Vitamin D and chronic pain in the elderly

Abstracts

JUSTIFICATIVA E OBJETIVOS: A dor crônica é queixa muito frequente nas consultas, principalmente entre os idosos. Na tentativa de buscar terapêuticas mais eficazes e com menos efeitos adversos, nessa população, especialmente considerando idosos com dor neuropática e musculoesquelética, tem-se observado estudos que vêm relacionando a vitamina D a quadros dolorosos, o que poderia propô-la como uma alternativa analgésica. O objetivo deste estudo foi rever, na literatura, o papel da vitamina D na dor crônica neuromusculoesquelética em idosos. CONTEÚDO: Realizada a revisão bibliográfica na base de dados do Pubmed, Medline, LILACS, Biblioteca Cochrane e Scielo, contemplando os últimos 10 anos, títulos em português e inglês. Os descritores usados na busca inicial foram "vitamina D" e "dor crônica", resultando 220 artigos, dos quais apenas os que se tratavam de dor neuromusculoesquelética em idosos foram utilizados. Destes, somente 10 preenchiam os critérios estabelecidos e foram analisados, resultando: um estudo de revisão sistemática, cinco estudos analíticos transversais, dois estudos retrospectivos do tipo série de casos, um estudo observacional prospectivo e um trial clínico randomizado e controlado. Observou-se em cinco estudos uma relação significativa entre a hipovitaminose D e dor crônica musculoesquelética, em três estudos uma melhora da dor após suplementação com vitamina D, e, em outros dois, não haver melhora da dor com esta suplementação. CONCLUSÃO: Os estudos relacionando a vitamina D e a dor crônica em idosos ainda são escassos e bastante heterogêneos. A avaliação do déficit de vitamina D deveria estar mais presente nas consultas geriátricas, pois este tem sido correlacionado com certas síndromes dolorosas e sua adequação poderia trazer beneficio terapêutico em alguns casos.

Dor crônica; Dor musculoesquelética; Idoso; Neuralgia; Vitamina D

REVIEW ARTICLE

Vitamin D and chronic pain in the elderly^*

Welington Saraiva de Oliveira; Niele Moraes; Fania Cristina Santos

Federal University of São Paulo. São Paulo, SP, Brazil

Correspondence

ABSTRACT

BACKGROUND AND OBJECTIVES: Chronic pain is a frequent complaint during medical visits, especially among the elderly. In the attempt to find more effective therapies with less adverse effects in this population, especially considering elderly people with neuropathic and musculoskeletal pain, there are studies relating vitamin D to pain, which could propose it as an analgesic alternative. This study aimed at reviewing in the literature the role of vitamin D in chronic musculoskeletal pain in the elderly.

CONTENTS: Pubmed, Medline, LILACS, Cochrane Library and Scielo databases were queried for the last ten years, looking for studies in Portuguese and English. Initial search keywords were "vitamin D" and "chronic pain", resulting in 220 articles, of which only those addressing musculoskeletal pain in the elderly were selected. From those, only ten met established criteria and were analyzed, resulting in: one systematic review, five transversal analytical studies, two case-series retrospective studies, one prospective observational study and one randomized and controlled clinical trial. Five studies have shown significant relationship between vitamin D deficit and chronic musculoskeletal pain; three studies have shown pain improvement after vitamin D supplementation and two have not observed pain improvement with such supplementation.

CONCLUSION: Studies relating vitamin D to chronic pain in the elderly are still scarce and highly heterogeneous. The evaluation of vitamin D deficit should be more frequent during geriatric consultations, because this has been correlated to some painful syndromes and its correction could bring therapeutic benefits in some cases.

Keywords: Chronic pain, Elderly, Musculoskeletal pain, Neuralgia, Vitamin D.

INTRODUCTION

Ageing is a worldwide phenomenon, due to low mortality and birth rates and increased life expectancy, resulting from major scientific and technological advances in the last decades^1,2. According to the demographic census of the Brazilian Institute of Geography and Statistics (IBGE), current population living in Brazil with 65 years of age or above, who were 4.8% in 1991, went to 5.9% in 2000 and reached 7.4% in 2010³.

