Combined Effect of Vitamin D Supplementation and Physiotherapy on Reducing Pain Among Adult Patients With Musculoskeletal Disorders: A Quasi-Experimental Clinical Trial

Abstract

Background: The prevalence of musculoskeletal disorders (MSD) and vitamin D insufficiency is high. Past research indicating vitamin D supplementation and physiotherapy are useful for the treatment of MSDs. However, to the best of our knowledge, the combined benefits of vitamin D and physiotherapy are not yet evaluated in MSD. We hypothesized that combined intervention of vitamin D supplementation and physiotherapy would be more effective in relieving the pain of MSD compared to only physiotherapy intervention.Objective: This study aimed to examine whether combined effect of vitamin D supplementation and physiotherapy was better than physiotherapy alone in reducing pain-related outcomes (e.g., pain severity, affective interference, and physical interference) in patients with MSD.Methods: A quasi-clinical experiment was conducted between May 2020 and April 2021. Vitamin D level in the blood was measured at the start of the study. Patients with vitamin D levels <20 ng/mL were assigned to the combined physiotherapy and vitamin D group. The physiotherapy group consisted of the patients with vitamin D levels more than 20 ng/mL. The Brief Pain Inventory scale was utilized to measure pain at baseline and after 12 weeks of interventions. We used the paired t-tests for unadjusted analysis. Further, a linear regression model was used to identify the combined effect of physiotherapy and vitamin D on reducing pain scores after adjusting potential confounders.Results: Combined intervention of vitamin D and physiotherapy showed significantly better results than only physiotherapy intervention in the reduction of three pain-related outcomes (p < 0.001). The multivariable analysis indicated that the combination of physiotherapy and vitamin D treatment reduced pain score by 1.126 (slope = −1.126, p = 0.035) compared to physiotherapy alone.Conclusion: Combined intervention (vitamin D with physiotherapy) had a better pain-relieving effect than physiotherapy alone. To confirm these findings, more research is needed with randomized control trials.Clinical Trial Registration: [http://ctri.nic.in/Clinicaltrials/advancesearchmain.php], identifier [CTRI/2020/04/024845].

Is Coronavirus Infection Associated With Musculoskeletal Health Complaints? Results From a Comprehensive Case-Control Study

“…The Global Burden of Disease Study 2019 found MHC the leading cause of disability that affected 1.7 billion people worldwide. 4 , 5 Subsequently, since the pandemic started in 2019, more than 0.56 billion of the world population have been infected by SARS-CoV-2, and the number is increasing every day. 6 To make the situation worse, scientists predicted the incidence of MHC would be raised in the post-pandemic era in 3 specific ways.…”

The Efficacy of Vitamin D Supplementation in the Treatment of Fibromyalgia Syndrome and Chronic Musculoskeletal Pain

“…The full texts of the 27 remaining studies were read, and their content was cross-referenced with the inclusion criteria. A total of 14 studies met the eligible criteria [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Details regarding the included studies are summarized in Table 1 .…”

“…A treatment with a vitamin D supplement and a standard antidepressant prescribed to FMS patients with 25OHD deficiency could lead to significant benefits in terms of both physical and psychological symptoms [ 36 ]. The combined benefit of vitamin D supplementation and physiotherapy was significantly higher than physiotherapy alone in improving pain-related symptoms (−4.92 vs. −3.79; p < 0.001) in CMP patients [ 41 ].…”

“…The risk of bias in the primary studies based on the Cochrane risk-of-bias tool is shown in Figure 2 . There was “high risk” of bias in six studies [ 29 , 32 , 38 , 39 , 41 , 42 ], whereas six papers had “low risk” [ 33 , 34 , 35 , 36 , 37 , 40 ], and two manuscripts had “some concerns” [ 30 , 31 ]. The overall risk of bias is illustrated in Figure 3 .…”

“…Gabapentinoids (gabapentin and pregabalin) [ 47 ], antidepressants (tricyclic antidepressants and serotonin noradrenaline reuptake inhibitors) [ 48 ], and melatonin [ 49 ] are often used for obtaining a direct myorelaxant effect and inducing a state of psychic relaxation, which has repercussions on the state of muscular tension, thus reducing pain. Indeed, a similar improvement occurs even when different treatments have been proposed, such as pain neuroscience education and physical training [ 50 ], acquisition of knowledge of pain neurophysiology [ 51 ], placebo [ 37 , 41 ], or alternative treatments [ 34 , 38 ]. The European League Against Rheumatism (EULAR) emphasizes the importance of a nonpharmacological approach to the treatment of FMS, e.g., through nutritional interventions, including vitamin D supplementation [ 52 ].…”