Chronic pain and fatigue, typical symptoms of fibromyalgia syndrome (FMS), may be treated with vitamin D supplements as an alternative or adjunct to other treatment, as found by researchers working at the Orthopaedic Hospital Speising in Vienna, Austria, whose study results were recently published in the Pain journal. Patients with FMS often have low vitamin D levels, leading to pain and fatigue, and the supplements are not only an alternative to treating the symptoms, but are also cost-effective.

The study, “Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial” focused on cacifediol, a pre-hormone developed by the cholecalciferol enzyme (vitamin D3) in the liver, which is converted to calcitriol and is the active form of vitamin D. Its concentration in the blood is thought suggest vitamin D levels, and researchers aimed to determine if higher levels would influence the pain in FMS patients.

“Low blood levels of calcifediol are especially common in patients with severe pain and fibromyalgia. But although the role of calcifediol in the perception of chronic pain is a widely discussed subject, we lack clear evidence of the role of vitamin D supplementation in fibromyalgia patients,” explained the lead investigator Florian Wepner, MD, of the Department of Orthopaedic Pain Management, Spine Unit, Orthopaedic Hospital Speising, in a press release.

“We therefore set out to determine whether raising the calcifediol levels in these patients would alleviate pain and cause a general improvement in concomitant disorders.” The research team conducted a randomized controlled trial with 30 FMS female patients who registered low serum calcifediol levels. While the participants had blood levels of calcifediol below the 32ng/ml prior to the study, the goal in the treatment group was to achieve serum levels between 32 and 48ng/ml.

The women in the study were administered oral cholecalciferol supplements over the course of 20 weeks, and their serum calcifediol levels were reexamined at the fifth and 13th weeks, as well as the dosage reviewed. At the 25th week of treatment the reevaluation was also the time for its discontinuation. 24 weeks the end of supplementation, the scientists observed a significant decrease in the perceived pain.

The treatment group reported significant improvements throughout the 25 weeks of supplementation on a scale of physical role functioning, while the placebo group did not report any alterations in the symptoms. In addition, the treatment group also registered significantly better scores on the question regarding morning fatigue on the Fibromalgia Impact Questionnaire (FIQ). Despite the positive results in both fatigue and pain, the authors noted that there were no changes reported in either depression nor anxiety.

“We believe that the data presented in the present study are promising. FMS is a very extensive symptom complex that cannot be explained by a vitamin D deficiency alone. However, vitamin D supplementation may be regarded as a relatively safe and economical treatment for FMS patients and an extremely cost-effective alternative or adjunct to expensive pharmacological treatment as well as physical, behavioral, and multimodal therapies,” added Wepner. “Vitamin D levels should be monitored regularly in FMS patients, especially in the winter season, and raised appropriately.”

Patients who suffer from FMS experience a series of symptoms that influence their quality of life, impacting their jobs and social activities. The disease, for which there is currently no cure or treatment able to alleviate all symptoms, causes not only pain and fatigue, but other symptoms like sleep disorders, morning stiffness, poor concentration, and occasionally mild-to-severe mental symptoms such as anxiety or depression. Even though there is no effective treatment, physical, cognitive behavioral, or temporary drug therapy, like amitriptyline, duloxetine, or pregabaline, and multimodal therapies may help reduce the burden of the disease.

However, a recently released white paper from the National Institutes of Health (NIH) reported that there is little evidence about the effectiveness of opioid drugs in the treatment of long-term chronic pain, notwithstanding widespread growth in prescribing them for managing that type of pain. The NIH paper incorporates the summary report of a seven-member expert panel the NIH appointed last September, which determined that that many studies cited as support for prescribing these drugs have been either poorly-conducted or of insufficient scope and focus.