Can vitamin D help with chronic pain and fibromyalgia? (SQ-95)

Everyone experiences pain whether in the form of headache, injury pain or menstrual cramps. But living with chronic pain is altogether a different thing. Extreme, continuous pain in the body is typically a sign that something is wrong. And then there is the toll it takes on your mental, physical and emotional well-being.

Chronic widespread pain is a chronic condition with pain that persists for more than 3 months. It is a broad umbrella that includes a number of painful, debilitating conditions such as migraines, rheumatoid arthritis, lower back pain and fibromyalgia.  

Fibromyalgia is one such condition characterized by chronic widespread pain in joints, muscle and connective tissue with increased, painful response to pressure. Other important symptoms that are helpful in making a diagnosis include extreme fatigue that can’t be explained, joint stiffness, especially in the morning, poor sleep, irritable bowel syndrome, painful periods, bladder problems, anxiety, depression, tingling sensation in hands and feet, and headaches. You may also have difficulty with remembering things, concentration and swallowing.

All these symptoms can impact your quality of life.  It can result in social withdrawal, relationship problems and poor performance at work. Worse yet, there is no cure for fibromyalgia. The symptoms like pain, lack of sleep and depression are typically managed with conventional drugs like analgesics, anti-inflammatory medicines and anti-depressants. But dependence on these drugs can lead to serious long-term side effects and addiction.   

A growing number of studies suggest that vitamin D may be effective in reducing pain, fatigue and other symptoms associated with chronic pain and fibromyalgia. Well, we know vitamin D as an important nutrient for building strong and healthy bones and also for healthy muscle function. Its role in maintaining immune health is also getting a lot of attention. So, about using vitamin D as a therapy to manage chronic pain and fibromyalgia? Let’s explore.

Vitamin D in chronic pain and fibromyalgia

Studies show that people with chronic pain conditions and fibromyalgia are often deficient in vitamin D. [1] [2] And a study published in the International Journal of Rheumatic Disease found that in patients suffering from rheumatoid arthritis (RA), vitamin D deficiency was associated with increased neuropathic pain. [3]

Low vitamin D levels can cause rickets in children and osteoporosis (weak and brittle bones) in adults. Severe, long-term vitamin D deficiency can lead to soft bones, a condition called osteomalacia. Both osteoporosis and osteomalacia make bones more likely to fracture.  

Excessive vitamin D deficiency can lead to all kinds of symptoms such as muscle pain and weakness, brittle bones and bone pain, increased risk of falling in the elderly and excessive fatigue. Low levels have also been associated with mood issues, depression and concentration problems. You can see how symptoms of both chronic vitamin D deficiency and fibromyalgia overlap.

That’s why people suffering from chronic pain or fibromyalgia symptoms should check their vitamin D levels. Sometimes, getting rid of fatigue and pain could be as simple as correcting your vitamin D deficiency, especially if you have low levels. However, it is important to note that fibromyalgia and chronic pain can be more than just vitamin D deficiency and may need a more multi-modal approach to deal with. Having said that, vitamin D appears to play important roles in reducing the levels of chemicals in the body that cause inflammation and associated pain, making it an important player in reducing symptoms of fibromyalgia.

What do studies tell us?

Not all, but most studies that have investigated the role of the sunshine vitamin in alleviating pain and other symptoms associated with fibromyalgia confirm that vitamin D supplementation can be effective, although in people with low levels.  
A 2017 meta-analysis found that vitamin D levels can be a determining factor in the development of fibromyalgia. And policymakers should consider using vitamin D supplementation as a strategy to prevent the condition. [4]

This 2017 meta-analysis found that vitamin D supplementation can reduce pain. [5] A 2016 study published in the International Journal of Rheumatic Diseases revealed that 50,000 IU of vitamin D3 per week for 3 months improved musculoskeletal symptoms, depression and quality of life among patients with chronic widespread pain. [6]

Another small randomized placebo-controlled trial also showed that vitamin D supplements can reduce pain and alleviate morning fatigue symptoms in people with low levels. [7]

This study investigated the effects of vitamin D supplementation in patients with Chronic Low Back Pain (CLBP). It concluded that 60,000 IU of vitamin D3 supplements given weekly for eight weeks was able to reduce pain and improve functional ability in those with CLBP, who were also deficient in vitamin D. [8]

How vitamin D helps?

