Effect of Vitamin-D supplementation in adults presenting with chronic lower back pain
Background: Chronic pain in the lower back of adults is a common problem and mostly associated with Vitamin D deficiency. Along with standard treatment, vitamin D supplementation can help in early and better relief from back pain.
Objective: To assess the effectiveness of vitamin D supplementation in patients with chronic lower back pain.
Study Design & Methods: This Quasi-experimental trial was conducted at Department of Orthopaedics, Benazir Bhutto Hospital for 6 months. The patients aged between 15 to 55 years with chronic low back pain were included and pain score was noted by using a visual analogue scale (VAS). Patients were prescribed with oral vitamin D3 with a dose of 50,000 IU weekly for eight weeks (induction phase) and oral vitamin D3 with a dose of 50,000 IU once monthly for 6 months (maintenance phase). Outcome parameters included pain measured by VAS, functional disability by modified Oswestry disability questionnaire scores, and Vitamin-D3 levels at baseline,2, 3 and 6 months post-supplementation.
Results: Mean age of patients was 44.21± 11.92 years.There were 337 (56.2%) male patients while 263 (43.8%) female patients. Baseline mean vitamin-D levels were 13.32 ± 6.10 ng/mL and increased to 37.18 ± 11.72 post supplementation (P < 0.0001). There was a significant decrease in the pain score after 2nd, 3rd& 6th months (61.7 ± 4.8, 45.2 ± 4.6 & 36.9 ± 7.9, respectively) than 81.2 ± 2.4 before supplementation (P < 0.001). The modified Oswestry disability score also showed significant improvement after 2nd, 3rd& 6thmonths (35.5 ± 11.4, 30.2 ± 9.4 & 25.8 ± 10.6, respectively) as compared to baseline 46.4 ± 13.2 (P < 0.001). About 418 (69.7%) patients attained normal levels after 6 months.
Conclusion: Prescription of Vitamin D in addition to standard therapy for chronic lower back pain can be beneficial in getting relief from pain and improving the functional ability of the patient.
2. Panwar A, Valupadas C, Veeramalla M, Vishwas HN. Prevalence of vitamin D deficiency in chronic and subacute low back pain patients in India: a triple-arm controlled study. Clinical rheumatology 2018;37(5):1367-74.
3. Çalık Y, Aygün Ü. Evaluation of vitamin D levels in patients with chronic low back-leg pain. Acta orthopaedica et traumatologica turcica. 2017 May 1;51(3):243-7. https://doi.org/10.1016/j.aott.2017.03.006
4. Turner MK, Hooten WM, Schmidt JE, Kerkvliet JL, Townsend CO, Bruce BK. Prevalence and clinical correlates of vitamin D inadequacy among patients with chronic pain. Pain Medicine. 2008 Nov 1;9(8):979-84. https://doi.org/10.1111/j.1526-4637.2008.00415.x
5. Yilmaz R, Salli A, Cingoz HT, Kucuksen S, Ugurlu H. Efficacy of vitamin D replacement therapy on patients with chronic nonspecific widespread musculoskeletal pain with vitamin D deficiency. International journal of rheumatic diseases. 2016 Dec;19(12):1255-62. https://doi.org/10.1111/1756-185X.12960
6. Bener A, Dafeeah EE, Alnaqbi K. Prevalence, and correlates of low back pain in primary care: what are the contributing factors in a rapidly developing country. Asian spine journal 2014;8(3):227. doi: 10.4184/asj.2014.8.3.227
7. Harinarayan C, Joshi SR. Vitamin D status in India–its implications and remedial measures. JAPI 2009;57:40-8.
8. Al Faraj S, Al Mutairi K. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine 2003;28(2):177-9.
9. Lotfi A, Abdel-Nasser AM, Hamdy A, Omran AA, El-Rehany MA. Hypovitaminosis D in female patients with chronic low back pain. Clinical rheumatology. 2007 Nov 1;26(11):1895-901.
10. Kim TH, Lee BH, Lee HM, Lee SH, Park JO, Kim HS, Kim SW, Moon SH. Prevalence of vitamin D deficiency in patients with lumbar spinal stenosis and its relationship with pain.
11. e Silva AV, Lacativa PG, Russo LA, De Gregório LH, Pinheiro RA, Marinheiro LP. Association of back pain with hypovitaminosis D in postmenopausal women with low bone mass. BMC musculoskeletal disorders. 2013 Dec;14(1):184.
12. Tague SE, Clarke GL, Winter MK, McCarson KE, Wright DE, Smith PG. Vitamin D deficiency promotes skeletal muscle hypersensitivity and sensory hyperinnervation. Journal of Neuroscience. 2011 Sep 28;31(39):13728-38. DOI: https://doi.org/10.1523/JNEUROSCI.3637-11.2011
13. Marwat IU, Hassan KA, Javed T, Chishti AL. Comparison of efficacy of Ferrous and Iron Polymaltose salts in the treatment of childhood Iron Deficiency Anemia. Annals of King Edward Medical University. 2013;19(4):322-. DOI: https://doi.org/10.21649/akemu.v19i4.535
14. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ. What low back pain is and why we need to pay attention. The Lancet. 2018 Jun 9;391(10137):2356-67. https://doi.org/10.1016/S0140-6736(18)30480-X
15. Murray CJ, Barber RM, Foreman KJ, Ozgoren AA, Abd-Allah F, Abera SF, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. The Lancet 2015;386(10009):2145-91.
16. Pereda CA, Nishishinya MB. Is there really a relationship between serum vitamin D (25OHD) levels and the musculoskeletal pain associated with statin intake? A systematic review. Reumatología Clínica (English Edition) 2016;12(6):331-5. https://doi.org/10.1016/j.reumae.2016.03.001
17. Chang K. Is serum hypovitaminosis D associated with chronic widespread pain including fibromyalgia? A meta-analysis of observational studies. Pain physician. 2015 Sep;18(E877):E877-87.
18. Heuch I, Heuch I, Hagen K, Mai X-M, Langhammer A, Zwart J-A. Is there an association between vitamin D status and risk of chronic low back pain? A nested case–control analysis in the Nord-Trøndelag Health Study. BMJ open 2017;7(11):e018521.
19. Le Goaziou MF, Kellou N, Flori M, Perdrix C, Dupraz C, Bodier E, Souweine G. Vitamin D supplementation for diffuse musculoskeletal pain: Results of a before-and-after study. The European journal of general practice. 2014 Mar 1;20(1):3-9. https://doi.org/10.3109/13814788.2013.825769
20. Gendelman O, Itzhaki D, Makarov S, Bennun M, Amital H. A randomized double-blind placebo-controlled study adding high dose vitamin D to analgesic regimens in patients with musculoskeletal pain. Lupus. 2015 Apr;24(4-5):483-9. https://doi.org/10.1177/0961203314558676
21. Mattam A, Sunny G. Correlation of vitamin D and body mass index with modic changes in patients with non-specific low back pain in a sub-tropical Asian population. Asian spine journal. 2016 Feb;10(1):14. doi: 10.4184/asj.2016.10.1.14
22. Lakkireddy M, Karra ML, Patnala C, Iyengar R, Cherukuri N, Hussain KA, Chodavarapu LM, Kumar KK, Aluka SK, Bodla AK, Badavath RR. Efficiency of vitamin D supplementation in patients with mechanical low back ache. Journal of clinical orthopaedics and trauma. 2019 Nov 1;10(6):1101-10. https://doi.org/10.1016/j.jcot.2019.06.018
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