pain without lower extremity pain (17% vs. 9%, P=0.04). However, no correlation was found between vitamin D levels and other pain patterns in women (lower extremities alone; both lower extremities and back). In men, vitamin D status did not correlate with any pattern of back or lower extremity pain.

In another study, rheumatologists in Kansas City, Missouri, randomized 50 patients with diffuse musculoskeletal pain and low 25-hydroxyvitamin D levels (9–20 ng/mL) to receive ergocalciferol (vitamin D₂; 50,000 IU once weekly) or placebo. At 3 months, pain scores in the two groups did not differ, despite achievement of significantly higher vitamin D levels in ergocalciferol recipients than in placebo recipients.

Comment: Taken together, these findings argue against any simple relation between diffuse pain and vitamin D deficiency. In particular, the randomized trial — although small — is a setback for the idea that vitamin D supplementation is an easy "fix" for unselected patients with diffuse pain. However, severe vitamin D deficiency clearly causes diffuse bony pain in some patients via the mechanism of osteomalacia; clinicians need better clinical criteria for identifying those patients.

— Allan S. Brett, MD

Published in Journal Watch General Medicine May 20, 2008

Citation(s):

Hicks GE et al. Associations between vitamin D status and pain in older adults: The Invecchiare in Chianti Study. J Am Geriatr Soc 2008 May; 56:785.

• Medline abstract (Free)

Warner AE and Arnspiger SA. Diffuse musculoskeletal pain is not associated with low vitamin D levels or improved by treatment with vitamin D. J Clin Rheumatol 2008 Feb; 14:12.

• Medline abstract (Free)