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. 2024 Nov 3;38(6):2955–2967. doi: 10.21873/invivo.13778

Updated Meta-analysis Reveals Limited Efficacy of Vitamin D Supplementation in Chronic Low Back Pain

TSAI-JEAN LEE 1, RU-YIN TSAI 2,3, CHI-CHUNG HO 4,5, CHIEN-MIN CHEN 6, CHEN-PI LI 7,8
PMCID: PMC11535934  PMID: 39477425

Abstract

Background/Aim

Chronic low back pain (CLBP) significantly reduces quality of life and increases reliance on healthcare resources. Despite many individuals opting for vitamin D supplementation to alleviate CLBP, its efficacy remains debatable. This meta-analysis aimed to evaluate the potential benefits of vitamin D supplementation in treating this condition.

Patients and Methods

Adhering to PRISMA guidelines, we systematically reviewed the effectiveness of vitamin D supplementation in adults with CLBP, focusing exclusively on randomized controlled trials (RCTs). A comprehensive literature search was conducted up to May 2024 across multiple databases, including PubMed, Scopus, Cochrane Library, and Web of Science.

Results

Ten RCTs meeting our inclusion criteria were analyzed. The results indicated that vitamin D supplementation did not significantly reduce pain scores compared to control groups (SMD: –0.130, 95%CI=–0.260 to 0.000; I²=0%), regardless of participants’ baseline vitamin D levels. Moreover, long-term supplementation showed no notable improvement in CLBP outcomes (SMD: –0.097, 95%CI=–0.290 to –0.097; I²=19.878%). Additionally, supplementation with active forms of vitamin D (SMD: –0.321, 95%CI=–0.670 to 0.028; I2=0.000%) did not result in significant pain relief for chronic lower back pain.

Conclusion

Vitamin D supplementation does not substantially alleviate CLBP. Nevertheless, it may still be considered as part of a comprehensive treatment plan. Further research is necessary to explore its long-term effects and the underlying mechanisms that may explain the observed lack of benefit.

Keywords: Chronic pain, analgesic, pain management, spinal pain, back ache

Chronic low back pain (CLBP) is a prevalent condition that significantly impairs quality of life and places a substantial burden on healthcare systems around the world (1). It is characterized by persistent pain and disability, often leading to reduced physical activity and productivity, as well as increased reliance on healthcare services (1,2). Despite various treatment options, effective management of CLBP remains challenging due to its multifactorial etiology and the complex interplay of physical, psychological, and social factors (3).

Recent research has explored the potential role of Vitamin D in the management of chronic pain conditions (4), including CLBP (5). Vitamin D, primarily known for its role in bone health and calcium homeostasis, has been implicated in various biological processes, including modulation of the immune response and inflammation, which are relevant to pain mechanisms (4). Some studies suggest that Vitamin D deficiency may be associated with increased pain sensitivity and chronic pain syndromes (5,6). A systematic review concluded that among generally healthy older adults with adequate vitamin D levels who were not specifically selected for vitamin D deficiency, low bone mass, or osteoporosis, daily supplementation with 2,000 IU of vitamin D did not provide any musculoskeletal health benefits (7). Burt et al. also found that while moderate doses (4,000 IU/day) may have beneficial effects, excessive supplementation can lead to negative outcomes, such as decreased bone density and increased risk of fractures (8). Thus, the benefits of vitamin D supplementation remain debatable. For patients with CLBP, it is still unclear whether vitamin D supplementation provides any improvement in pain management.

A previous meta-analysis addressed this topic (9); however, we have updated the analysis by including only randomized controlled trials (RCTs), adding five additional RCTs, and examining the effectiveness of active vitamin D supplementation in improving CLBP. We will perform a systematic review and meta-analysis of RCTs to assess the efficacy of vitamin D supplementation in adults with CLBP. By analyzing current evidence, we aimed to determine whether vitamin D offers significant pain relief and its potential role as a non-analgesic option in comprehensive treatment plans. Given the mixed results of previous studies, further examination of long-term effects and underlying mechanisms is necessary to guide clinical practice and future research.

Patients and Methods

The study protocol was a priori registered in the international prospectively register of systematic reviews (PROSPERO; registration code CRD42024556217).

