Condition
    Moderate Evidence
    Effectiveness 3/5

    Vitamin D for Tender Points

    Vitamin D deficiency is common in people with widespread musculoskeletal pain and tender points, and correcting deficiency can modestly reduce pain in deficient individuals. It is not a fibromyalgia treatment, but testing is worthwhile.

    Overview

    Vitamin D deficiency is common in people with widespread musculoskeletal pain and tender points, and correcting deficiency can modestly reduce pain in deficient individuals. It is not a fibromyalgia treatment, but testing is worthwhile.

    Verdict

    Mixed evidence

    How It Works

    Vitamin D receptors in muscle and nerve tissue influence pain signaling; deficiency causes osteomalacic bone pain and muscle weakness that can present as diffuse tenderness.

    Dosing & Protocol

    Typical dose

    Recommended dose
    1000-2000 IU (25-50 mcg) vitamin D3 daily with a fat-containing meal, after checking 25-hydroxyvitamin D
    Expected timeframe
    12-24 weeks if deficient

    Protocol

    form
    Vitamin D3 (cholecalciferol)
    duration
    12-24 weeks with a tender point count or pain score at baseline and end
    co factor
    Take with the largest meal. Evidence is mixed: a randomised trial in vitamin-D-deficient women with fibromyalgia found repletion reduced pain scores, and severe deficiency causes osteomalacia with widespread bone tenderness that resolves on treatment. In people with normal vitamin D, supplementation does not reduce widespread tenderness.
    titration
    Target 75-125 nmol/L; fibromyalgia trials have used weekly loading in deficient patients under supervision
    starting dose
    1000-2000 IU vitamin D3 daily with the largest meal, having checked 25-hydroxyvitamin D

    Evidence

    What the studies say

    Meta-analyses show low vitamin D correlates with chronic widespread pain, and supplementation trials in deficient patients show small pain reductions. Benefit appears confined to those who are actually deficient — supplementation with normal levels shows little effect.

    Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial

    Score: 6/10
    2014
    rct
    n=30

    Wepner F

    Optimization of calcifediol levels in FMS had a positive effect on the perception of pain.

    View source

    Safety

    Caveats

    Widespread tenderness needs a proper assessment: polymyalgia rheumatica, inflammatory arthritis, hypothyroidism, statin myopathy and osteomalacia all mimic fibromyalgia and are treated differently. Fibromyalgia itself responds best to graded exercise, sleep management, CBT and, where needed, prescribed medication - vitamin D is a small adjunct. Safety ceiling: the tolerable upper intake level is 4000 IU (100 mcg) per day; excess causes hypercalcaemia, kidney stones and kidney injury, and high intermittent bolus doses have increased falls. Avoid unsupervised use in sarcoidosis, granulomatous disease and primary hyperparathyroidism. Interacts with thiazide diuretics and digoxin. Safe in pregnancy at 400-1000 IU/day.

    Less likely to help if

    People with normal vitamin D levels, in whom trials show no reduction in tenderness.

    Medical Disclaimer

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    Individual results may vary. The statements on this website have not been evaluated by the Food and Drug Administration. Products and information are not intended to diagnose, treat, cure, or prevent any disease.