Vitamin D Supplementation Reduces Pain Scores in Chronic Widespread Pain
Chronic non-specific widespread pain including fibromyalgia is characterized by widespread pain, reduced pain threshold, and multiple tender points on examination, causing disability and decreased quality of life. Vitamin D has been proposed as an associated factor in chronic nonspecific widespread pain. This meta-analysis aimed to explore the benefit of vitamin D supplementation in the management of chronic nonspecific widespread pain . A comprehensive search of the CENTRAL, MEDLINE, and Embase databases was performed from inception through January 2017. The inclusion criterion was the randomized clinical trials’ evaluating the effects of vitamin D treatment in adult subjects with chronic nonspecific widespread pain or fibromyalgia. Chronic nonspecific widespread pain was defined as chronic recurrent musculoskeletal pain without secondary causes; fibromyalgia patients met the American College of Rheumatology criteria for fibromyalgia. Study outcome was assessed using visual analog scale of pain intensity. Pooled mean difference (MD) of visual analog scale and 95% confidence interval (CI) were calculated using a random-effect meta-analysis. Meta-regression analysis using a random-effects model was performed to explore the effects of change in vitamin D in the treatment group on difference in the mean of visual analog scale. Sensitivity analysis was performed to evaluate the robustness of results. The between-study heterogeneity of effect size was quantified using the Q statistic and I (2). Data were extracted from four randomized controlled trials involving 287 subjects. Pooled result demonstrated a significantly lower visual analog scale in chronic nonspecific widespread pain patients who received vitamin D treatment compared with those who received placebo (MD = 0.46; 95% CI 0.09-0.89, I (2) = 48%). Meta-regression analysis revealed no significant relationship between the changes of vitamin D and visual analog scale (coefficient = 0.04 (95% CI -0.01 to 0.08), p = 0.10). In this meta-analysis, we conclude that vitamin D supplementation is able to decrease pain scores and improve pain despite no significant change in visual analog scale after increasing serum vitamin D level. Further studies need to be conducted in order to explore the improvement of functional status, quality of life, and the pathophysiological change that improves chronic widespread pain.
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* The authors of this meta-analysis (statistical analysis that combines the results of multiple scientific studies) of four randomized controlled trials evaluated the efficacy of vitamin D supplementation in the management of chronic nonspecific widespread pain including fibromyalgia. Patients with chronic nonspecific widespread pain who received vitamin D supplementation reported significantly lower pain intensity as measured by the visual analog scale compared with those taking placebo. There was no association seen between changes of vitamin D level and visual analog scale.
* Patients with chronic nonspecific widespread pain report significantly lower pain scores with vitamin D supplementation, and this benefit is not associated with the serum vitamin D level. Further studies are needed to understand the pathophysiological changes that are responsible for the symptom improvement.
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Published in Primary Care
Journal Scan / Research · August 24, 2017
Article Citation
Clinical Rheumatology
Effect of Vitamin D Supplementation in Chronic Widespread Pain: A Systematic Review and Meta-Analysis
Clin. Rheumatol. 2017 Aug 15;[EPub Ahead of Print], WC Yong, A Sanguankeo, S Upala
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
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