Vitamin D supplementation attenuates oxidative stress in paraspinal skeletal muscles in patients with low back pain

Background: Vitamin D has a significant role to play in bone metabolism and neuromuscular function. Several researchers have indicated that Vitamin D deficiency may be possibly related to chronic musculoskeletal pain including chronic low back pain (CLBP). Objectives: The present study was conducted to determine the prevalence of hypovitaminosis D and its contribution to chronic lower back pain. Study Design: Controlled study Setting: Outpatient pain clinic of tertiary care hospital. Methods: Data presented in this manuscript are from patients who were screened for inclusion in an open label, single arm clinical trial aimed to assess the effectiveness of vitamin D supplementation in patients with CLBP. Consecutive patients visiting the outpatient pain clinic of a tertiary care hospital with a diagnosis of CLBP with or without leg pain were recruited. A visual analogue scale (VAS) was used to measure low back pain intensity, and the Modified Oswestry disability questionnaire (MODQ) was used to measure functional ability. Plasma 25-OHD levels of all patients were measured and the prevalence of hypovitaminosis D was calculated. The multivariate logistic regression model was used to investigate the association between vitamin D deficiency and patient characteristics. Results: A total of 328 patients were included in the study. Mean age of the study population was 43.8 years. Two hundred eighty-two (86%) (men 153/172 [89%], women 129/156 [83%]) of patients had below normal plasma vitamin D levels. Among these, 217 (66%) (men 126 [73%], women 91 [58%]) were found to be deficient and 65 (20%) (men 27 [16%], women 38 [24%]) were had insufficient levels. Multivariate regression analysis found that men were significantly more prone to have deficiency as compared to women (OR = 1.78 (1.10 – 2.88), P = 0.02). We also found a significantly positive relationship between vitamin D deficiency and increased functional disability (OR = 1.53 (1.24 – 1.87), P = 0.01). However, we did not find any relationship with pain severity, presence of other co-morbidities and educational level. Limitations: Not possible to access a good quality data on sun exposure and vitamin D dietary inake dieat in study population. No bone scans were performed. Conclusion: The result of this study provides a message about the high prevalence of hypovitaminosis D in the Indian CLBP population. Clinical guidelines for managing CLBP should include assessment of vitamin D status, together with advice on appropriate vitamin D supplementation in those found to be deficient. Clinical trial registration: CTRI/2014/03/004459 Key words: Chronic low back pain, disability, hypovitaminosis D, India, pain severity, prevalence, vitamin D, visual analogue scale

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Is Vitamin D Supplementation Effective for Low Back Pain? A Systematic Review and Meta-Analysis

January 2018 - Pain Physician ◽

10.36076/ppj.2018.2.121 ◽

2018 ◽

Vol 1 (21;1) ◽

pp. 121-145 ◽

Cited By ~ 13

Author(s):

Joshua Robert Zadro

Keyword(s):