With increased life expectancy, there is increased prevalence of chronic and degenerative diseases. Many of these presentations are followed by chronic pain, important public health problem, which has recently received attention^1,2.

Chronic pain, described as "that lasting more than a reasonable period of time for the healing of an injury", may be associated to several factors, such as depression, physical and functional incapacity, social isolation, changes in family dynamics and hopelessness. It may induce fatigue, anorexia, sleep disorders, constipation and concentration difficulties. The inability to control it brings severe physical and psychical distress and may significantly interfere with the quality of life of the elderly, affecting their daily activities in variable ways^4-6.

In the attempt to find more effective therapies with less side-effects, especially for the elderly, several studies were observed, which bring vitamin D as alternative for the management of chronic pain.

This study aimed at reviewing in the literature the role of vitamin D for chronic musculoskeletal pain in the elderly.

CONTENTS

Pubmed, Medline, LILACS, Cochrane Library and Scielo databases were queried for the last ten years, looking for studies in Portuguese and English. Search keywords were "vitamin D" and "chronic pain", resulting in 220 articles, of which only those addressing musculoskeletal pain in the elderly (aged 60 years or above) were selected, even if not exclusively. A total of 65 articles were selected. We have also directly looked for related articles, which have not appeared in the initial search: three publications.

From those, only ten met established criteria: vitamin D and chronic musculoskeletal pain involving the elderly. So, included and analyzed papers were: one systematic review, five transversal analytical studies, two case-series retrospective studies, one prospective observational study and one randomized and controlled clinical trial. Table 1 is a summary of selected articles and their major results.

DISCUSSION

Analyzing the articles of this review, it was observed that the association of vitamin D deficit and chronic pain seems to be frequent, but other points are still unclear and deserve consideration, such as a possible action of vitamin D on mood disorders, such as anxiety and depression which usually follow chronic pain presentations. It is also suggested that vitamin D has anti-inflammatory activity decreasing some pro-inflammatory cytokines, thus decreasing pain¹⁷.

Not all people with vitamin D deficit will develop musculoskeletal pain but the probability for such increases with decreased vitamin D levels. One could expect that vitamin D would be of major value for the management of chronic pain syndrome in the elderly. But, analyzing the studies selected for this review, some have reached this conclusion, while others have not.

It is not clear whether vitamin D is cause effect or simply an epiphenomenon in painful situations.

More recently, authors have also suggested that vitamin D deficit may induce several neurological disorders, such as epilepsy¹⁸. So, once more, we propose the need for additional consideration of vitamin D status in elderly patients, who often present neurological disorders.

In looking for the dose of vitamin D to be used for chronic pain, there is also no standard among studies. The suggestion is to use higher doses of vitamin D aiming not only at increasing the deposits of such vitamin, especially in fatty tissues, but also aiming at improving chronic pain. A total daily vitamin D supplementation of 2300 to 2800 IU, to start, would be potentially beneficial for patients which chronic musculoskeletal pain and fatigue syndromes¹⁹. It is worth stressing the report that it may take up to nine months for the maximum effects of such supplementation to be reached¹⁹.

CONCLUSION

Existing studies on vitamin D and chronic pain in the elderly are still scarce, and those using vitamin D to manage chronic pain, especially neuromusculoskeletal pain, are even scarcer, in addition to being highly heterogeneous.

Our review has observed a high prevalence of chronic pain in individuals with vitamin D deficiency, especially females, and its supplementation was beneficial for some cases, but not for others. So, there is the need for further studies, with better defined objectives and criteria, to reach further conclusions about the subject.

Vitamin D deficit evaluation should be more present during geriatric medical visits, especially those with chronic neuropathic and musculoskeletal pain complaints, through its dosage and supplementation, considering that it has low cost and could be beneficial for pain management, in addition to being well tolerated in standard doses.

REFERENCES

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Publication Dates

• Publication in this collection
  29 Oct 2013
• Date of issue
  Sept 2013

History

• Received
  07 Feb 2013
• Accepted
  24 July 2013