Data sources and selection criteria. We conducted a systematic search for RCTs evaluating the effects of Vitamin D on individuals with CLBP. Our comprehensive search spanned multiple databases, including PubMed, Scopus, Cochrane Library, and Web of Science, up to May 2024. The search strategy included keywords such as “Vitamin D”, “calcitriol”, “alfacalcidol”, “chronic low back pain”, “chronic lower back pain”, “low back pain”, “lower back pain”, “spinal pain”, “lumbago”, and “back ache” focusing exclusively on clinical trials involving human participants. We adhered strictly to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in our methodology (10). Identified articles were meticulously reviewed, including their bibliographies, to uncover additional relevant studies. We included only studies published in English and excluded case reports, technical reports, conference papers, reviews, letters, editorials, and laboratory-based research.

Selection of studies. The study screening and selection process was independently performed by two researchers, CPL, and CMC, with verification by a third researcher, RYT. All relevant articles were obtained in hard copy and thoroughly reviewed for detailed analysis. The study selection process is depicted in the PRISMA flow diagram (Figure 1). Studies were required to fulfill the following eligibility criteria: a) Eligibility was limited to RCTs. b) Studies involving patients with CLBP were deemed eligible regardless of the cause, duration, intensity, or radiation pattern of the pain. There were no age restrictions. c) Studies were eligible if they compared vitamin D treatment with either a placebo or no treatment. d) Studies were excluded if vitamin D was included as part of a combination therapy rather than being the primary intervention.

Figure 1.

Figure 1

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Diagram of the study selection process for the systematic review and meta-analysis.

Data extraction and outcomes. Data extraction was independently conducted by authors CPL and RYT using a standardized template following the Cochrane Handbook guidelines. Extracted data included study author names, publication year and country, inclusion criteria, participant demographics (number and age), study design, intervention details, and outcome measures and their assessment methods. The primary outcome analysis focused on pain scale assessments. Subgroup analysis included the duration of the intervention.

Risk of bias in individuals. Two independent researchers, CPL and CCH, thoroughly assessed the potential biases in the included studies using the Cochrane Collaboration’s Risk of Bias tool. Any discrepancies in their assessments were carefully resolved through discussions with a third reviewer, RYT, to reach a consensus. Studies were classified as having a high risk of bias if they showed issues in one or more domains specified by this assessment framework.

Data analysis. Data from each included study were analyzed by calculating the Standard Mean Difference (SMD) and 95% confidence intervals (CIs) to compare outcomes between the intervention and placebo groups. These SMDs were then combined using a random-effects model to account for variability across studies. All statistical analyses were conducted with Comprehensive Meta-Analysis software, version 3. Heterogeneity was evaluated using the I² statistic, where values over 50% indicated substantial heterogeneity. Publication bias was assessed through funnel plots and Egger’s regression test, with a significance level of p<0.05 for most analyses, and a threshold of p<0.10 for publication bias. Subgroup analyses were carried out to identify sources of heterogeneity, and sensitivity analyses were performed by systematically excluding individual studies to evaluate the stability of the overall results.

Results

Study search and characteristics of included patients. The trial screening and selection process is illustrated in Figure 1. We initially conducted a comprehensive search of four databases (PubMed, Scopus, Cochrane Library, and Web of Science) and employed an additional resource, the ‘related articles’ feature in PubMed. This search strategy yielded 2,494 trials. After eliminating duplicates, we screened the titles and abstracts of 650 trials, which resulted in the exclusion of 633 trials. We then performed an in-depth full-text review of the remaining 17 trials, which led to the further exclusion of six trials due to unrelated outcomes (11), non-randomized controlled trials (12-14), or comorbid diseases (15-17). Consequently, our meta-analysis incorporated ten articles (18-27). It is important to note that all the included studies were published in English. Table I presents a summary of the key characteristics of the considered trials. These ten trials, published between 1994 and 2017, involved a total of 1,008 participants, with the number of participants in each trial ranging from 28 to 233. Of these selected randomized controlled trials, nine employed a double-blind methodology and one was an open-label study. Table I provides detailed information about the demographics of the participants and the methodologies of the studies.

Table I. Summary of randomized placebo-controlled trials of honey for radiation-induced oral mucositis.

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BMD: Bone mineral density; C: control; I: intervention; NTX: N-terminal telopeptides of type I collagen; P: placebo; VAS: Visual Analogue Scale.

