Can Vitamin D Help Patients with Fibromyalgia?
Abstract & Commentary
By Martin S. Lipsky, MD
Adjunct Professor, Institute on Aging, School of Community Health,
Portland State University; Dean Emeritus, University of Illinois
College of Medicine, Rockford
Dr. Lipsky is a retained consultant for Health Solutions & Strategies.
Synopsis: The authors concluded that vitamin D supplementation in patients with fibromyalgia syndrome (FMS) and low levels
of vitamin D might be an economical, safe, and effective therapy
for patients with FMS.
Source: Wepner F, et al. Effects of vitamin D on patients with fibromyalgia syndrome: A randomized placebo-controlled trial. Pain 2014;155:261-268.
Patients with fibromyalgia syndrome (fms) typically experience fatigue and muscle pain. Low serum levels of vitamin D are common among those with FMS who suffer from pain as a prominent symptom. In this Austrian study, Wepner et al studied 30 patients who met FMS criteria set by the American College of Rheumatology and who had low serum calcifediol levels (also known as 25-hydroxycholecalciferol and considered the best marker of vitamin D levels). Fifteen participants were assigned to the test group and 15 to the control group. Seventy percent of the study participants’ serum levels were below 24 ng/mL. The remaining participants had levels between 24-32 ng/mL. The study goal was to achieve levels between 32-48 ng/mL in the test group via oral supplementation. The control group received a placebo medication. The hypothesis was that achieving higher serum levels would result in less pain using a visual analog scale as the outcome measure. Other outcome measures included a Short Form Health Survey 36 questionnaire, the Fibromyalgia Impact Questionnaire, and the Hospital Anxiety and Depression Scale.
Serum levels in the test group were measured at 5 and 13 weeks with dose adjustments as needed to keep the treatment group at a level between 32-48 ng/mL for 20 weeks. At 25 weeks, supplementation was discontinued. Levels were measured when treatment was discontinued and repeated again after 24 weeks without supplementation.
Twenty-four weeks after supplementation was stopped, the group receiving vitamin D experienced a marked reduction in their level of perceived pain. The treatment group improved significantly on the scale of physical functioning while the placebo group remained unchanged. The treatment group also scored significantly better on a Fibromyalgia Impact Questionnaire on the question of "morning fatigue." However, there was no significant alteration in depression or anxiety symptoms.
The authors concluded that vitamin D supplementation in patients with FMS and low levels of vitamin D might be an economical, safe, and effective therapy for patients with FMS.
COMMENTARY
More and more research is coming out about vitamin D and its extraskeletal health benefits, including its role in modulating cell growth and immune function, maintaining cardiovascular health, and reducing inflammation. It is also well known that vitamin D is important for muscular function. A recent paper by Shuler and colleagues exploring the sports health benefits of vitamin D found that many athletes have low levels of vitamin D and supplementation improved muscular performance.1 Shuler et al recommended treating athletes with low vitamin D levels with a weekly dose of 50,000 IU of vitamin D3 for 8 weeks and then retesting at 3 months. If the 25-hydroxyvitamin D level remains < 30 ng/mL, then repeating supplementation and retesting is recommended. Once sufficiency is achieved, then daily supplementation of 1500-2000 IU is recommended for maintenance.2 An alternative maintenance regimen is to receive 50,000 of vitamin D once or twice per month. No improved performance is noted for athletes with levels > 50 ng/mL and levels > 4000 IU per day increase the risk of toxicity.3
Therefore, it should not be surprising that patients with FMS might have low levels of vitamin D and that supplementation to achieve adequate levels improved their muscular discomfort. For those in primary care, FMS is a challenging chronic disease that can be difficult to manage. While not life threatening, FMS can significantly affect an individual’s quality of life. While treatments such as TCAs and physical therapy may help, they can be expensive or have troubling side effects. The possibility that vitamin D might improve pain and fatigue for those with FMS is attractive since vitamin D is both a relatively safe and economical treatment. While the small number of patients in this study suggests the need to confirm these findings with a larger clinical trial, it still seems reasonable to check and monitor the vitamin D levels in FMS patients with pain and fatigue and to supplement those with lower levels.
References
- Shuler FD, et al. Sports health benefits of vitamin D. Sports Health 2012;4:496-501.
- National Institutes of Health, Office of Dietary Supplements. Vitamin D Fact Sheet for Health Professionals. http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/. Accessed on April 16, 2014.
- Holick MF, et al. Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96: 1911-1930.
