Article Figures & Data
Tables
- Table 1.
Summary of Patient Data: Demographics, Brief Description of Patients, Vitamin D Levels Before and After, and Result of Repletion Therapy
Patient # Age (years) Gender 25(OH)D Levels Before Treatment (nmol/l)* Patient Description§ Symptoms Vitamin D3 Dose Used to Treat (IU/d) 25(OH)D Level After Repletion (nmol/l)‖ Symptom Improvement/Comments 1 75 Female N/A (estimated at 66)† Pain began after a slip and fall and had persisted for several years. An X-ray showed osteoarthritis of the lumbar spine. Vitamin D was increased to 2000 IU daily and the husband noticed a significant improvement in mood. Chronic low back pain 1000 91 Some improvement and less use of pain medications. 2 47 Male N/A (estimated at 70)†‡ This patient had a long history of back pain. He required disc surgery and initially had improvement, but symptoms returned within 6 months. His pain became progressively worse: he had to curtail his usual activities and was no longer able to do yard work or play golf. He used medication for pain control. He was advised that occasionally pain like this can be from insufficiency of vitamin D. A 25(OH)D level was not obtained before treatment. Patient was able to return to his usual activities and had no further back pain. He no longer required any pain medications. Severe back pain 2000 120 Complete resolution of pain in 4 weeks, no further need for pain medication. Patient stopped the vitamin D for several months and his pain returned only to disappear again after restarting vitamin D. 3 44 Female 49 This patient had significant back pain for years She was not able to do housework, such as washing the floor or vacuuming, and had other members of the family do this work. She found it difficult to work because of back spasms when she sat for too long and had to do stretching exercises almost every hour. She was not able to participate in some sports activities that she previously enjoyed. Her symptoms of back pain and spasms completely resolved within 3 weeks and she is able to do her housework, sit for longer periods of time without stretches, and participate in sports. Her mood markedly improved and she considers Vitamin D her happy pill, as does her husband. Chronic severe back pain Muscular pain 5000 171 Complete resolution of pain within 3 weeks; no further need for pain medications. 4 30 Female 18 This patient had significant back pain, which had become worse after pregnancy (a known risk factor for vitamin D deficiency). She was not able to work for a number of years. Each morning she had difficulty getting out of bed because of severe back pain. Her pain was only partially controlled with medication. She was found to have a severe deficiency of vitamin D and her back pain improved within 3 to 4 weeks with 2000 IU of vitamin D; it completely resolved within 6 weeks. She was able to return to work and has been gainfully employed. Her mood improved significantly. Disabling chronic back pain 2000 72 (did not achieve normal levels even with 2000 IU daily) Complete resolution of pain; no further need for pain medication 5 63 Male 20 This patient had a history of four back operations for disc protrusion. The last one was in 1993. His diagnosis was failed back surgery and he was on long-term disability and had to attend a pain management clinic. He was found to be severely deficient in vitamin D. His symptoms completely resolved after six weeks on 4000IU of vitamin D after years of having pain. He was able to reduce his medication but was not able to come off it completely, because of withdrawal headaches and a long history of migraines. He is slowly tapering his pain medications. Failed back surgery 4000 87 Complete resolution of pain in 6 weeks 6 52 Male 29 This patient had 2 surgeries for lumbar discs. He developed chronic low back pain after the operations, which never resolved despite using all modalities listed above. He was found to be vitamin D deficient and initially was supplemented with 2000 IU of vitamin D, with no improvement of his symptoms. His vitamin D level was still suboptimal despite taking this dose. The dose was increased to 4000 IU and there was some improvement in pain but it did not completely resolve; he continues to be on pain medication. Failed back surgery 2000 77 (did not achieve normal levels even with 2000 IU daily) Some improvement but continued need for pain medication. * Normal value is >80 nmol/l; insufficient value is <80 nmol/l; deficiency is <25 nmol/l.
† Barger-Lux, MJ, et al. Vitamin D and its major metabolites: serum levels after graded oral dosing in healthy men. Osteoporos Int 1998;8:222–30.
‡ A rough estimate of this patient's level before treatment was 65 to 70 nmol/l (400 IU of vitamin D/day will raise levels from 7 to 11 nmol/l), or about 2.5 nmol per 100 IU of vitamin D.
§ All patients had tried various pain treatments, including physiotherapy, visiting a chiropractor, acupuncture, or visit to a pain management clinic, all without much benefit.
‖ Levels were taken 6 to 12 months after treatment.
