Low vitamin D status can be a source of chronic low back pain. As early as 2003, supplementation of Vitamin D has demonstrated an option for relief that has yet to become a commonly known solution before other, more costly options (Al Faraj & Al Mutairi, 2003). Indian and Saudi populations have been studied and the correlation between low vitamin D status and low back pain has been observed (greater than 83% in those studied) as well as significantly positive relationships between vitamin D deficiency and increased functional disability (Ghai et al., 2015). These populations may be at higher risk due to dark skin and clothing that offers complete blocking of the sun’s rays. It is important to be mindful of the higher risk of Vitamin D associated back pain in these populations, as well as the elderly, obese, and homebound populations, or those living in northern latitudes (Gaby, 2011).
Those with low vitamin D levels and concurrent low back pain may need higher doses of Vitamin D than available in common multivitamins to experience relief. Al Faraj and Al Mutairi dosed oral 25-OH cholecalciferol to patients according to weight, offering their patients several thousand IUs of Vitamin D3 daily. After three months of treatment, clinical improvement in symptoms was seen in all the groups with low levels of vitamin D. Schwalfenber’s case series (2009) also showed that patients with chronic low back pain or failed back surgery who made the most significant improvement were dosed at 4000 to 5000 IU of vitamin D3/day. Some saw improvement in as short as 4 weeks’ time.
Vitamin D deficiency may be a major contributor to chronic low back pain in areas where vitamin D deficiency is endemic. It is especially critical for the patient-centered surgeon and chiropractor to check the patient’s vitamin D status in high risk populations to avoid unnecessary, complex, and higher cost options as an immediate solution. Al Faraj & Al Mutairi (2015) write that screening for vitamin D deficiency and treatment with supplements is nothing less than mandatory when vitamin D deficiency presents alongside chronic low back pain.
Because Vitamin D is stored in fatty tissue and has complex interactions with other vitamins and minerals it is important to monitor your Vitamin D status regularly, especially if you are taking high doses. The doses mentioned in these studies are not intended to be used as a daily maintenance dose, but rather a dose to bring one from deficiency to stability, at which point a lower dose is utilized to maintain adequate vitamin D status.
Resources:
Al Faraj S. & Al Mutairi K. Vitamin D deficiency and chronic low back pain in Saudi Arabia. (2003) Spine,15, 28(2), 177-9.
Gaby, A.R. (2011). Chapter 161: Back Pain. Nutritional Medicine (pp. 621). Concord, NH: Fritz Perlberg Publishing.
Ghai B., Bansal D., Kapil G., Kanukula R., Lavudiya S., & Sachdeva N. High Prevalence of Hypovitaminosis D in Indian Chronic Low Back Patients. (2015) Pain Physician, 18(5), E853-62.
Schwalfenberg, G. (2009) Improvement of Chronic Back Pain or Failed Back Surgery with Vitamin D Repletion: A Case Series. Journal of the American Board of Family Medicine, 22(1), 69-74
