vitamin-d-2 and Pain

Vitamin D is produced in the skin after sun-light exposure and can also be obtained through food. Vitamin D deficiency has recently been linked with a range of diseases including chronic pain. Observational and circumstantial evidence suggests that there may be a role for vitamin D deficiency in the aetiology of chronic pain conditions.. To assess the efficacy and adverse events of vitamin D supplementation in chronic painful conditions.. We searched Cochrane CENTRAL, MEDLINE, EMBASE and the Oxford Pain Relief Database for studies to September 2009. This was supplemented by searching the reference lists of retrieved articles, textbooks and reviews.. Studies were included if they were randomised double blind trials of vitamin D supplementation compared with placebo or with active comparators for the treatment of chronic pain conditions in adults.. Two review authors independently selected the studies for inclusion, assessed methodological quality, and extracted data. Pooled analysis was not undertaken due to paucity and heterogeneity of data.. Four studies, with a total of 294 participants, were included. The studies were heterogeneous with regard to study quality, the chronic painful conditions that were investigated, and the outcome measures reported. Only one study reported a beneficial effect, the others found no benefit of vitamin D over placebo in treating chronic pain.. The evidence base for the use of vitamin D for chronic pain in adults is poor at present. This is due to low quality and insufficient randomised controlled trials in this area of research.

Topics: Adult; Arthritis, Rheumatoid; Chronic Disease; Ergocalciferols; Humans; Hydroxycholecalciferols; Pain; Randomized Controlled Trials as Topic; Vitamin D; Vitamin D Deficiency; Vitamins

Four cases of hypovitaminosis D were seen in a general practitioner's population in the Netherlands: a Somalian veiled woman aged 53 and her 11-year-old daughter, a dark-skinned Surinam woman aged 31, and a veiled Moroccan woman aged 56 years. This cause of myopathy has only been recently recognised and is more prevalent than often thought, especially in high-risk groups such as veiled and dark-skinned immigrants who lack sunlight in the Netherlands. Symptoms are muscle pain and mainly proximal muscle weakness resulting in difficulties in ascending a staircase or getting up out of a chair. The diagnosis is made on the basis of a detailed history and measurement of serum 25-hydroxyvitamin D. Calcium and serum alkaline phosphatase activity may be normal. Treatment with ergocalciferol is effective and cheap. As diagnosis and treatment are relatively simple, finding and treating hypovitaminosis D is a rewarding challenge to primary health care practitioners in the Netherlands.

Topics: 25-Hydroxyvitamin D 2; Adult; Child; Cultural Characteristics; Ergocalciferols; Female; Humans; Life Style; Middle Aged; Morocco; Muscle Weakness; Muscular Diseases; Netherlands; Pain; Risk Factors; Skin Pigmentation; Somalia; Suriname; Vitamin D Deficiency

Patients receiving long-term treatment with total parenteral nutrition often develop bony abnormalities characterized by patchy osteomalacia and low bone turnover. The patients present evidence of physiologic hypoparathyroidism, although low levels of iPTH cannot entirely explain the osteomalacia. Abnormally low serum levels of 1,25(OH)2-vitamin D have been demonstrated, but the significance of these reduced levels in the pathogenesis of the bone lesions is not defined. Aluminum has been detected in large quantities in the plasma, urine, and bone of some patients treated with TPN, and there is mounting evidence that aluminum may be associated with skeletal pathology, particularly osteomalacia. There is, however, no clear documentation that aluminum accumulation produces the skeletal lesions observed, although it could be a contributing factor. There has been the unusual empiric observation that the removal of vitamin D2 from the infusate is associated with a decrease in the quantity of unmineralized osteoid in TPN patients. A possible role of vitamin D2 in producing osteomalacia is not easy to understand since normal serum levels of 25(OH)-D2, the circulating form of vitamin D2, have been reported. The long-term consequences of intravenous nutritional support for many aspects of metabolism remain unknown. Administration into the systemic circulation of predetermined quantities of calcium and phosphorus via a route that bypasses their passage across the intestinal mucosa, the portal system and the liver may have adverse consequences. It is possible that bypassing homeostatic mechanisms may affect bone formation and metabolism or lead to alterations in vitamin D sterols. Alternatively, a deficiency of an essential trace metal or the accumulation of a toxic trace substance could be responsible for the bony abnormalities. Much remains to be clarified concerning calcium homeostasis and bone disease during total parenteral nutrition. Among various possible factors, it seems likely that the significance of the low levels of 1,25(OH)2-vitamin D and of the accumulation of aluminum in this condition will soon be clarified.