Systematic Review ◽

Vitamin D ◽

Low Back Pain ◽

Back Pain ◽

Meta Analysis ◽

Vitamin D Supplementation ◽

Low Back ◽

Pharmacological Interventions ◽

Meta Analyses

Background: Low back pain (LBP) is the leading cause of years lived with disability worldwide. Current intervention strategies are failing to reduce the enormous global burden of LBP and are prompting researchers to investigate alternative management strategies, such as vitamin D supplementation. Vitamin D supplementation appears to down regulate pro-inflammatory cytokines which lead to pain and up regulate anti-inflammatory cytokines that reduce inflammation. These mechanisms might explain the increasing interest in the use of vitamin D supplementation for LBP. Objectives: To determine whether vitamin D supplementation improves pain more than a control intervention for individuals with LBP. Study Design: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Methods: We performed searches in numerous electronic databases combining key words relating to “vitamin D” and “LBP” until March 2017. Studies were included if they investigated vitamin D supplementation in participants with LBP, provided there was a comparison intervention. There was no restriction on the type of LBP, the intervention parameters investigated, or the type of clinical trial (e.g., randomized, non-randomized). Two reviewers independently performed the selection of studies, extracted data, rated the methodological quality of the included studies, and evaluated the overall quality of the evidence using the Grading of Recommendations Assessment, Delevopment, and Evaulation (GRADE) approach. Results: After screening 3,534 articles, 8 clinical trials were included in this systematic review. There is very low quality evidence (based on the GRADE approach) that vitamin D supplementation is not more effective than any intervention (including placebo, no intervention, and other conservative/ pharmacological interventions) (continuous pain measures [0–100]: mean difference [MD] = -2.65, 95% confidence interval [CI]: -10.42 to 5.12, P = 0.504, n = 5; self-reported reduction in pain: pooled odds ratio [OR] = 1.07, 95% CI: 0.35 to 3.26, P = 0.906, n = 5) or placebo/no intervention for individuals with LBP (continuous pain measures: MD = 1.29, 95% CI: -3.81 to 6.39, P = 0.620, n = 4; self-reported reduction in pain: pooled OR = 1.53, 95% CI: 0.38 to 6.20, P = 0.550, n = 4), where ‘n’ is the number of studies included in the meta-analysis. These results did not change when we stratified the meta-analyses by the type of vitamin supplementation (vitamin D3 vs. alfacalcidol) or the type of LBP (non-specific vs. LBP resulting from osteoporosis or vertebral fractures). Limitations: The overall quality of evidence was “very low” due to the poor methodological quality and small sample sizes of the included studies. Conclusions: Vitamin D supplementation is not more effective than placebo, no intervention, or other conservative/pharmacological interventions for LBP (based on very low quality evidence). These results are consistent, regardless of the type of LBP or vitamin D supplementation. Until well-designed and adequately powered clinical trials suggest otherwise, the prescription of vitamin D for LBP cannot be recommended. PROSPERO Registration No: CRD42016046874. www.crd.york.ac.uk/PROSPERO/display_record. asp?ID = CRD42016046874 Key words: Vitamin D, low back pain, chronic low back pain, alfacalcidol, osteoporosis, vertebral fractures, serum 25-hydroxyvitamin D, systematic review

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Vitamin D Supplementation in Patients with Chronic Low Back Pain: An Open Label, Single Arm Clinical Trial

January 2018 - Pain Physician ◽

10.36076/ppj.2017.1.e99 ◽

2017 ◽

Vol 1 (21;1) ◽

pp. E99-E105 ◽

Cited By ~ 14

Author(s):

Babita Ghai

Keyword(s):

Vitamin D ◽

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Functional Disability ◽

Vitamin D Supplementation ◽

Low Back ◽

Open Label ◽

Time Intervals ◽

Vitamin D Levels

Background: Vitamin-D deficiency may possibly be related to chronic low back pain (CLBP). Objective: The study is aimed to assess the impact of vitamin-D supplementation on pain intensity, functional disability, and vitamin-D levels in patients with CLBP. Study Design: Single arm open-label study. Setting: Outpatient pain clinic of a tertiary care hospital. Methods: Sixty-eight eligible patients (CLBP for ≥ 3 months, pain score ≥ 50 on visual analogue scale (VAS) and plasma 25-Hydroxyvitamin D3 levels < 30 ng/mL) were enrolled. Patients were supplemented with 60,000 IU of oral vitamin-D3 given every week for 8 weeks. Efficacy parameters included pain intensity and functional disability measured by VAS and modified Oswestry disability questionnaire (MODQ) scores at baseline, 2, 3, and 6 months post-supplementation. Plasma 25(OH) D3 levels were measured at baseline and 8 weeks. Results: Baseline mean (SD) vitamin-D levels were 12.8 (5.73) ng/mL and increased to 36.07 (12.51) post supplementation (P < 0.01). Forty-five (66%) patients attained normal levels (> 29 ng/mL) post supplementation. Significant reduction in VAS was observed at 2, 3, and 6 months [61 (19), 45 (19), 36 (18)] as compared to 81 (19) at baseline (P ≤ 0.001 at all-time intervals). A significant improvement in the functional ability was also observed at 2, 3, and 6 months [36 (12), 31 (13), and 26 (10)] as compared to baseline 45 (16) (P ≤ 0.001 at all-time intervals). Conclusion: Vitamin-D supplementation in deficient CLBP patients may lead to improvement in pain intensity and functional ability apart from normalization of the levels. Future controlled clinical trials are required to confirm the hypothesis. Key words: Vitamin D, deficiency, screening, low back pain, chronic, supplementation

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Mapping the Association between Vitamin D and Low Back Pain: A Systematic Review and MetaAnalysis of Observational Studies

January 2018 - Pain Physician ◽

10.36076/ppj/2017.7.611 ◽

2017 ◽

Vol 7 (20;7) ◽

pp. 611-640

Author(s):

Joshua Zadro

Keyword(s):

