title: Vitamin D deficiency as a cause of chronic pain in the palliative medicine clinic: two case reports.
abstract: BACKGROUND
  Vitamin D deficiency is common in the general population and has been implicated as a cause of chronic pain. The palliative care population has a number of risk factors for vitamin D deficiency. We present two cases of unexplained pain in patients attending the palliative medicine outpatient clinic that improved after vitamin D replacement.
  
  
  METHODS
  Case 1 is a 46-year-old man with thalassaemia intermedia and back and leg pain without a clear cause. Case 2 is a 28-year-old woman undergoing treatment for cervical cancer whose initial disease and treatment-related abdominal pain resolved but subsequently reported ongoing non-specific aches and pains. Case management: Both patients were found to have vitamin D levels <50 nmol/L and were treated with vitamin D replacement therapy. Case outcome: Following vitamin D replacement therapy, pain resolved in both patients allowing a reduction in analgesic therapy.
  
  
  CONCLUSIONS
  The prevalence of vitamin D deficiency in the palliative care population merits further investigation, since these patients are at high risk of deficiency. Having an index of suspicion, particularly in those patients with known risk factors and pain that is not fully explained, may result in better pain control and functional outcomes.
authors.affiliation: 1Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Whitehurst
authors.forename: Colette M
authors.initials: CM
authors.lastname: Reid
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D019090:Case Management; D059350:Chronic Pain / Q000209:etiology* / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012307:Risk Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy*; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications* / Q000628:therapy; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: Vitamin D deficiency; cancer; case report; pain; palliative care; vitamin D replacement