Effect of monthly vitamin D on chronic pain among community-dwelling seniors: a randomized, double-blind controlled trial

Authors: SCHLOGL, MATHIAS - University Of Zurich; CHOCANO-BEDOYA, PATRICIA - University Of Zurich; DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; ORAV, ENDEL - Harvard University; FREYSTAETTER, GREGOR - University Of Zurich; THEILER, ROBERT - University Of Zurich; KRESSIG, RETO - University Of Basel; EGLI, ANDREAS - University Of Zurich; BISCHOFF-FERRARI, HEIKE - University Of Zurich

Submitted to: Journal of the American Medical Directors Association - Post-Acute and Long Term Care Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/9/2018
Publication Date: 3/5/2019
Citation: Schlogl, M., Chocano-Bedoya, P., Dawson-Hughes, B., Orav, E.J., Freystaetter, G., Theiler, R., Kressig, R.W., Egli, A., Bischoff-Ferrari, H. 2019. Effect of monthly vitamin D on chronic pain among community-dwelling seniors: a randomized, double-blind controlled trial. Journal of the American Medical Directors Association - Post-Acute and Long Term Care Medicine. 20(3):356-361. https://doi.org/10.1016/j.jamda.2018.09.004.
DOI: https://doi.org/10.1016/j.jamda.2018.09.004

Interpretive Summary: With advancing age, the prevalence of vitamin D deficiency and musculoskeletal pain increases. However, published data on the effectiveness of vitamin D supplementation in reducing chronic pain are inconclusive. The purpose of this study was to test the effect of 3 different monthly doses of vitamin D on chronic pain in seniors 70 years and older with a prior fall event. In this clinical trial, 200 adults aged 70 years and older who had fallen in the last year were treated with a low-dose of vitamin D (24,000 IU vitamin D3 per mo), a high dose of vitamin D3 (60,000 IU vitamin D3 per mo), or a combination of vitamin D3 and calcifediol (24,000 IU vitamin D3 plus 300 micrograms of calcifediol per mo) for one year. The purpose of this study was to determine whether vitamin D affected the number of painful areas in the body. We found that the changes in the mean number of painful areas did not differ significantly among treatment groups; however, among those who had adequate vitamin D levels at baseline, seniors in the low dose group had a marginally significant decrease in their total mean pain score, whereas there were no changes in the two higher-dose groups. Our results suggest that both the starting level of vitamin D level and the monthly treatment dose of vitamin D may be important with respect to chronic pain reduction-with the only benefit seen among vitamin D-replete seniors treated with a monthly low dose of vitamin D3.

Technical Abstract: Objective: With advancing age, the prevalence of vitamin D deficiency and musculoskeletal pain increases. However, published data on the effectiveness of vitamin D supplementation in reducing chronic pain are inconclusive. The purpose of this study was to test the effect of 3 different monthly doses of vitamin D on chronic pain in seniors 70 years and older with a prior fall event. Design: 1-year, double-blind randomized clinical trial. Setting: The trial was conducted in Zurich, Switzerland. Participants were 200 community-dwelling men and women 70 years and older with a prior fall. Intervention: Three study groups with monthly treatments were randomized to either a low-dose control group of vitamin D (24,000 IU vitamin D3/mo), a high dose of vitamin D3 (60,000 IU vitamin D3/mo), or a combination of calcifediol and vitamin D3 (24,000 IU vitamin D3 plus 300 micrograms calcifediol/mo). Measurements: The primary endpoint was the change in the mean number of painful areas using the McGill Pain map over 12 months of follow-up. All analyses were adjusted for age, sex, body mass index, 25-hydroxyvitamin (OH)D3 levels, and pain scores at baseline. A predefined subgroup analysis was performed by baseline 25(OH)D status (<20 vs >/=20 ng/mL). Results: The mean age of the participants was 78 years, 67.0% (134 of 200) were female, and 58.0% (116 of 200) were vitamin D deficient (<20 ng/mL) at baseline. Over 12 months of follow-up, the changes in the mean number of painful areas did not differ significantly among treatment groups ( P = .46). However, there was a significant interaction effect between baseline vitamin levels (<20 vs >/= 20 ng/mL) and treatment ( P = .02). Among those who were vitamin D replete at baseline (n = 84), there was a significant difference between treatment groups over time ( P = .04), and only seniors in the 24,000-IU vitamin D3 group had a marginally significant decrease in their total mean pain score (-0.77; 95% CI, -1.56 to 0.01, P = .05), whereas there were no changes in the high-dose groups. Among seniors who were vitamin D deficient at baseline (n = 116), chronic pain did not differ by treatment groups over time ( P = .33). Conclusion: Our results suggest that both starting level of 25(OH)D3 and monthly treatment dose of vitamin D may be important with respect to chronic pain reduction-with the only benefit seen among vitamin D-replete seniors treated with a monthly dose of 24,000 IU vitamin D3.