Vitamin D ◽

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Vitamin D Deficiency ◽

Vitamin D Supplementation ◽

Low Back ◽

Cross Sectional ◽

Hydroxyvitamin D ◽

Vitamin D Levels

Background: Low back pain (LBP) is the highest contributor to disability worldwide, with current intervention strategies only providing small to moderate analgesic effects. The use of vitamin D supplementation for LBP has gained interest due to its proposed anti-inflammatory and neuromodulatory properties. However, it is still unclear whether vitamin D levels differ between those with and without LBP or if vitamin D levels are associated with pain intensity. Objectives: We aim to investigate the association between vitamin D levels and LBP and to determine if vitamin D levels correlate with pain intensity in individuals with LBP. Study Design: This study was conducted in accordance with the guidelines for performing a Metaanalysis and Systematic Review Of Observational Studies in Epidemiology (MOOSE). Methods: We performed electronic database searches combined keywords relating to vitamin D and LBP in MEDLINE, CINAHL, EMBASE, AMED, WEB OF SCIENCE, and SCOPUS from the earliest record to March 2017. Studies were included if they reported any quantitative measure of vitamin D, such as serum 25-hydroxyvitamin D [25(OH)D], with adequate data in patients with and without LBP or adequate data on pain intensity in patients with LBP. No restriction on the type or duration of LBP, nor the age and gender of patients was applied. Two reviewers independently performed the selection of studies, extracted data, and assessed the methodological quality of the included studies using a modified 15-item Downs and Black checklist. Results: After the removal of duplicates and the screening of titles and abstracts, 105 full texts were evaluated. There were 29 articles included in this systemic review (22 entered into a meta-analysis), including 19 cross-sectional studies, 9 case-control studies, and one single-arm surgical trial where the pre-operative data were used in our analyses. The pooled results from 19 studies showed that individuals with LBP were more likely to have vitamin D deficiency (pooled OR = 1.60, 95% CI: 1.20 - 2.12, P = 0.001, n = 19), severe deficiency (pooled OR = 2.08, 95% CI: 1.19 - 3.64, P = 0.010, n = 7), and lower serum concentrations of 25(OH)D (weighted MD = 3.86, 95% CI: 0.20 - 7.52, P = 0.039, n = 12) compared to those without LBP (where “n” is the number of studies). The association between vitamin D deficiency (pooled OR = 1.83, 95% CI: 1.26 - 2.66, P = 0.002, n = 9) or serum 25(OH)D (weighted MD = 7.64, 95% CI: 4.02 - 11.26, P < 0.001, n = 4) and LBP was stronger for women but failed to be statistically significant for men (pooled OR = 1.06, 95% CI: 0.62 - 1.81, P = 0.213, n = 3). In addition, there were strong associations between vitamin D deficiency and LBP in patients < 60 years old (particularly women). We found minimal evidence to support an association between vitamin D levels and pain intensity in patients with LBP. Limitations: We were unable to investigate whether vitamin D deficiency increases the risk of developing LBP as there were no longitudinal studies included in this review. Conclusion: Vitamin D deficiency is associated with LBP, with stronger associations observed in younger women and those with severe levels of deficiency. The association between vitamin D levels and pain intensity is inconsistent. These results may guide the implementation of future studies on vitamin D supplementation for LBP. PROSPERO Registration No: CRD42016046874. Key words: Vitamin D, low back pain, deficiency, pain intensity, serum 25-hydroxyvitamin D, supplementation, cross-sectional study, case-control study

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Effect of Core Stability Exercise and Vitamin D Intake on Liver Enzymes Activities in Women With Chronic Low Back Pain

The Journal of Qazvin University of Medical Sciences ◽

10.32598/jqums.24.4.2 ◽

2020 ◽

Vol 24 (4) ◽

pp. 332-345

Author(s):

Seyyed Javad Hashemi Sangatrashani ◽

◽

Masoumeh Habibian ◽

Seyyed Jafar Moosavi ◽

◽

...