Quality assessment. In our meta-analysis, we assessed the risk of bias across the included trials and identified moderate concerns in five separate domains. Among the seven studies scrutinized, two demonstrated significant quality constraints. In particular, six studies were classified as randomized controlled trials, one as an open-labeled study, and three as a three-arm RCT. Nevertheless, we encountered difficulties in the transparency of outcome data, with three studies exhibiting uncertainties in outcome measurement (21,26,27). The consolidated results of the risk of bias evaluation, using the Cochrane Collaboration’s tool, are methodically depicted in Figure 2A and B of our report. These graphical illustrations offer a lucid demarcation of the methodological merits and demerits inherent in our pool of studies.

Figure 2.

Figure 2

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Assessment of methodological quality of the included trials. (A) Risk of bias for each included study. (B) The overall summary of bias of the ten studies.

Impact of vitamin D on CLBP. As illustrated in Figure 3, the forest plot indicates that none of the interventions significantly reduced pain compared to the control group (SMD: –0.130, 95%CI=–0.260 to 0.000; I²=0%, p=0.559). A subgroup analysis was conducted to evaluate the effectiveness of vitamin D in individuals with and without vitamin D deficiency (Figure 4A). The results showed that neither the vitamin D deficient group (SMD: –0.281, 95%CI=–0.541 to –0.021; I²=0%, p=0.841) nor the non-deficient group (SMD: –0.080, 95%CI=–0.234 to –0.073; I²=3.584%, p=0.394) experienced a significant reduction in pain compared to the placebo. Furthermore, an additional subgroup analysis revealed that neither short-term (SMD: –0.192, 95%CI=–0.396 to –0.011; I²=0%, p=0.709) nor long-term use of vitamin D (SMD: –0.097, 95%CI=–0.290 to –0.097; I²=19.878%, p=0.288) significantly mitigated CLBP (Figure 4B). Long-term supplementation did not show a significant benefit over short-term supplementation in terms of pain relief or functional improvement in CLBP. This implies that prolonging the duration of vitamin D supplementation does not improve its efficacy in managing CLBP. Collectively, these findings suggest that vitamin D, regardless of the duration of supplementation, does not significantly alleviate pain in individuals with CLBP.

Figure 3.

Figure 3

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Forest plot of visual analog scale comparison. The horizontal line through the square illustrates the 95% confidence interval, while the diamond symbol summarizes the overall effect size.

Figure 4.

Figure 4

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Displays a forest plot illustrating the subgroup analyses of vitamin D supplementation on chronic low back pain. Panel (A) focuses on the impact of baseline vitamin D deficiency, while Panel (B) examines the effect of varying treatment durations. The horizontal line through the square illustrates the 95% confidence interval, while the diamond symbol summarizes the overall effect size. Y: Yes; N: No.

Active vitamin D effect on CLBP and supplementation time analysis. Our examination of the incorporated RCTs indicated that neither supplementation with active forms of vitamin D (such as calcitriol or alfacalcidol; SMD: –0.321, 95%CI=–0.670 to 0.028; I²=0.000%, p=0.398) nor non-active forms of vitamin D (SMD: –0.099, 95%CI=–0.239 to 0.041; I²=0.000%, p=0.575) significantly diminished pain scores in patients suffering from CLBP in comparison to control groups (Figure 5A). This was consistent across various baseline levels of vitamin D among participants. Figure 5B illustrates that neither active nor non-active forms of vitamin D, regardless of the duration of supplementation, offer significant pain relief for individuals afflicted with CLBP. Long-term use of active vitamin D (SMD: –0.321, 95%CI=–0.670 to 0.028; I²=0.000%, p=0.398), as well as both short-term (SMD: –0.192, 95%CI=–0.396 to 0.011; I²=0.000%, p=0.709) and long-term (SMD: –0.015, 95%CI=–0.209 to 0.179; I²=0.624%, p=0.366) use of non-active vitamin D, did not demonstrate notable effectiveness in alleviating CLBP.

Figure 5.

Figure 5

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Forest plot depicting the subgroup analyses specifically for the active form of vitamin D in the context of chronic low back pain. Panel (A) assesses the overall impact of active vitamin D supplementation, and Panel (B) evaluates the outcomes based on the duration of active vitamin D treatment. The horizontal line through the square illustrates the 95% confidence interval, while the diamond symbol summarizes the overall effect size. Y: Yes; N: No.

Publishing bias. Egger’s regression analysis revealed that there was no significant publication bias present in our dataset (p=0.46684). Funnel plots, which depict the Standard Mean Difference for the effectiveness of non-pharmacological apical aromatherapy in alleviating CLBP, are presented in Figure 6.

