Vitamin D supplementation has no major effect on pain or pain behavior in bedridden geriatric patients with advanced dementia.
OBJECTIVE
In a few, earlier, uncontrolled trials, alleviation of chronic pain has been documented by vitamin D supplementation. This randomized double-blind placebo controlled trial addressed the association between pain and vitamin D deficiency and the effects of vitamin D supplementation on pain in institutionalized aged patients.


METHODS
216 long-term care patients were enrolled in Helsinki, Finland. Pain was assessed by three tools: Resident Assessment Instrument (RAI), Discomfort Behavior Scale, and Pain Assessment in Advanced Dementia Scale. Scores for Cognitive Performance Scale (CPS) and other clinical assessments were also collected from the RAI-database. Levels of 25-hydroxyvitamin D (25- OHD) and parathyroid hormone were also determined. Patients in pain (n=202) were randomized into three treatment groups, each receiving 0, 400, or 1200 IU cholecalciferol per day, respectively. Assessments were repeated after six-month vitamin D supplementation.


RESULTS
Patients were aged (84.5+/-7.5 yrs), demented (CPS= 4.9+/-1.4, range 1-6), and chronically bedridden. Pain was present in 38.4% to 83.8% of patients depending on assessment tool. Low 25-OHD levels (<50 nmol/L) were very common (98.1%). However, vitamin D deficiency was not associated with pain or pain behavior. The supplementation resulted in a marked increase in 25-OHD levels. However, neither prevalence of painlessness nor pain scores changed significantly after vitamin D supplementation.


CONCLUSIONS
We were not able either to show an association between vitamin D deficiency and pain or to observe alleviation of pain by vitamin D supplementation. The independent role of vitamin D in the etiology of pain remains controversial.
Björkman
Mikko
M
Clinics of Internal Medicine and Geriatrics, Helsinki University Central Hospital, POB 340, FI-00029 HUS, Helsinki, Finland. mikko.bjorkman@helsinki.fi
Sorva
Antti
A
Tilvis
Reijo
R
D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000188:drug therapy* / Q000473:pathology*; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007103:Immobilization; D008297:Male; D010146:Pain / Q000188:drug therapy*; D014807:Vitamin D / Q000097:blood / Q000494:pharmacology* / Q000627:therapeutic use*
D014807:Vitamin D