Chronic pain is pain that continues past the anticipated period of healing. Sometimes, patients can clearly relate it to a disease, such as diabetic neuropathy or chest pain from angina. More commonly, the pain is musculoskeletal and idiopathic (the doctor does not know what is causing the pain). Chronic pain is particularly common in the elderly.
This month, Dr. Vasant Hirani of the University College London Medical School reported on her study of the pain in over two thousand elderly English subjects (average age 74). She is a nutritional epidemiologist who collected the data for this paper by herself, without co-authors, an amazing task.
Hirani V. Vitamin D status and pain: aLori Schreier
916 River Road
Westmoreland, New Hampshire 03467nalysis from the Health Survey for England among English adults aged 65 years and over. Br J Nutr. 2012 Apr;107(7):1080-4.
After the surveyors interviewed the patients about their pain, a 25(OH)D was obtained to see if an association existed between the vitamin D levels and pain. Fifty-three percent of the 2,070 subjects had chronic pain. Those with vitamin D levels less than 10 ng/ml were more than twice as likely (OR= 2.18) to have pain compared to subjects with vitamin D levels above 30 ng/ml. Patients with levels between 10 and 20 ng/ml were also more likely (OR= 1.58) to have pain. Even patients with levels between 20 and 30 ng/ml had more pain but the effect was not statistically significant.
Only 14% of subjects had vitamin D levels above 30 ng/ml, while 44% had levels below 20 ng/ml, and 97% of these 2070 patients were classified as “white British.” The fact their vitamin D levels in the white elderly in England did not change with the seasons may indicate they hear and heed the sun-scare message loudly and clearly.
Of course, one could explain the results in another very reasonable way by saying that the elderly with chronic pain do not go outside very often. However, as Dr. Hirani found no seasonal variation in 25(OH)D levels in all the patients, this appears to indicate that few of the 2070 subjects went outside, even the ones without pain. Anyway, I believe this is the fourth or fifth such study, all showing pain and low vitamin D levels are closely associated and some of those studies corrected for outdoor exposure.
I liked her conclusion,
“Regardless of the direction of causation, the higher than expected co-occurrence of poor vitamin D status and pain is an important public health issue for older populations living in northern latitudes.”
She went on the say that doctors should diagnose and treat both conditions (pain and vitamin D deficiency) because “both conditions are common in older people and both have adverse health consequences.”
I agree. I just came back from speaking at a nursing home and wanted to cry. I saw so many people in obvious pain, and so many had to use wheelchairs and walkers. Besides chronic pain, vitamin D helps reverse the muscle weakness so common in the elderly. Luckily, many were receptive to my talk and eagerly took the free vitamin D we handed out.