Figure 6.

Figure 6

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Funnel plot summarizing the findings from all studies included.

Discussion

The primary aim of this meta-analysis was to evaluate the efficacy of vitamin D supplementation in alleviating CLBP. Our comprehensive search and selection process yielded ten RCTs, involving 1,008 participants, which were subjected to rigorous quality assessment and bias analysis. The overall findings suggest that vitamin D supplementation, whether in active or non-active forms, does not significantly alleviate pain in individuals with CLBP, regardless of their baseline vitamin D levels or the duration of supplementation.

Vitamin D supplementation has garnered significant interest as a potential treatment for chronic widespread pain and fibromyalgia syndrome. These conditions are characterized by persistent, diffuse musculoskeletal pain and reduced pain thresholds, significantly impairing quality of life. Previous studies have suggested potential benefits of vitamin D in pain management (28-30), particularly in conditions associated with low vitamin D levels (31). However, our findings align with recent literature questioning the efficacy of vitamin D supplementation for chronic pain conditions (12). For instance, studies found no significant improvement in musculoskeletal pain with vitamin D supplementation (9,32). Similarly, our results are consistent with a meta-analysis by Gaikwad et al. (27), which reported minimal impact of vitamin D on chronic pain outcomes. Together, we suggest that vitamin D supplementation should not be considered a primary intervention for CLBP. While vitamin D is crucial for overall health and maintaining bone density, its role in pain management appears limited. Clinicians should consider other evidence-based non-pharmacological and pharmacological treatments for managing CLBP. However, vitamin D supplementation may still be beneficial as part of a comprehensive treatment plan, particularly for patients with confirmed deficiency or other indications for its use.

Moreover, the lack of significant pain reduction observed in our meta-analysis raises questions about the underlying mechanisms and biological plausibility of vitamin D’s role in pain management. Vitamin D is known to play a crucial role in bone health, immune function, and inflammation regulation. However, its direct impact on pain pathways, particularly in the context of chronic pain conditions like CLBP, remains unclear. One potential explanation for the observed results is the multifactorial nature of CLBP, which involves complex interactions between biological, psychological, and social factors. Vitamin D supplementation alone may not be sufficient to address the multifaceted etiology of CLBP. Additionally, the dosages and formulations of vitamin D used in the included studies varied, which could have influenced the overall effectiveness of the intervention.

The analysis of the included RCTs provides nuanced insights into the role of vitamin D supplementation in managing CLBP. Our findings indicate that neither active forms of vitamin D (e.g., calcitriol or alfacalcidol) nor non-active forms significantly reduce pain scores in patients with CLBP compared to control groups. This lack of significant effect was consistent across various baseline levels of vitamin D among participants and regardless of the duration of supplementation, as demonstrated by the SMD and confidence intervals. Similarly, Zadro et al., pooled results from three studies (20,22,23) prescribing vitamin D3 for non-specific low back pain showed no beneficial effect on pain intensity compared to placebo, with weighted mean differences indicating non-significant outcomes. The shorter duration of studies with higher vitamin D3 doses precluded a comprehensive assessment of the overall dosage impact on treatment outcomes. For instance, a trial that administered 179 μg of vitamin D3 daily for six weeks—close to the upper intake levels—failed to show benefits for non-specific CLBP. This discrepancy suggests that the target population may be a more critical factor than the overall dosage in future research on vitamin D3 supplementation for non-specific LBP. Although our review did not clearly identify a responsive sub-group, evidence from existing observational studies indicates that younger women with CLBP (<50 years old) may exhibit greater vitamin D deficiency, suggesting they might benefit more from supplementation (33,34). Conversely, the association between vitamin D levels and LBP in older adults (>60 years old) remains conflicting, possibly due to geographical differences (35), as significant associations were reported in studies conducted in the Middle-East or India (34,36). We suggest that future research should prioritize measuring and reporting serum 25(OH)D levels before and after supplementation to better understand the underlying mechanisms. Not all the studies in our review used vitamin D deficiency (<20 ng/ml) as part of the inclusion criteria, though a couple reported baseline serum 25(OH)D concentrations below this threshold. The effect size might depend on pre-existing vitamin D deficiency, emphasizing the importance of this parameter.