There is a little understanding of how exactly vitamin D helps in the management of chronic pain and fibromyalgia.

You need an adequate amount of vitamin D to maintain healthy muscle function and strength. In addition, some studies suggest that vitamin D alleviates the symptoms of fibromyalgia due to its anti-inflammatory properties and its ability to regulate the immune system. At the same time, individuals affected by this condition tend to spend less time outdoors. Symptoms like pain and reduced mobility make it difficult for fibromyalgia patients to go out in the sunshine and get vitamin D naturally.

Infections and injury activate inflammatory chemicals (cytokines) in the tissue cause damage. Some researchers believe that this may explain the development of pain in muscles and joints.

Studies show that vitamin D lowers the production of pain-related cytokines and also supresses T-cell responses. The sunshine vitamin also inhibits the production of prostaglandin E2, involved in pain responses during inflammation. These effects of vitamin D on the immune cells and pro-inflammatory chemicals help in reducing pain and inflammation in the body.

This randomized, double-blinded and placebo-controlled study concluded that just 4,000 IU of vitamin D for patients with musculoskeletal pain may be effective in reducing pain and reducing the levels of cytokines that promote inflammation and pain. [9]

Studies also suggest how vitamin D supplements combined with good sleep can help in chronic pain conditions such as fibromyalgia, lower back pain, musculoskeletal pain and rheumatoid arthritis. Pain causes sleep disturbance, which in turn aggravates pain and other symptoms like fatigue. Studies show that vitamin D helps in both sleep disorders and chronic pain.

This 2017 study concluded “The supplementation of vitamin D associated with good sleep hygiene may have a therapeutic role, not only in sleep disorders but also in the prevention and treatment of chronic pain conditions.” [10] The study suggests that vitamin D activates the anti-inflammatory response, which reduces sensitivity to pain and in turn improves sleep quality. In addition, maintaining sleep hygiene not only helps in dealing with sleep issues but also reduces pain sensitivity.

However, vitamin D deficiency alone cannot explain the development of fibromyalgia. But as suggested by Wepner, the lead researcher of the study we discussed above [7], “vitamin D supplementation may be regarded as a relatively safe and economical treatment for FMS patients and an extremely cost-effective alternative or adjunct to expensive pharmacological treatment as well as physical, behavioral, and multimodal therapies”. [11]

Not all studies show that vitamin D could be effective in chronic pain management, especially in people with sufficient levels of vitamin D. We need more randomized and placebo-controlled studies to make solid conclusions, but most studies confirm that “patients with deficient levels, defined here as 25-OHD <30 nmol/L, are most likely to benefit from supplementation”. [12]

Vitamin D deficiency and risk of other diseases

Vitamin D deficiency is not only related to poor bone health. It has also been associated with increased risk of heart disease, type 2 diabetes, depression, auto immune disorders, infections, lung disorders, respiratory infections, miscarriage, and increased risk of many types of cancer.

Emerging data shows that vitamin D supplements can be extremely helpful in managing asthma symptoms and preventing acute respiratory tract infections, that can trigger asthma attacks or make them worse. This is due to vitamin D’s anti-inflammatory properties and its important role in strengthening natural immunity.

On the other hand, it regulates adaptive immunity by increasing the number and activity of T regulatory cells that play a central role in balancing an overactive immune system. T regulatory cells help the immune system differentiate between foreign invaders and the body’s own healthy cells. Unnecessary immune responses lead to inflammation and increased risk of auto immune disorders.

