RCT: Vitamin D in musculoskeletal pain

Posted on: March 30, 2015   by  Amber Tovey

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A new randomized controlled trial published in the journal Lupus found that vitamin D supplementation in patients with musculoskeletal pain led to faster improvement of pain.

Musculoskeletal (MSK) disorders are injuries or pain in the body’s joints, muscles, ligaments, tendons, and bones. They encompass a wide spectrum of conditions ranging from inflammatory diseases such as rheumatoid arthritis to neuropathic pain such as fibromyalgia.

MSK disorders are estimated to affect one-fifth of the adult population.MSK strongly impacts one’s ability to function and reduces quality of life. In a recent survey, over one quarter of patients suffering from MSK reported that their therapy was insufficient and almost 80% suggested that better treatments should be investigated.

Vitamin D may play an important role in MSK by maintaining skeletal muscle strength and reducing inflammation. However, most studies that have evaluated the relationship between MSK and vitamin D, have not been of high quality. Therefore, researchers from Israel conducted a randomized double-blind placebo controlled trial, the gold standard of research, to investigate the efficacy of treating MSK with vitamin D.

The researchers enrolled 80 adults who were divided randomly into two groups: the placebo group and the vitamin D group. The adults in the vitamin D group received 4000 IU of vitamin D daily, while those in the placebo group received a dummy pill daily. The study lasted for 3 months.

The researchers measured multiple inflammatory and pain-related parameters, including tumor necrosis factor alpha (TNF), leukotriene B4 (LTB4), and prostaglandin E2 (PGE2).

Often times, anti-inflammatory drugs are used to treat musculoskeletal pain. Therefore, a reduction in these parameters would indicate an effective treatment.

These parameters were scored 3 times throughout the study: prior to the intervention, at week 6 and at week 12.

Visual analogue scale (VAS) scores of pain perception were recorded after 6 and 12 weeks. VAS is used to measure a characteristic that cannot be directly measured and is believed to range across a continuum of values, such as pain. Individual reports of pain range across a continuum, from none to an extreme amount.

The researchers compared the measured parameters and VAS scores between the placebo group and the vitamin D group. Here is what they found:

  • At baseline, 73% of the participants had low vitamin D levels, defined as levels less than 30 ng/ml.
  • The researchers measured vitamin D levels again at 6 six weeks to find that those in the vitamin D group experienced an increase in vitamin D levels of about 46%, whereas the placebo group’s vitamin D levels dropped by about 6%.
  • The vitamin D group achieved a significantly larger decline of their VAS measurement for pain compared with the placebo at 6 and 12 weeks (p < 0.001).
  • After 6 weeks, TNF levels dropped by 54.3% in the group treated with vitamin D and increased by 16.1% in the placebo group (p < 0.026).
  • After 6 weeks, PGE2 levels decreased by 39.2% in the vitamin D group and increased by 16.1% in the placebo group (p < 0.008).
  • LTB4 levels decreased in both groups by about 24%.

The researchers stated,

“In conclusion, we were able so show in this study that vitamin D supplementation had a beneficial role in several parameters associated with pain perception and mediation; however, this association was not robust.”

They continued,

“This study clearly underlines the importance of continuing to seek the optimal dosage and duration of administration vitamin D that may be associated with successful pain treatment.”

This study was extremely well designed and conducted. The researchers used a population group that had the condition, MSK pain, and the majority of the study’s population was considered deficient. The participants in the vitamin D group received daily supplementation, rather than intermittent, which has research strongly suggests is more effective. Also, the dosage was substantial enough to effectively increase vitamin D levels and bring them into a therapeutic range. The researchers ensured this by measuring the vitamin D levels twice.

Source

Gendelman O., et al. A randomized double-blind placebo-controlled study adding high dose vitamin D to analgesic regimens in patients with musculoskeletal pain. Lupus, 2015.

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