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Vitamin D supplementation has no major effect on pain or pain behavior in bedridden geriatric patients with advanced dementia

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Abstract

Background and aims: In a few, earlier, uncontrolled trials, alleviation of chronic pain has been documented by vitamin D supplementation. This randomized double-blind placebo controlled trial addressed the association between pain and vitamin D deficiency and the effects of vitamin D supplementation on pain in institutionalized aged patients. Methods: 216 long-term care patients were enrolled in Helsinki, Finland. Pain was assessed by three tools: Resident Assessment Instrument (RAI), Discomfort Behavior Scale, and Pain Assessment in Advanced Dementia Scale. Scores for Cognitive Performance Scale (CPS) and other clinical assessments were also collected from the RAI-database. Levels of 25-hydroxyvitamin D (25-OHD) and parathyroid hormone were also determined. Patients in pain (n=202) were randomized into three treatment groups, each receiving 0, 400, or 1200 IU cholecalciferol per day, respectively. Assessments were repeated after six-month vitamin D supplementation. Results: Patients were aged (84.5±7.5 yrs), demented (CPS= 4.9±1.4, range 1–6), and chronically bedridden. Pain was present in 38.4% to 83.8% of patients depending on assessment tool. Low 25-OHD levels (<50 nmol/L) were very common (98.1%). However, vitamin D deficiency was not associated with pain or pain behavior. The supplementation resulted in a marked increase in 25-OHD levels. However, neither prevalence of painlessness nor pain scores changed significantly after vitamin D supplementation. Conclusions: We were not able either to show an association between vitamin D deficiency and pain or to observe alleviation of pain by vitamin D supplementation. The independent role of vitamin D in the etiology of pain remains controversial.

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References

  1. Gloth FM 3rd, Lindsay JM, Zelesnick LB, Greenough WB 3rd. Can vitamin D deficiency produce an unusual pain syndrome? Arch Intern Med 1991; 151: 1662–4.

    Article  PubMed  Google Scholar 

  2. Nellen JF, Smulders YM, Jos Frissen PH, Slaats EH, Silberbusch J. Hypovitaminosis D in immigrant women: slow to be diagnosed. BMJ 1996; 312: 570–2.

    Article  PubMed  CAS  Google Scholar 

  3. Prabhala A, Garg R, Dandona P. Severe myopathy associated with vitamin D deficiency in western New York. Arch Intern Med 2000; 160: 1199–203.

    Article  PubMed  CAS  Google Scholar 

  4. de Torrente de la Jara G, Pecoud A, Favrat B. Musculoskeletal pain in female asylum seekers and hypovitaminosis D3. BMJ 2004; 329: 156–7.

    Article  PubMed  Google Scholar 

  5. Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, non-specific musculoskeletal pain. Mayo Clin Proc 2003; 78: 1463–70.

    Article  PubMed  Google Scholar 

  6. Macfarlane GJ, Palmer B, Roy D, Afzal C, Silman AJ, O’Neill T. An excess of widespread pain among South Asians: are low levels of vitamin D implicated? Ann Rheum Dis 2005; 64: 1217–9.

    Article  PubMed  CAS  Google Scholar 

  7. Benson J, Wilson A, Stocks N, Moulding N. Muscle pain as an indicator of vitamin D deficiency in an urban Australian Aboriginal population. Med J Aust 2006; 185: 76–7.

    PubMed  Google Scholar 

  8. Erkal MZ, Wilde J, Bilgin Y, et al. High prevalence of vitamin D deficiency, secondary hyperparathyroidism and generalized bone pain in Turkish immigrants in Germany: identification of risk factors. Osteoporos Int 2006; 17: 1133–40.

    Article  PubMed  CAS  Google Scholar 

  9. Glerup H, Mikkelsen K, Poulsen L, et al. Hypovitaminosis D myopathy without biochemical signs of osteomalacic bone involvement. Calcif Tissue Int 2000; 66: 419–24.

    Article  PubMed  CAS  Google Scholar 

  10. Al Fara] S, Al Mutairi K. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine 2003; 28: 177–9.

    Article  Google Scholar 

  11. de Torrente de la Jara G, Pecoud A, Favrat B. Female asylum seekers with musculoskeletal pain: the importance of diagnosis and treatment of hypovitaminosis D. BMC Fam Pract 2006; 7: 4.

