Vitamin D in Pain Management

Abstract

Vitamin D is a hormone synthesized in the skin in the presence of sunlight. Like other hormones, vitamin D plays a role in a wide range of processes in the body. Here we review the possible role of vitamin D in nociceptive and inflammatory pain. In observational studies, low vitamin D levels have been associated with increased pain and higher opioid doses. Recent interventional studies have shown promising effects of vitamin D supplementation on cancer pain and muscular pain—but only in patients with insufficient levels of vitamin D when starting intervention. Possible mechanisms for vitamin D in pain management are the anti-inflammatory effects mediated by reduced cytokine and prostaglandin release and effects on T-cell responses. The recent finding of vitamin D-mediated inhibition of Prostaglandin E2 (PGE2) is especially interesting and exhibits a credible mechanistic explanation. Having reviewed current literature, we suggest that patients with deficient levels defined as 25-hydroxyvitamin D (25-OHD) levels <30 nmol/L are most likely to benefit from supplementation, while individuals with 25-OHD >50 nmol/L probably have little benefit from supplementation. Our conclusion is that vitamin D may constitute a safe, simple and potentially beneficial way to reduce pain among patients with vitamin D deficiency, but that more randomized and placebo-controlled studies are needed before any firm conclusions can be drawn.

Dysregulated Tear Fluid Nociception-Associated Factors, Corneal Dendritic Cell Density, and Vitamin D Levels in Evaporative Dry Eye

“…There is emerging evidence on the role of vitamin D in nociceptive response and management of pain in various conditions including corneal neuralgia. 6,26,69 The negative association between tear vitamin D and OSDI, particularly the discomfort scale, suggests a causal role of vitamin D in modulating pain in DED. The possible Bold entries indicate statistically significant observations.…”

The effectiveness of vitamin D supplementation in functional outcome and quality of life (QoL) of lumbar spinal stenosis (LSS) requiring surgery

“…The effect of vitamin D on the functional outcome and QoL of patients with LSS has not been elucidated but may be deduced from several studies. There is much debate about the pain relief effect of Vitamin D. Although it is a study of idiopathic chronic LBP, Cannell et al [17] have reported on the pain relief effect of vitamin D. Helde-Frankling et al [18] have commented on the pain reducing effect of Vitamin D, Cakar et al [19] said that in a cohort of 149 patients, the authors found that serum vitamin D concentration was not associated with knee pain in patients with osteoarthritis, and Heuch et al [20] said that after analyzing a data set including 1685 individuals with LBP and 3137 controls without LBP, the authors found no association between vitamin D status and risk of LBP. In addition, it appears that vitamin D may have an effect to enhance mood, but there are not sufficient studies regarding accurate mechanism [21].…”

The Role of Vitamin D in Primary Headache–from Potential Mechanism to Treatment

“…In addition, in vitro studies show 25(OH)D inhibits the synthesis of prostaglandin E2 (PGE2) in fibroblasts [34]. There is also evidence that vitamin D supplementation stops musculoskeletal pain through diminished levels of inflammatory cytokines including PGE2 [35]. Thus, suppression of PGE2 is a credible explanation for the analgesic effect of vitamin D [35,36].…”