Jose G. Veliz, M.D. M.S.A.
Medical Director
Palomar Pain Management Center

Posted December 1, 2008

LOW VITAMIN D LEVELS FOUND IN WOMEN WITH CHRONIC WIDESPREAD PAIN

Chronic pain syndrome has been generally defined as ongoing pain lasting longer than six months. Other definitions of chronic pain syndrome are pain which lasts longer than the expected healing pain for the tissues involved. The causes are unclear and therapy is challenging.

Some researchers and doctors describe chronic pain syndrome as a learned behavioral syndrome which is initiated by a painful stimulus. The behavior is rewarded and reinforced and, eventually, will occur without any painful stimulus. Several psychological syndromes are associated with chronic pain syndrome.

Chronic pain syndrome is also related to spinal excitability which involves nerve cells (neurons) becoming more sensitive to painful stimuli as a result of the initial tissue injury. Neurons which are involved in transmission of pain signals to the brain, begin to fire spontaneously, for longer periods, at higher amplitudes, and more easily. These persistent changes are called central sensitization and are important factors in defining chronic pain syndrome.

Opioid-induced hyperalgesia has a negative effect on the treatment of chronic pain. Examples of opioids include morphine, codeine, oxycodone, fentanyl, tramadol (Ultram), propoxyphene (Darvocet), Vicodin, Norco and Percocet. Opioid-induced hyperalgesia is defined as a paradoxical increase in pain, unrelated to the original painful stimulus, which occurs with prolonged use of opioids. Using a multi-disciplinary approach to the treatment of pain can decrease the occurrence and incidence of opioid induced hyperalgesia.

A study published in the August 12, 2008, issue of the Annals of the Rheumatic Diseases, has found that women with low Vitamin D levels have more chronic, widespread pain. The researchers recommend that further studies be performed in order to determine whether higher Vitamin D intake could lower the risk of developing chronic, widespread pain.

References: Atherton K., Berry D., Parsons T. “Vitamin D and Chronic Widespread Pain in a White Middle Aged British Population: Evidence from a Cross Sectional Population Survey.” Ann Rheum Dis. “12 August 2008.”