Vitamin D and Pain
Vitamin D seems to alleviate chronic pain, but it's uncertain how much supplementation can lessen the unique pain of people with SCI/D.
Because most of us don’t work outside and we know to limit sun exposure, we have become a vitamin D-deficient society.
Our skin may be less wrinkled, but there are health consequences. We’re much more likely to die from disorders aggravated by chronic underexposure to vitamin D-producing sunlight than disorders aggravated by overexposure.
Studies are showing that vitamin D-deficiency is associated with numerous health problems, such as osteoporosis, cancer, cardiovascular disease, mental-health problems, multiple sclerosis, and diabetes.
Furthermore, because an efficient immune system requires ample vitamin D, virtually any disorder mediated through immune-system mechanisms will be adversely affected by the lack of this nutrient.
Nothing to Lose
Specifically, vitamin D-deficient individuals tend to have more chronic pain, which seems to be alleviated by vitamin D supplementation.
Although understandings are still evolving, evidence indicates vitamin D regulates the synthesis of key immune system molecules (cytokines) implicated in pain-associated inflammatory responses.
Vitamin D influences many physiological processes, including inflammation associated with pain.
It’s uncertain how much supplementation can lessen the unique pain experienced by people with spinal-cord injury or disease (SCI/D).
It may help in the shoulder pain associated with pushing a wheelchair or too many transfers but have little impact on neuropathic pain. Nevertheless, vitamin D is a nothing-to-lose-potentially-much-to-gain approach that, at minimum, will enhance overall health.
The Right Levels
Vitamin D levels can be measured through a simple blood test. Some are available through self-test kits found on the Internet (zrtlab.com/vitamindcouncil) or walk-in, lab-testing services.
The test measures levels of a specific metabolite called 25-hydroxvitamin D, which the body converts to biologically active vitamin D. Levels above 30 nanograms (one billionth of a gram) per milliliter are considered sufficient, between 20–29 ng/ml insufficient, and < 20 ng/ml inadequate.
Scientists estimate that a billion people worldwide lack health-optimizing vitamin D levels. At special risk are individuals who are elderly or have dark skin pigmentation, especially those who live in cloudy, northern latitudes. Wintertime sunlight possesses little of the wavelengths needed to produce vitamin D in much of the northern U.S.
In my case, moving from sunny Colorado to the overcast Pacific Northwest resulted in my levels plummeting to 15 ng/ml. When I relocated to sun-drenched New Mexico a few years later, it increased to 50 ng/ml.
If you don’t have sufficient sun exposure, closely monitor vitamin D levels and take corrective actions as needed.
Limited Time Outside
Scientists speculate that people with physical disabilities are more likely to have compromised vitamin D levels because the disability limits time outside in the sun.
One study indicated that individuals with chronic SCI/D were twice as likely to have deficient vitamin D levels compared to able-bodied individuals.
Levels apparently go down quickly after injury. Another study showed deficient vitamin D levels in 93% of patients admitted to acute, inpatient rehabilitation, including 21% who were considered severely deficient with levels <10 ng/ml.
A Role in Pain
Numerous studies suggest vitamin D deficiency has a role in pain manifestation.
Vasant Hirani, PhD, looked at the relationship of pain and vitamin D levels in more than 2,000 adults aged 65 and older living in cloudy England.
Overall, as we age we become less efficient in synthesizing vitamin D and converting it to its physiologically active form. Hirani’s study indicated moderate to extreme pain was present in 53% of these individuals and correlated with poor vitamin D status.
Wei Huang, MD, PhD, and collaborators at the Atlanta VA Medical Center and Emory University evaluated the effects of vitamin D supplementation in 28 veterans with chronic pain and low vitamin D levels.
Average age of the study participants was 46 and included 18 men and 20 African Americans (reflecting this group’s tendency to possess suboptimal vitamin D levels). The average vitamin D level was a deficient 18.6 ng/ml. After receiving supplementation for three months, levels increased to 26 ng/ml.
Subjects rated their pain before and after supplementation using a pain scale, in which zero was no pain and ten was the worst possible pain. In addition, a quality-of-life questionnaire asked about physical functioning, general health, mental health, and more. Another questionnaire was used to assess sleep quality, which is frequently affected by pain.
Using the scale, average pain levels decreased from 7.1 to 5.7 after supplementation. Overall, subjects reported fewer areas of pain and a decreased use of pain medications.
There was also an improvement in most of the quality-of-life components. Finally, sleep improved after supplementation.
Investigators concluded that “vitamin D supplementation in veterans with multiple areas of chronic pain can be effective in alleviating their pain and improving sleep, and various aspects of quality of life.”
Individuals with SCI often experience neuropathic pain due to neural-tissue damage.
Although studies focused on using vitamin D to lessen such pain are limited, Paul Lee, MD, and Roger Chen, PhD, examined vitamin D’s potential to relieve pain in 51 deficient diabetics.
A common disorder in individuals with SCI/D, diabetes frequently causes pain-generating, peripheral nerve damage. Three months of supplementation increased levels in subjects from an average of 18 to 30 ng/ml.
Several pain measures were assessed before and after supplementation, including a zero (no pain) to five (excruciating pain) scale. Pain levels decreased from 3.3 before supplementation to 1.7 afterward.
Bang for the Buck
Few therapies have the potential to enhance the overall wellness of individuals with SCI/D as much as vitamin D.
In this era of costly, side-effect-laden medicine, vitamin D is an extraordinarily simple way to augment health with a huge bang-for-the-buck impact.
Vitamin D and Pain
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