Study limitations. First, the included studies varied in terms of dosage, duration, and forms of vitamin D supplementation, which might have introduced heterogeneity into the results. Second, the number of studies included in our meta-analysis was relatively small, which may limit the generalizability of our findings. Third, while we used a comprehensive search strategy and rigorous selection criteria, the limited number of high-quality RCTs and the moderate risk of bias in some studies could affect the robustness of our conclusions. Fourth, the assessment of pain, often subjective, may introduce biases despite the use of standardized measurement tools. Furthermore, the included trials predominantly involved populations from specific geographical regions, potentially limiting the generalizability of our findings.

Future research should focus on larger, well-designed RCTs with standardized protocols to further investigate the role of vitamin D in CLBP. Additionally, exploring the potential mechanisms underlying the observed lack of benefit, such as vitamin D metabolism, receptor polymorphisms, and interactions with other treatments, could provide valuable insights

Conclusion

In conclusion, our meta-analysis indicates that vitamin D supplementation does not significantly alleviate CLBP. Despite the lack of observed efficacy, vitamin D may still be considered as part of a broader, multimodal treatment plan, particularly for individuals with confirmed vitamin D deficiency, for overall health benefits. However, given the limitations of our study and the conflicting results in the literature, future research should aim to elucidate the long-term effects and underlying mechanisms of vitamin D in pain modulation to better understand its role in managing CLBP.

Declaration of Generative AI and AI-assisted Technologies in the Writing Process

During the preparation of this work the authors used chatGPT4 to check grammar and improve the paper’s readability but not to produce any content. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.

Conflicts of Interest

The Authors declare no conflicts of interest in relation to this study.

Authors’ Contributions

Tsai-Jean Lee: Conceptualization, Investigation, Visualization. Ru-Yin Tsai: Data curation, Investigation, Visualization, Writing-original draft, Writing-review and editing. Chi-Chung Ho: Data curation and Visualization. Chien-Min Chen: Validation. Chen-Pi Li: Conceptualization, Data curation, Investigation, Visualization, Writing-original draft.

Acknowledgements

The present study was supported by grants provided by the Chang Gung Memorial Hospital Research Foundation (CMRPG2M0101) and Tungs’ Taichung MetroHarbor Hospital (TTMHH-R1120039).