Topics: Adult; Aged; Aluminum; Bone and Bones; Bone Diseases, Metabolic; Bone Resorption; Calcitriol; Calcium; Ergocalciferols; Female; Humans; Infant; Male; Middle Aged; Minerals; Pain; Parathyroid Hormone; Parenteral Nutrition; Parenteral Nutrition, Total; Phosphates; Prospective Studies; Rickets; Trace Elements; Vitamin D

A double-blind placebo-controlled randomized phase II trial was performed to determine whether High Dose Vitamin D2 supplementation (HDD) in women receiving adjuvant anastrozole improves aromatase inhibitor-induced musculoskeletal symptoms (AIMSS) and bone loss. Patients with early breast cancer and AIMSS were stratified according to their baseline 25-hydroxy vitamin D (25OHD) level. Stratum A (20-29 ng/ml) received either HDD 50,000 IU capsules weekly for 8 weeks then monthly for 4 months or placebo. Stratum B (10-19 ng/ml) received either HDD for 16 weeks and then monthly for 2 months, or placebo. AIMSS was assessed by the Brief Pain Inventory-Short Form (BPI-SF), the Fibromyalgia Impact Questionnaire (FIQ), and the Health Assessment Questionnaire-Disability Index (HAQ-DI) at baseline, 2, 4, and 6 months. Bone Mineral Density (BMD) was measured at baseline and at 6 months. The primary endpoint of the study was the change-from-baseline musculoskeletal pain. The secondary endpoint was the percent change in BMD at 6 months. Sixty women were enrolled. Baseline characteristics were comparable between the groups. At 2 months, FIQ pain (P = 0.0045), BPI worst-pain (P = 0.04), BPI average-pain (P = 0.0067), BPI pain-severity (P = 0.04), and BPI interference (P = 0.034) scores were better in the HDD than placebo group. The positive effect of HDD on AIMSS was stronger across all time points in Stratum B than Stratum A (FIQ pain, P = 0.04; BPI average, P = 0.03; BPI severity, P = 0.03; BPI interference, P = 0.04). BMD at the femoral neck decreased in the placebo and did not change in the HDD group (P = 0.06). Weekly HDD improves AIMSS and may have a positive effect on bone health. Vitamin D supplementation strategies for breast cancer patients on AI should be further investigated.

Topics: Aged; Anastrozole; Antineoplastic Agents, Hormonal; Aromatase Inhibitors; Bone Density; Bone Density Conservation Agents; Breast Neoplasms; Calcium; Ergocalciferols; Female; Humans; Middle Aged; Musculoskeletal Diseases; Nitriles; Pain; Parathyroid Hormone; Triazoles; Vitamin D

Uncontrolled studies have suggested that vitamin D insufficiency causes diffuse musculoskeletal pain.. Comparison of vitamin D levels in patients with diffuse musculoskeletal pain with controls; evaluation of the effect of treatment with vitamin D on diffuse pain.. 25-Hydroxyvitamin D levels were measured in patients with diffuse musculoskeletal pain and osteoarthritis (controls) recruited from a community rheumatology practice. The diffuse pain patients with 25-hydroxyvitamin D levels < or = 20 ng/mL were randomized to receive placebo or ergocalciferol 50,000 IU once weekly for 3 months. Outcomes assessed were pain measured by visual analog scale (VAS) and functional pain score (FPS).. One hundred eighty-four patients with diffuse pain and 104 with osteoarthritis entered the study. Mean 25-hydroxyvitamin D levels did not differ between the groups (diffuse pain 29.2 ng/mL +/- 13.0, controls 28.8 ng/mL +/- 10.5; P = 0.78); nor did the percent of patients in each group with vitamin D levels < or = 20 ng/mL (diffuse pain 29%, controls 20%; P = 0.09). Fifty patients with diffuse pain who had 25-hydroxyvitamin D levels < or = 20 ng/mL were randomized to receive vitamin D or placebo for 3 months. Vitamin D treatment had no effect on pain in comparison to baseline (VAS P = 0.73; FPS P = 0.18) or at 3 months in comparison to placebo (VAS P = 0.12; FPS P = 0.05, in favor of placebo).. Low vitamin D levels are not associated with diffuse musculoskeletal pain, and treatment with vitamin D does not reduce pain in patients with diffuse pain who have low vitamin D levels.

Topics: Adult; Aged; Case-Control Studies; Double-Blind Method; Ergocalciferols; Female; Fibromyalgia; Humans; Male; Middle Aged; Osteoarthritis; Pain; Pain Measurement; Vitamin D Deficiency; Vitamins; White People

Topics: Bone Density Conservation Agents; Calcium; Ergocalciferols; Humans; Hyperparathyroidism, Secondary; Pain; Parathyroid Hormone; Renal Dialysis

A case report where parathyroid bone disease simulates bone metastases. Subsequent treatment of underlying hyperparathyroidism causes a marked improvement in bone disease, leading to a review of the initial diagnosis.

