Serum vitamin D and chronic musculoskeletal pain: a cross-sectional study of 349,221 adults in the UK

Yanfei Xie; Scott F Farrell; Nigel Armfield; Michele Sterling

doi:10.1016/j.jpain.2024.104557

Serum vitamin D and chronic musculoskeletal pain: a cross-sectional study of 349,221 adults in the UK

J Pain. 2024 May 9:104557. doi: 10.1016/j.jpain.2024.104557. Online ahead of print.

Authors

Yanfei Xie¹, Scott F Farrell¹, Nigel Armfield¹, Michele Sterling²

Affiliations

¹ RECOVER Injury Research Centre, The University of Queensland, Brisbane, Queensland; NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Brisbane, Queensland; STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health.
² RECOVER Injury Research Centre, The University of Queensland, Brisbane, Queensland; NHMRC Centre of Research Excellence: Better Health Outcomes for Compensable Injury, The University of Queensland, Brisbane, Queensland; STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health. Electronic address: m.sterling@uq.edu.au.

PMID: 38734042
DOI: 10.1016/j.jpain.2024.104557

Abstract

Insufficient and deficient vitamin D may be associated with chronic musculoskeletal pain, but study findings are conflicting, and few account for important confounding factors. This cross-sectional study explored the association between serum vitamin D status and chronic musculoskeletal pain in various body sites, adjusting for a wide range and number of potential confounding factors. Data collected at the baseline assessments of 349,221 UK Biobank participants between 2006 and 2010 were analysed. Serum 25-hydroxyvitamin D (25-(OH) D) were measured and categorised as <25.0 nmol/L (severe deficiency), 25.0-49.9 nmol/L (deficiency), 50.0-74.9 nmol/L (insufficiency) and ≥75.0 nmol/L (sufficiency). The outcome was self-reported chronic musculoskeletal pain at any site, neck/shoulder, back, hip, knee, or widespread pain that interfered with usual activities. Potential confounders were identified using Directed Acyclic Graphs, and included sociodemographic, lifestyle, psychological factors, and medical comorbidities. Simple models adjusted for age and sex showed significant associations between suboptimal vitamin D status and chronic pain across all sites (odds ratios [ORs] ranged 1.07-2.85). These associations were weakened or became insignificant after accounting for all confounding factors (ORs ≤1.01) for chronic regional musculoskeletal pain. Severe vitamin D deficiency remained a significant and positive association with chronic widespread pain after adjusting for all confounding factors (OR [95% confidence interval]: 1.26 [1.07, 1.49]). This study suggests that while vitamin D status is not a key independent determinant of chronic regional musculoskeletal pain, severe vitamin D deficiency may be associated with chronic widespread pain. PERSPECTIVES: After counting for various confounders, severe vitamin D deficiency remained significantly associated with increased risk of experiencing chronic widespread pain. Considering the low risk and affordability of vitamin D supplements, their potential use in treating chronic widespread pain in severely vitamin D deficient individuals warrants further exploration.

Keywords: 25-hydroxyvitamin D; chronic pain; confounding effect.