References

  • 1.Low back pain. Available at: https://www.who.int/news-room/fact-sheets/detail/low-back-pain. [Last accessed on July 15, 2024]
  • 2.Manchikanti L, Singh V, Falco FJ, Benyamin RM, Hirsch JA. Epidemiology of low back pain in adults. Neuromodulation 17 Suppl. 2014;17:3–10. doi: 10.1111/ner.12018. [DOI] [PubMed] [Google Scholar]
  • 3.Quittan M. Management of back pain. Disabil Rehabil. 2002;24(8):423–434. doi: 10.1080/09638280110108850. [DOI] [PubMed] [Google Scholar]
  • 4.Helde-Frankling M, Björkhem-Bergman L. Vitamin D in pain management. Int J Mol Sci. 2017;18(10):2170. doi: 10.3390/ijms18102170. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003;78(12):1463–1470. doi: 10.4065/78.12.1463. [DOI] [PubMed] [Google Scholar]
  • 6.Wu Z, Malihi Z, Stewart AW, Lawes CM, Scragg R. Effect of vitamin D supplementation on pain: A systematic review and meta-analysis. Pain Physician. 2016;19(7):415–427. [PubMed] [Google Scholar]
  • 7.LeBoff MS, Bischoff-Ferrari HA. The effects of vitamin D supplementation on musculoskeletal health: The VITAL and DO-Health trials. J Gerontol A Biol Sci Med Sci. 2023;78(Suppl 1):73–78. doi: 10.1093/gerona/glad073. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Burt LA, Billington EO, Rose MS, Raymond DA, Hanley DA, Boyd SK. Effect of high-dose vitamin D supplementation on volumetric bone density and bone strength: a randomized clinical trial. JAMA. 2019;322(8):736–745. doi: 10.1001/jama.2019.11889. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Zadro JR, Shirley D, Ferreira M, Carvalho Silva AP, Lamb SE, Cooper C, Ferreira PH. Is vitamin D supplementation effective for low back pain? A systematic review and meta-analysis. Pain Physician. 2018;21(2):121–145. [PubMed] [Google Scholar]
  • 10.Ioannidis JP. Integration of evidence from multiple meta-analyses: a primer on umbrella reviews, treatment networks and multiple treatments meta-analyses. CMAJ. 2009;181(8):488–493. doi: 10.1503/cmaj.081086. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Ghai B, Bansal D, Kanukula R, Gudala K, Sachdeva N, Dhatt SS, Kumar V. Vitamin D supplementation in patients with chronic low back pain: An open label, single arm clinical trial. Pain Physician. 2017;20(1):E99–E105. [PubMed] [Google Scholar]
  • 12.Ghai B, Bansal D, Kapil G, Kanukula R, Lavudiya S, Sachdeva N. High prevalence of hypovitaminosis d in indian chronic low back patients. Pain Physician. 2015;18(5):E853–862. [PubMed] [Google Scholar]
  • 13.Majima T, Shimatsu A, Komatsu Y, Satoh N, Fukao A, Ninomiya K, Matsumura T, Nakao K. Effects of risedronate or alfacalcidol on bone mineral density, bone turnover, back pain, and fractures in Japanese men with primary osteoporosis: results of a two-year strict observational study. J Bone Miner Metab. 2009;27(2):168–174. doi: 10.1007/s00774-008-0024-8. [DOI] [PubMed] [Google Scholar]
  • 14.Al Faraj S, Al Mutairi K. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine (Phila Pa 1976) 2003;28(2):177–179. doi: 10.1097/00007632-200301150-00015. [DOI] [PubMed] [Google Scholar]
  • 15.Warner AE, Arnspiger SA. Diffuse musculoskeletal pain is not associated with low vitamin D levels or improved by treatment with vitamin D. J Clin Rheumatol. 2008;14(1):12–16. doi: 10.1097/RHU.0b013e31816356a9. [DOI] [PubMed] [Google Scholar]
  • 16.Wepner F, Scheuer R, Schuetz-Wieser B, Machacek P, Pieler-Bruha E, Cross HS, Hahne J, Friedrich M. Effects of vitamin D on patients with fibromyalgia syndrome: A randomized placebo-controlled trial. Pain. 2014;155(2):261–268. doi: 10.1016/j.pain.2013.10.002. [DOI] [PubMed] [Google Scholar]
  • 17.Brady SR, Naderpoor N, De Courten MP, Scragg R, Cicuttini F, Mousa A, De Courten B. Vitamin D supplementation may improve back pain disability in vitamin D deficient and overweight or obese adults. J Steroid Biochem Mol Biol. 2019;185:212–217. doi: 10.1016/j.jsbmb.2018.09.005. [DOI] [PubMed] [Google Scholar]
  • 18.Arvold DS, Odean MJ, Dornfeld MP, Regal RR, Arvold JG, Karwoski GC, Mast DJ, Sanford PB, Sjoberg RJ. Correlation of symptoms with vitamin D deficiency and symptom response to cholecalciferol treatment: a randomized controlled trial. Endocr Pract. 2009;15(3):203–212. doi: 10.4158/EP.15.3.203. [DOI] [PubMed] [Google Scholar]
  • 19.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. 2008;20(4):316–321. doi: 10.1007/BF03324862. [DOI] [PubMed] [Google Scholar]
  • 20.Knutsen KV, Madar AA, Brekke M, Meyer HE, Natvig B, Mdala I, Lagerlv P. Effect of vitamin D on musculoskeletal pain and headache: A randomized, double-blind, placebo-controlled trial among adult ethnic minorities in Norway. Pain. 2014;155(12):2591–2598. doi: 10.1016/j.pain.2014.09.024. [DOI] [PubMed] [Google Scholar]