Topics: Adjuvants, Immunologic; Aged; Bone Neoplasms; Calcium; Diagnosis, Differential; Diphosphonates; Ergocalciferols; Female; Homeostasis; Humans; Hydroxycholecalciferols; Hyperparathyroidism; Kidney Neoplasms; Osteitis Fibrosa Cystica; Pain; Radionuclide Imaging; Treatment Outcome

Topics: Adolescent; Bone Density; Calcium; Diphosphonates; Ergocalciferols; Female; Fibrous Dysplasia of Bone; Follow-Up Studies; Fractures, Spontaneous; Humans; Pain; Pamidronate; Radiography

A 60-year-old man with portal hypertensive gastropathy due to type C liver cirrhosis developed severe bone pains, marked hypophosphatemia with inappropriately increased urinary excretion of phosphate (%TRP; 9.6%), and hyperalkaline phosphatasia, after intravenous administration of saccharated ferric oxide (SFO) at a dose of 80-240 mg/week over a period of more than 5 years. The total iron infused was estimated to be more than 25 g. On a diagnosis of SFO-induced osteomalacia, the infusion of iron was immediately discontinued, and phosphate and vitamin D2 (1000 IU/day) were administered. Serum levels of 25-OHD2 increased after 1 week, whereas levels of 1,25-(OH)2D2 did not increase until 3 months later, accompanied by improvement of renal tubular reabsorption of phosphate and gradual improvement of the bone pains. The patient has been doing well for the last 2 years, with normal serum levels of phosphate, calcium, and alkaline phosphatase, without any supplementation of phosphate, vitamin D, or iron-containing agents. In primary culture of neonatal mouse renal tubules, in which 1,25-(OH)2D3 was produced from 25-OHD3 in response to PTH, SFO significantly inhibited PTH-induced production of 1,25-(OH)2D3 at 30 mumol/L, which is attainable in the urine of patients receiving a therapeutic intravenous dose of SFO. Furthermore, SFO decreased the calcium content and inhibited 45Ca incorporation in cultured fetal mouse parietal bones at 3 mumol/L. Such SFO concentration may be transiently observed in the plasma of patients receiving excessive intravenous doses of SFO for a prolonged period. These in vitro findings together with the clinical observations suggest that SFO, after filtration through the glomerulus and reabsorption in the proximal renal tubules, impaired proximal renal tubular function, such as tubular reabsorption of phosphate and 1 alpha-hydroxylase activity, leading to hypophosphatemic osteomalacia. Furthermore, it is highly likely that SFO in the peripheral blood, when transferrin is saturated with iron, may impair bone formation and aggravate osteomalacia. Although SFO-induced osteomalacia is reversible simply by discontinuation of the agent, excessive and prolonged administration of SFO should be avoided.

Topics: Alkaline Phosphatase; Animals; Bone Development; Calcitriol; Calcium; Dose-Response Relationship, Drug; Ergocalciferols; Ferric Compounds; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Hypophosphatemia; Injections, Intravenous; Kidney Tubules; Liver Cirrhosis; Male; Mice; Middle Aged; Osteomalacia; Pain; Parathyroid Hormone; Parietal Bone; Phosphates

An unusual pain occurred in five patients in the presence of compromised vitamin D status and resolved 5 to 7 days after supplementation with vitamin D in the form of ergocalciferol. The pain had a hyperesthetic quality and did not respond to the use of analgesics, including opiate derivatives. Treatment with therapeutic levels of a tricyclic antidepressant did not bring relief of symptoms. In one case, months after treatment and subsequent improvement of vitamin D status and pain, the vitamin D status again declined and the pain recurred. The pain again resolved with vitamin D replacement and improvement of levels. There may be a pain syndrome associated with vitamin D depletion that appears as hyperesthesia worsened by light, superficial pressure or even small increments of movement. This pain restricts mobility and function and may lead to further complications, such as pressure sores.

Topics: Adult; Aged; Aged, 80 and over; Ergocalciferols; Female; Humans; Hyperesthesia; Leg; Male; Pain; Vitamin D Deficiency

We describe four children with idiopathic juvenile osteoporosis. All patients were initially seen between the ages of 10 and 13 years and spontaneously recovered following puberty. We review 27 similar cases reported in the literature. Theories on the cause of idiopathic osteoporosis in children are critically discussed. It may be that milder forms remain undiagnosed because of the self-limited course and the pain being confused with a variety of rheumatic disorders. It would be worth observing these cases to determine if they are otherwise prone to development of osteoporosis during pregnancy or in later life.

Topics: Adolescent; Bone Resorption; Calcium; Calcium, Dietary; Child; Diagnosis, Differential; Ergocalciferols; Female; Humans; Male; Osteogenesis Imperfecta; Osteoporosis; Pain; Puberty; Radiography

Fourteen women averaging 69.5 years of age with painful osteoporosis of the spine were treated with sodium fluoride, calcium salts and calciferol. At assessment after 5-19 months of therapy 8 patients were free of pains while in 5 women pains had decreased and mobility improved. One patient had unaltered pains. Side effects were few and mild.

Topics: Age Factors; Aged; Calcium; Denmark; Ergocalciferols; Female; Fluorides; Follow-Up Studies; Humans; Middle Aged; Osteoporosis; Pain; Spinal Diseases

Topics: Adolescent; Adult; Anemia, Macrocytic; Bicarbonates; Calcium; Ergocalciferols; Female; Folic Acid Deficiency; Humans; Hypocalcemia; Middle Aged; Neurologic Manifestations; Osteomalacia; Pain; Seizures; Tetany; Vitamin B 12 Deficiency; Vitamin D; Vitamin D Deficiency