The anti-inflammatory properties also help in reducing the risk of heart disease. In addition to lowering oxidative stress and inflammation, a central player in the development of atherosclerosis, vitamin D also appears to reduce stiffness in the blood vessels, lower blood pressure and improve endothelial functions [13]. In fact, a very recent study found that vitamin D may play a significant role in reversing endothelial damage, which is observed in many health conditions including atherosclerosis, high blood pressure and diabetes. [14]

Not only this, vitamin D deficiency in pregnant women is associated with increased risk of miscarriages, preeclampsia and gestational diabetes. Low levels in mothers also impact the health of your child both in early years and later as it can increase the risk of low birth weight, allergies, asthma, autism and even obesity in the baby. Many studies show that healthy levels of vitamin D can reduce the risk of miscarriage in women who are struggling to become pregnant and have had a previous loss of pregnancy. [15]

In a nutshell, vitamin D is making its presence felt like never before. You need healthy levels of vitamin D to:

• Maintain healthy bones
• Maintain muscle health
• Keep respiratory tract infections and allergies at bay
• Lower inflammation
• Protect heart health
• Maintain lung functions
• Manage chronic pain conditions including fibromyalgia, especially if you have poor vitamin D status
• Reduce the risk of miscarriage and other adverse outcomes in pregnancy like pre-eclampsia and gestational diabetes
• Reduce the risk of autoimmune disorders such as irritable bowel syndrome and thyroid

But are you getting enough vitamin D?

Sensible sun exposure always helps, but it can be especially difficult to maintain healthy levels if you are not living in a sunny place. Your body can make its own supply of vitamin D in the presence of UVB rays. People living at higher altitudes don’t get enough exposure to UVB rays and thus it is common to be deficient in the fall season or winters.

In addition, it is not possible to get adequate vitamin D through food sources alone. People nowadays are wary of getting out in the sun. Spending little time outdoors and excessive use of sunscreens have led to vitamin D deficiency on a wide-spread level. However, it is of course wise to avoid sun exposure if you are at an increased risk of getting skin cancer.

Vitamin D supplements are an inexpensive and effective means to reverse vitamin D deficiency and reduce your risk of many chronic health conditions, including chronic pain and fibromyalgia. Get your levels tested today.

References:

1. Okyay et al. Vitamin D levels in women with fibromyalgia and relationship between pain, tender point count and disease activity. Acta Med Mediterr. 2016
2. Olama et al. Serum vitamin D level and bone mineral density in premenopausal Egyptian women with fibromyalgia. Rheumatol Int. 2013
3. Yesil et al. Association between serum vitamin D levels and neuropathic pain in rheumatoid arthritis patients: A cross-sectional study. Int J Rheum Dis. 2017
4. Makrani et al. Vitamin D and fibromyalgia: a meta-analysis. Korean J Pain. 2017
5. Yong et al. Effect of vitamin D supplementation in chronic widespread pain: a systematic review and meta-analysis. Clin Rheumatol. 2017
6. Yilmaz, R. et al. Efficacy of vitamin D replacement therapy on patients with chronic nonspecific widespread musculoskeletal pain with vitamin D deficiency. International Journal of Rheumatic Diseases, 2016.
7. Wepner et al. Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial. Pain. 2014
8. Ghai B et al. Vitamin D supplementation in patients with chronic low back pain: an open label, single arm clinical trial. Pain Physician. 2017
9. Gendelman et al. A randomized double-blind placebo-controlled study adding high dose vitamin D to analgesic regimens in patients with musculoskeletal pain. Lupus. 2015
10. de Oliveira DL et al. The interfaces between vitamin D, sleep and pain. J Endocrinol. 2017
11. Elsevier. "Vitamin D supplements reduce pain in fibromyalgia sufferers." ScienceDaily. 2014.
12. Maria Helde-Frankling et al. Vitamin D in Pain Management. Int J Mol Sci. 2017
13. Ioana Mozos, Otilia Marginean. Links between Vitamin D Deficiency and Cardiovascular Diseases. BioMed Research International. 2015
14. Khan et al. Nanomedical studies of the restoration of nitric oxide/peroxynitrite balance in dysfunctional endothelium by 1,25-dihydroxy vitamin D3 – clinical implications for cardiovascular diseases. International Journal of Nanomedicine. 2018.
15. Mumford, SL, et al. Association of preconception serum 25-hydroxyvitamin D concentrations with livebirth and pregnancy loss: a prospective cohort study. The Lancet Diabetes & Endocrinology. 2018

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