  • 21.Sakalli H, Arslan D, Yucel AE. The effect of oral and parenteral vitamin D supplementation in the elderly: a prospective, double-blinded, randomized, placebo-controlled study. Rheumatol Int. 2012;32(8):2279–2283. doi: 10.1007/s00296-011-1943-6. [DOI] [PubMed] [Google Scholar]
  • 22.Sandoughi M, Zakeri Z, Mirhosainee Z, Mohammadi M, Shahbakhsh S. The effect of vitamin D on nonspecific low back pain. Int J Rheum Dis. 2015;18(8):854–858. doi: 10.1111/1756-185X.12172. [DOI] [PubMed] [Google Scholar]
  • 23.Schreuder F, Bernsen RM, van der Wouden JC. Vitamin D supplementation for nonspecific musculoskeletal pain in non-Western immigrants: a randomized controlled trial. Ann Fam Med. 2012;10(6):547–555. doi: 10.1370/afm.1402. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Dzik K, Skrobot W, Flis DJ, Karnia M, Libionka W, Kloc W, Kaczor JJ. Vitamin D supplementation attenuates oxidative stress in paraspinal skeletal muscles in patients with low back pain. Eur J Appl Physiol. 2018;118(1):143–151. doi: 10.1007/s00421-017-3755-1. [DOI] [PubMed] [Google Scholar]
  • 25.Gendelman O, Itzhaki D, Makarov S, Bennun M, Amital H. A randomized double-blind placebo-controlled study adding high dose vitamin D to analgesic regimens in patients with musculoskeletal pain. Lupus. 2015;24(4-5):483–489. doi: 10.1177/0961203314558676. [DOI] [PubMed] [Google Scholar]
  • 26.Iwamoto J, Takeda T, Ichimura S, Matsu K, Uzawa M. Effects of cyclical etidronate with alfacalcidol on lumbar bone mineral density, bone resorption, and back pain in postmenopausal women with osteoporosis. J Orthop Sci. 2003;8(4):532–537. doi: 10.1007/s00776-003-0655-5. [DOI] [PubMed] [Google Scholar]
  • 27.Lyritis GP, Androulakis C, Magiasis B, Charalambaki Z, Tsakalakos N. Effect of nandrolone decanoate and 1-α-hydroxy-calciferol on patients with vertebral osteoporotic collapse. A double-blind clinical trial. Bone Miner. 1994;27(3):209–217. doi: 10.1016/s0169-6009(08)80194-8. [DOI] [PubMed] [Google Scholar]
  • 28.Gaikwad M, Vanlint S, Mittinity M, Moseley GL, Stocks N. Does vitamin D supplementation alleviate chronic nonspecific musculoskeletal pain? A systematic review and meta-analysis. Clin Rheumatol. 2017;36(5):1201–1208. doi: 10.1007/s10067-016-3205-1. [DOI] [PubMed] [Google Scholar]
  • 29.Shipton EA, Shipton EE. Vitamin D and pain: Vitamin D and its role in the aetiology and maintenance of chronic pain states and associated comorbidities. Pain Res Treat. 2015;2015:904967. doi: 10.1155/2015/904967. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30.Straube S, Derry S, Straube C, Moore RA. Vitamin D for the treatment of chronic painful conditions in adults. Cochrane Database Syst Rev. 2015;2015(5):CD007771. doi: 10.1002/14651858.CD007771.pub3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Goyal V, Agrawal M. Effect of supplementation of vitamin D and calcium on patients suffering from chronic non-specific musculoskeletal pain: A pre-post study. J Family Med Prim Care. 2021;10(5):1839–1844. doi: 10.4103/jfmpc.jfmpc_1699_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Yong WC, Sanguankeo A, Upala S. Effect of vitamin D supplementation in chronic widespread pain: a systematic review and meta-analysis. Clin Rheumatol. 2017;36(12):2825–2833. doi: 10.1007/s10067-017-3754-y. [DOI] [PubMed] [Google Scholar]
  • 33.Zadro J, Shirley D, Ferreira M, Carvalho-Silva AP, Lamb SE, Cooper C, Ferreira PH. Mapping the association between vitamin D and low back pain: A systematic review and meta-analysis of observational studies. Pain Physician. 2017;20(7):611–640. [PubMed] [Google Scholar]
  • 34.Abdulmonem A, Hanan A, Elaf A, Haneen T, Jenan A. The prevalence of musculoskeletal pain & its associated factors among female Saudi school teachers. Pak J Med Sci. 2014;30(6):1191–1196. doi: 10.12669/pjms.306.5778. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Tanaka S, Kuroda T, Yamazaki Y, Shiraki Y, Yoshimura N, Shiraki M. Serum 25-hydroxyvitamin D below 25 ng/mL is a risk factor for long bone fracture comparable to bone mineral density in Japanese postmenopausal women. J Bone Miner Metab. 2014;32(5):514–523. doi: 10.1007/s00774-013-0520-3. [DOI] [PubMed] [Google Scholar]
  • 36.Lodh M, Goswami B, Mahajan RD, Sen D, Jajodia N, Roy A. Assessment of vitamin D status in patients of chronic low back pain of unknown etiology. Indian J Clin Biochem. 2015;30(2):174–179. doi: 10.1007/s12291-014-0435-3. [DOI] [PMC free article] [PubMed] [Google Scholar]

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