Vitamin D as an Analgesic for Chronic Musculoskeletal Pain
Chronic pain involving muscles, bones and/or joints is the leading complaint that drives patients to their doctors seeking relief. Now, according to peer-reviewed clinical research looking at adult patients of all ages, inadequacies of vitamin D might be linked to pain of all types including fibromyalgia, chronic fatigue syndrome, seasonal affective disorder, rheumatic disorders, osteoarthritis, migraine headaches and other somatic complaints.
Vitamin D has long been known to be involved in other metabolic processes other than building strong bones. The process that links vitamin D to musculoskeletal pain is presumed to begin with a lack of circulating calcium due to an inadequacy of vitamin D. This calcium deficiency stimulates increased parathyroid secretion and precipitates a cascade of events that leads to chronic pain.
Vitamin D receptors have been found in various brain structures, the spinal cord, and the sensory ganglia. Results of some studies suggest that benefits of vitamin D supplementation might also help with neuropathies, another pain syndrome frequently found in people with diabetes.
Vitamin D deficiency may be subclinical and not easily identified by looking just at serum calcium. While a universal consensus is lacking, a minimum of about 30 ng/ml or more of 25(0H)D or more is necessary to achieve favorable calcium absorption, suppression of parathyroid hormone and good health. Optimal 25(OH)D concentrations generally range around 50 ng/ml or somewhat higher with anything >150 ng/ml being potentially toxic.
So how much vitamin D should you take? Many experts believe that the newly recommended 1000 IU/day may be inadequate for healthy persons and some have suggested that up to 4,000 IU per day of D3 or more may be proposed as a reasonable approach. For patients with pain a supplement of 2400 – 2800 IU per day is being proposed as a reasonable dose.
It might be noted that while exposure to sun can produce the equivalent of 10,000 to 20,000 IU of vitamin D, prolonged exposure to the sun can put the patient at risk for skin cancer. Supplements are readily available on the market in doses up to 50,000 IU, but these higher doses should not be taken unless directed to by a physician.
The tolerable upper limit for vitamin D has been defined in the US as 2000 IU for adults, but many experts have asserted that this level should be increased to 2400 – 10,000 IU per day of this vitamin. The report further states that the safety profile of vitamin D is favorable with a few cautions – very high doses of vitamin D should be avoided with digitalis or thiazide diuretics.
In fact, some medications reduce the potency of vitamin D such as the antiretrovirals, anticonvulsants, barbiturates, corticosteroids, hydroxychloroquine or rifampin.
Further clinical studies in this area are suggested and therapy with vitamin D should be considered adjunctive therapy and not as a “cure” for all chronic pain.
About the author
Kathy Shattler received her Master of Science degree from Michigan State University in E. Lansing Michigan in Human Nutrition. Her twenty-two years of practice includes holding positions as a Lecturer, Chief Clinical Dietitian and Program Manager. Kathy is the Founder of Nutri-Care Consulting and is currently the Nutrition Director of www.CEU4U.COM, an online continuing education management company for Registered Dietitians and Dietetic Technicians.