Keyword(s):

Vitamin D ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Liver Enzymes ◽

Vitamin D Supplementation ◽

Core Stability ◽

Low Back ◽

Vitamin D Intake ◽

Combined Intervention

Background: Deficiency or insufficient level of vitamin D is very common in patients with liver disease, and is closely related to musculoskeletal pains, including low back pain. Objective: The current study aims to investigate of the activity of liver enzymes in women with chronic low back pain following core stability exercises and vitamin D intake. Methods: This clinical trial was conducted on 48 women (Mean±SD of age=36.59±5.50 years) in 2019 selected by using a convenience sampling method. They were randomly divided into four groups of control, vitamin D, exercise and combined (exercise +vitamin D). The last two exercise groups performed 8 weeks of core stability exercises with different intensities. The vitamin D and combined groups received 50,000 IU/week of vitamin D for 8 weeks. Alanine aminotransferase (ALT), Aspartate aminotransferase (AST) and Alkaline phosphatase (ALP) activities were measured before and after the interventions. Data were analyzed by using paired t-test and one-way ANOVA. Findings: Eight weeks of core stability exercises, vitamin D intake, and the combined exercise and vitamin D supplementation caused a significant reduction in the activity of AST, ALT, and ALP enzymes. The combined intervention induced more reduction in the AST and ALP activities compared to other two groups received exercise and supplementation alone, and the decrease in ALT activity following the combined intervention was higher compared to the exercise group. Conclusion: It seems that the core stability exercises, vitamin D intake, and combination of exercise and vitamin D supplementation can improve liver function in women with chronic low back pain who have vitamin D deficiency by reducing the activity of liver enzymes. The combined intervention has greater effectiveness in improving liver function.

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Correlation of Vitamin D and Body Mass Index with Modic Changes in Patients with Non-Specific Low Back Pain in a Sub-Tropical Asian Population

Asian Spine Journal ◽

10.4184/asj.2016.10.1.14 ◽

2016 ◽

Vol 10 (1) ◽

pp. 14 ◽

Cited By ~ 5

Author(s):

Anoop Mattam ◽

George Sunny

Keyword(s):

Body Mass Index ◽

Vitamin D ◽

Low Back Pain ◽

Back Pain ◽

Body Mass ◽

Asian Population ◽

Modic Changes ◽

Low Back

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Assessment of Vitamin D Levels in Patients Presenting With Chronic Low Back Pain at a Tertiary Care Hospital

Cureus ◽

10.7759/cureus.11867 ◽

2020 ◽

Author(s):

Mukesh Kumar ◽

Masroor Ahmed ◽

Ghulam Hussain ◽

Muhammad Bux ◽

Naveed Ahmed ◽

...

Keyword(s):

Vitamin D ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Low Back ◽

Vitamin D Levels

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Vitamin D Deficiency Is Associated with Muscle Atrophy and Reduced Mitochondrial Function in Patients with Chronic Low Back Pain

Oxidative Medicine and Cellular Longevity ◽

10.1155/2019/6835341 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 10

Author(s):

Katarzyna Patrycja Dzik ◽

Wojciech Skrobot ◽

Katarzyna Barbara Kaczor ◽

Damian Jozef Flis ◽

Mateusz Jakub Karnia ◽

...

Keyword(s):

Vitamin D ◽

Low Back Pain ◽

Back Pain ◽

Protein Content ◽

Vitamin D Deficiency ◽

Muscle Atrophy ◽

Mitochondrial Function ◽

Chronic Low Back Pain ◽

Low Back ◽

Multifidus Muscle

Recent studies show that vitamin D deficiency may be responsible for muscle atrophy. The purpose of this study was to investigate markers of muscle atrophy, signalling proteins, and mitochondrial capacity in patients with chronic low back pain with a focus on gender and serum vitamin D level. The study involved patients with chronic low back pain (LBP) qualified for posterior lumbar interbody fusion (PLIF). Patients were divided into three groups: supplemented (SUPL) with vitamin D (3200 IU/day for 5 weeks), placebo with normal levels of vitamin D (SUF), and the placebo group with vitamin D deficiency (DEF). The marker of muscle atrophy including atrogin-1 and protein content for IGF-1, Akt, FOXO3a, PGC-1α, and citrate synthase (CS) activity were determined in collected multifidus muscle. In the paraspinal muscle, IGF-1 levels were higher in the SUF group as compared to both the SUPL and DEF groups (p<0.05). In the SUPL group, we found significantly increased protein content for pAkt (p<0.05) and decreased level of FOXO3a (p<0.05). Atrogin-1 content was significantly different between men and women (p<0.05). The protein content of PGC-1α was significantly higher in the SUF group as compared to the DEF group (p<0.05). CS activity in the paraspinal muscle was higher in the SUPL group than in the DEF group (p<0.05). Our results suggest that vitamin D deficiency is associated with elevated oxidative stress, muscle atrophy, and reduced mitochondrial function in the multifidus muscle. Therefore, vitamin D-deficient LBP patients might have reduced possibilities on early and effective rehabilitation after PLIF surgery.

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