Editor’s comment: Prior research has consistently shown that fibromyalgia patients tend to have low calcifediol levels, which indicates a lack of sufficient vitamin D. (Calcifediol is a prehormone produced in the liver by hydroxylation of vitamin D3.) An Austrian research team sought to find out what effect supplementation with vitamin D would have on chronic pain in FM patients. They found that vitamin D supplementation was effective in reducing pain and concluded, “This economical therapy with a low side effect profile may well be considered in patients with FMS.”
Effects of vitamin D on patients with fibromyalgia syndrome: A randomized placebo-controlled trial
The role of calcifediol in the perception of chronic pain is a widely discussed subject. Low serum levels of calcifediol are especially common in patients with severe pain and fibromyalgia syndrome (FMS). We lack evidence of the role of vitamin D supplementation in these patients. To our knowledge, no randomized controlled trial has been published on the subject.
Thirty women with FMS according to the 1990 and 2010 American College of Rheumatology criteria, with serum calcifediol levels <32 ng/mL (80 nmol/L), were randomized to treatment group (TG) or control group (CG). The goal was to achieve serum calcifediol levels between 32 and 48 ng/mL for 20 weeks via oral supplementation with cholecalciferol. The CG received placebo medication. Re-evaluation was performed in both groups after a further 24 weeks without cholecalciferol supplementation.
The main hypothesis was that high levels of serum calcifediol should result in a reduction of pain (visual analog scale score). Additional variables were evaluated using the Short Form Health Survey 36, the Hospital Anxiety and Depression Scale, the Fibromyalgia Impact Questionnaire, and the Somatization subscale of Symptom Checklist-90-Revised.
A marked reduction in pain was noted over the treatment period in TG: a 2 (groups) × 4 (time points) variance analysis showed a significant group effect in visual analog scale scores. This also was correlated with scores on the physical role functioning scale of the Short Form Health Survey 36. Optimization of calcifediol levels in FMS had a positive effect on the perception of pain.
This economical therapy with a low side effect profile may well be considered in patients with FMS. However, further studies with larger patient numbers are needed to prove the hypothesis.
Source: Pain, February 2014. Florian Wepnera, Raphael Scheuera, Birgit Schuetz-Wiesera, Peter Machaceka, Elisabeth Pieler-Bruhaa, Heide S. Crossb, Julia Hahnea and Martin Friedricha. Department of Orthopedic Pain Management, Spine Unit, Center of Excellence for Orthopaedic Pain Management, Speising, Vienna, Austria.