Vitamin D Levels and Chronic Pain
By: Dale J. Buchberger, PT, DC, CSCS, DACBSP
Living in Central New York with its short summer and long winter reduces the volume of available sunlight. As a consequence Central New Yorkers and their northern hemisphere counterparts tend to run low on Vitamin-D. What they may not realize is that a deficiency of Vitamin-D may be linked to patients with chronic generalized pain and chronic lower back pain. Vitamin-D levels of 30-40 ng/mL are the accepted normal. Studies comparing patients with back pain have shown levels <12 ng/ml.
As the discipline of integrative medicine grows the research of non-pharmaceutical treatments for common ailments also increases. Over the last decade researchers have found an association of extreme vitamin D deficiency and patients with chronic pain syndromes that have failed traditional treatments. One recent study revealed that since 1990 Americans of all ages, races and ethnic groups are experiencing vitamin-D deficiency.
Vitamin D isn’t like other vitamins in the body. Your body has the ability to make its own vitamin D when your skin is exposed to direct sunlight. Other vitamins need to be taken in through the diet. For example, vitamin C is taken in by eating fruits and vegetables. Once vitamin D is ingested or made in the body it needs to be transformed into its hormone form commonly known as “activated vitamin D” or “calcitriol.”
Traditionally we have been taught that Vitamin D is the “bone vitamin”, but it would be more accurate to refer to it as the “sun hormone”. Only the UVB wavelength of light can generate vitamin D. It is a hormone like thyroid, estrogen or testosterone. Vitamin D is essential to every cell in the body and it was never intended to be part of the food supply. It has been added to milk but since a cup of milk contains approximately 100 IU (international units) of vitamin D it would take approximately 100 cups of milk a day to prevent vitamin D deficiency.
Patients with vitamin-D deficiency never walk in saying, “I think my vitamin-D is low”. Instead they commonly go from doctor to doctor describing a variety of symptoms such as weakness, general aches and pains, fatigue, depression, tendonitis, back pain, etc. These generalized symptoms are commonly met with generalized treatments that fail to fix the underlying problem. As the research is showing sometimes it is better to go back to basics. In the northern hemisphere a simple check of vitamin-D levels can be a cost effective test, yielding useful information and a simple remedy of a complicated problem. In fact one researcher stated, “So if you’ve got chronic pain, it can’t hurt to ask your doctor to check your vitamin D levels. I believe this is absolutely medically indicated, and it should be the standard of care for everyone with chronic, nonspecific musculoskeletal pain”.
Vitamin-D deficiency is so common that one study on 150 people experiencing chronic pain in Minnesota found that 93% had clinically low levels of vitamin-D. The largest group within the 150 was comprised of Caucasian women of childbearing age. A large portion of this group was, stereotyped by their doctors as experiencing “depression or whining” and an “inability to manage stress”. The two most common reasons for dropping vitamin D levels are a reduction in direct sun exposure and the use of high SPF sunscreens that block the UVB wavelength of light. The amount of sun you need to meet your daily vitamin D requirements varies greatly. It is dependent on your geographic location, your skin type, the time of year, the time of day, and even the atmospheric conditions at the time of exposure.
Researchers at the Mayo Clinic published results of a 2009 study that demonstrated a relationship between excessively low vitamin D levels and the dose of narcotic pain medication required to control their pain. The group with low vitamin D required double the dose compared to patients with normal vitamin D levels. While more research is needed to clearly identify the relationship of vitamin D and chronic pain we do know that if a patient is suffering from chronic pain and has excessively low vitamin D levels, bringing those levels back up to the normal range will contribute to the recovery. If a patient suffering from chronic pain already has normal vitamin D levels, additional vitamin D may not provide any assistance in the recovery.
Low vitamin D levels have been linked to other conditions such as cancer, asthma, type-II diabetes, high blood pressure, depression, Alzheimer’s and autoimmune diseases like multiple sclerosis, Crohn’s and type-I diabetes.
The daily dosing of vitamin supplementation varies widely depending on the reason for the supplementation. The Mayo clinic website at the following link supplies a very detailed resource of conditions and dosage, http://www.mayoclinic.org/drugs-supplements/vitamin-d/dosing/hrb-20060400
If you have very low levels of Vitamin-D, you should consult your doctor before trying to increase your Vitamin-D levels on your own. Excessive vitamin-D can be dangerous, leading to vitamin D toxicity and potential issues with calcium accumulation in the body.
