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ACR 2017 | Daily Highlights
Effect of Vitamin D Supplementation in Chronic Widespread Pain: A Systematic Review and Meta-Analysis
Authors: Wai Chung Yong, Anawin Sanguankeo and Sikarin Upala, Bassett Medical Center, Cooperstown, NY
Chronic non-specific widespread pain (CWP) including fibromyalgia (FM) is characterized by widespread pain, reduced pain threshold and multiple tender points on examination, causing disability and decreased quality of life. Vitamin D has been proposed as an associated factor in CWP. This meta-analysis aimed to explore the benefit of vitamin D supplementation in the management of CWP.
A comprehensive search of the CENTRAL, MEDLINE and EMBASE databases was performed from inception through January 2017. The inclusion criterion was the randomized clinical trials’ evaluating the effects of vitamin D treatment in adult subjects with CWP or fibromyalgia. CWP was defined as chronic recurrent musculoskeletal pain without secondary causes; fibromyalgia patients met the American College of Rheumatology criteria for fibromyalgia. Study outcome was assessed using visual analog scale (VAS) of pain intensity. Pooled mean difference (MD) of VAS and 95% confidence interval (CI) were calculated using a random-effect meta-analysis. Meta-regression analysis using random-effects model was performed to explore the effects of change in vitamin D in the treatment group on difference in mean of VAS. Sensitivity analysis was performed to evaluate the robustness of results. The between-study heterogeneity of effect-size was quantified using the Q statistic and I2.
Data were extracted from 4 randomized control trials involving 287 subjects. Pooled result demonstrated a significant lower VAS in CWP patients who received vitamin D treatment compared with those who received placebo (MD=0.46; 95% CI: 0.09 – 0.89, I2 = 48%). Meta-regression analysis revealed no significant relationship between the changes of vitamin D and VAS with a coefficient = 0.04 (95% CI: -0.01 to 0.08), p=0.10.
n this meta-analysis, we conclude that vitamin D supplementation is able to decrease pain scores and improve pain despite no significant change in VAS after increasing serum vitamin D level. Further study needs to be conducted in order to explore the improvement of functional status, quality of life, and the pathophysiological change that improves chronic widespread pain.
W. C. Yong, None; A. Sanguankeo, None; S. Upala, None.
In this systematic review the data of 4 RCT concerning the effect of vitamin D supplementation in patients with chronic widespread pain including fibromyalgia was analysed.
The pooled data results demonstrated a significant lower VAS (visual analogue pain scale) in chronic widespread pain patients who received vitamin D treatment compared with placebo. But meta-regression analysis did not show a significant relation between the changes of vitamin D level and VAS.
In conclusion vitamin D supplementation reduces pain in patients with chronic widespread pain including fibromyalgia. Interestingly this effect seems not to depend on the baseline vitamin D level.
From my personal experience I would have expected that pain patients with a low vitamin D level at baseline have a greater benefit of the vitamin D supplementation. Further prospective studies examining the effect on pain in chronic widespread pain with special regard to vitamin D levels at baseline need to be conducted.
Dr. Thomas Langenegger