Vitamin D deficiency and its role in chronic nonspecific musculoskeletal pain

Abstract

Pain is a universal and costly medical health problem. It is estimated that approximately one in ten individuals develop chronic pain each year. Chronic pain is among the top 10 complaints for which individuals seek help from primary care health professionals. In spite of its prevalence, doctors report a lack of confidence in managing chronic painful conditions. Moreover, the use of opioids for non-malignant chronic pain has increased recently and has become more regulated. Not surprisingly there is a high demand for alternative treatment options for managing chronic pain. Chronic nonspecific musculoskeletal pain (CNMP) is a type of chronic pain, marked by the absence of a clear patho-physiological or anatomical origin. CNMP causes major disruption to patients’ lives, relationships, and functionality. A rising prevalence of CNMP is observed in the general population but especially in children and adolescents. A diagnosis of CNMP early in life is recognized as a predictor for disability later. The limited information on its etiology, diagnosis and management perplexes doctors and patients alike. There is a growing body of evidence that suggests vitamin D deficiency may play an important role in the etiology of CNMP. The discovery of vitamin D receptors in most tissues and cells in the human body and the identification of non-classical functions support the potential involvement of vitamin D in multiple chronic painful conditions including CNMP. In addition, vitamin D deficiency, by itself, is also reported as a major public health concern. Therefore because vitamin D supplementation is cheap and safe, it is increasingly being used as a management option. However the evidence base for such treatment is limited. The management of CNMP, its perceived relationship with vitamin D deficiency and advice about using vitamin D supplementation by GPs has not been described previously. Nor do we know if supplementing vitamin D deficiency might improve symptomatology for patients with CNMP. In addition, very little is known about patient’s perspectives, beliefs and views of their chronic pain management, especially in relation to vitamin D testing and supplementation, pain education and the patient-provider relationship. Patient perspectives are fundamental for identifying areas of management which require improvement to achieve better treatment outcomes.