    Article  PubMed  Google Scholar 

  12. Kao PC, Grant CS, Klee GG, Khosla S. Clinical performance of parathyroid hormone immunometric assays. Mayo Clin Proc 1992; 67: 637–45.

    Article  PubMed  CAS  Google Scholar 

  13. Turpeinen U, Hohenthal U, Stenman U-H. Determination of 25-Hydroxyvitamin D in Serum by HPLC and immunoassay. Clin Chem 2003; 49: 1521–4.

    Article  PubMed  CAS  Google Scholar 

  14. Fries BE, Simon SE, Morris JN, Flodstrom C, Bookstein FL. Pain in US nursing homes: validating a pain scale for the minimum data set. Gerontologist 2001; 41: 173–9.

    Article  PubMed  CAS  Google Scholar 

  15. Stevenson KM, Brown RL, Dahl JL, Ward SE, Brown MS. The Discomfort Behavior Scale: a measure of discomfort in the cognitively impaired based on the Minimum Data Set 2.0. Res Nurs Health 2006; 29: 576–87.

    Article  PubMed  Google Scholar 

  16. Morris JN, Hawes C, Fries BE, et al. Designing the national resident assessment instrument for nursing homes. Gerontologist 1990; 30: 293–307.

    Article  PubMed  CAS  Google Scholar 

  17. Warden V, Hurley AC, Volicer L. Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. J Am Med Dir Assoc 2003; 4: 9–15.

    Article  PubMed  Google Scholar 

  18. Morris JN, Fries BE, Mehr DR, et al. MDS Cognitive Performance Scale. J Gerontol 1994; 49: M174–82.

    Article  PubMed  CAS  Google Scholar 

  19. Burrows AB, Morris JN, Simon SE, Hirdes JP, Phillips C. Development of a minimum data set-based depression rating scale for use in nursing homes. Age Ageing 2000; 29: 165–72.

    Article  PubMed  CAS  Google Scholar 

  20. Morris JN, Fries BE, Morris SA. Scaling ADLs within the MDS. J Gerontol Med Sci 1999; 54A: M546–53.

    Article  Google Scholar 

  21. Helliwell PS, Ibrahim GH, Karim Z, Sokoll K, Johnson H. Unexplained musculoskeletal pain in people of South Asian ethnic group referred to a rheumatology clinic — relationship to biochemical osteomalacia, persistence over time and response to treatment with calcium and vitamin D. Clin Exp Rheumatol 2006; 24: 424–7.

    PubMed  CAS  Google Scholar 

  22. Holick MF. Vitamin D deficiency: what a pain it is. Mayo Clin Proc 2003; 78: 1457–9.

    Article  PubMed  Google Scholar 

  23. Mascarenhas R, Mobarhan S. Hypovitaminosis D-induced pain. Nutr Rev 2004; 62: 354–9.

    Article  PubMed  Google Scholar 

  24. Van Veldhuizen PJ, Taylor SA, Williamson S, Drees BM. Treatment of vitamin D deficiency in patients with metastatic prostate cancer may improve bone pain and muscle strength. J Urol 2000; 163: 187–90.

    Article  PubMed  Google Scholar 

  25. Benedetti F, Vighetti S, Ricco C, et al. Pain threshold and pain tolerance in Alzheimer’s disease. Pain 1999; 80: 377–82.

    Article  PubMed  CAS  Google Scholar 

  26. Scherder E, Oosterman J, Swaab D, et al. Recent developments in pain in dementia. BMJ 2005; 330: 461–4.

    Article  PubMed  Google Scholar 

  27. Bergman S. Management of musculoskeletal pain. Best Pract Res Clin Rheumatol 2007; 21: 153–66.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Clinics of Internal Medicine and Geriatrics, Helsinki University Central Hospital, POB 340, FI-00029 HUS, Helsinki, Finland

    Mikko Björkman MD (Researcher) & Reijo Tilvis

  2. Department of Long-Term Care,Helsinki Health Center, Laakso Hospital, Helsinki, Finland

    Antti Sorva

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  1. Mikko Björkman MD
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  2. Antti Sorva
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  3. Reijo Tilvis
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Correspondence to Mikko Björkman MD.

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Björkman, M., Sorva, A. & Tilvis, R. Vitamin D supplementation has no major effect on pain or pain behavior in bedridden geriatric patients with advanced dementia. Aging Clin Exp Res 20, 316–321 (2008). https://doi.org/10.1007/BF03324862

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  • DOI: https://doi.org/10.1007/BF03324862

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