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Kunow A, Freyer Martins Pereira J, Chenot JF. Extravertebral low back pain: a scoping review. BMC Musculoskelet Disord 2024; 25:363. [PMID: 38714994 PMCID: PMC11075250 DOI: 10.1186/s12891-024-07435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Low back pain (LBP) is one of the most common reasons for consultation in general practice. Currently, LBP is categorised into specific and non-specific causes. However, extravertebral causes, such as abdominal aortic aneurysm or pancreatitis, are not being considered. METHODS A systematic literature search was performed across MEDLINE, Embase, and the Cochrane library, complemented by a handsearch. Studies conducted between 1 January 2001 and 31 December 2020, where LBP was the main symptom, were included. RESULTS The literature search identified 6040 studies, from which duplicates were removed, leaving 4105 studies for title and abstract screening. Subsequently, 265 publications were selected for inclusion, with an additional 197 publications identified through the handsearch. The majority of the studies were case reports and case series, predominantly originating from specialised care settings. A clear distinction between vertebral or rare causes of LBP was not always possible. A range of diseases were identified as potential extravertebral causes of LBP, encompassing gynaecological, urological, vascular, systemic, and gastrointestinal diseases. Notably, guidelines exhibited inconsistencies in addressing extravertebral causes. DISCUSSION Prior to this review, there has been no systematic investigation into extravertebral causes of LBP. Although these causes are rare, the absence of robust and reliable epidemiological data hinders a comprehensive understanding, as well as the lack of standardised protocols, which contributes to a lack of accurate description of indicative symptoms. While there are certain disease-specific characteristics, such as non-mechanical or cyclical LBP, and atypical accompanying symptoms like fever, abdominal pain, or leg swelling, that may suggest extravertebral causes, it is important to recognise that these features are not universally present in every patient. CONCLUSION The differential diagnosis of extravertebral LBP is extensive with relatively low prevalence rates dependent on the clinical setting. Clinicians should maintain a high index of suspicion for extravertebral aetiologies, especially in patients presenting with atypical accompanying symptoms.
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Affiliation(s)
- Anna Kunow
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany.
| | | | - Jean-François Chenot
- Department of General Practice, University Medicine Greifswald, 17475, Fleischmannstraße, Greifswald, Germany
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Albadayneh BA, Alrawashdeh A, Obeidat N, Al-Dekah AM, Zghool AW, Abdelrahman M. Medical magnetic resonance imaging publications in Arab countries: A 25-year bibliometric analysis. Heliyon 2024; 10:e28512. [PMID: 38590895 PMCID: PMC10999917 DOI: 10.1016/j.heliyon.2024.e28512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024] Open
Abstract
Magnetic Resonance Imaging (MRI) is increasingly becoming a cornerstone in modern diagnostic healthcare, offering unparalleled capabilities in stroke, dementia, and cancer screening. Therefore, this study aims to map medical MRI literature affiliated with Arab countries, focusing on publication trends, top journals, author affiliations, study countries, and authors' collaboration, and keyword analysis. The scientific database used is the Scopus database. Microsoft Excel, VOSviewer software, and Biblioshiny for the Bibliometrix R package are the bibliometric tools used in this analysis. A total of 2592 publications were published between 1988 and 2022, with total citations of 22,115. Most of them were original articles (91,7%) and 89.9% were published in traditional journals. The number of total publications exhibited a steady increase over time, whereas total citations showed fluctuations, peaking in 2015 with 1571 citations for publications from that year. The most cited article was authored by Yaseen M. Arabi, receiving 286 citations. Saudi Arabia was the top active country. In addition, the most prolific author was Maha S Zaki, and the most prolific source was the "Egyptian Journal of Radiology and Nuclear Medicine". The most prolific affiliation was Cairo University. The "multiple sclerosis" and "case report" were the most trending keywords. The analysis revealed a significant growth in MRI research inside Arab countries, as shown by an increase in the total number of publications and international collaborations. Despite these developments, the results of this study suggest that there is still room for MRI research in the Arab region to advance. This can be achieved through increasing international collaboration and multidisciplinary work.
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Affiliation(s)
| | - Ahmad Alrawashdeh
- Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Naser Obeidat
- Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Arwa M. Al-Dekah
- Department of Biotechnology and Genetic Engineering, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan
- Kernel Research and Data Analytics Center, Irbid, Jordan
| | - Ahmad Waleed Zghool
- Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mostafa Abdelrahman
- Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
- Department of Medical Imaging Sciences, Gulf Medical University, Ajman, United Arab Emirates
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Alsaqqa RM, Alghamdi MK, Basamih K, AlSulami M, Almajnooni M, Al Saedi ZS, Alhudhudi WH, Shatla M. Knowledge of Back Pain and Spinal Disorders Among the General Population in the Western Region of Saudi Arabia. Cureus 2024; 16:e55587. [PMID: 38576677 PMCID: PMC10994650 DOI: 10.7759/cureus.55587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Low back pain (LBP) is one of the most common global health problems and the second most common reason for seeking medical advice. However, most LBP does not indicate a serious disorder. Over half of the Saudi Arabian population experiences LBP at least once in their lives. Therefore, it is important to assess and understand how people manage this health problem. This study assessed back pain and spinal disorder knowledge among the general population in Saudi Arabia's western region. Methods This was a cross-sectional study of the general population in western Saudi Arabia. The data were collected using an online, self-administered, Arabic version of the validated questionnaire about LBP. A statistical analysis of the collected data was performed using a software program. Results A total of 754 eligible participants completed the questionnaire. Less than half of the participants could correctly define acute and chronic LBP and sciatica. Only 19.2% of participants were aware that medical history and clinical examinations are used to diagnose LBP. Young participants, university graduates, and unmarried participants had good LBP knowledge. Conclusion This study showed that the general population of Saudi Arabia in the Western region needs more knowledge about the definitions of acute and chronic LBP. However, they had fair knowledge about the aggravating factors and triggers of LBP. Young participants had better knowledge about LBP. Awareness campaigns with brochures and flyers can be used to increase the population's knowledge.
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Affiliation(s)
| | | | - Khalid Basamih
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Maria AlSulami
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
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Channarong P, Phongamwong C. Prevalence and risk factors of vitamin D deficiency among patients with chronic myofascial pain syndrome: a cross-sectional study. BMC Nutr 2023; 9:129. [PMID: 37964354 PMCID: PMC10647172 DOI: 10.1186/s40795-023-00792-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/10/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Myofascial pain syndrome (MPS) is a common muscle condition characterized by painful trigger points. Vitamin D deficiency has been recognized as a precipitating factor of MPS. The present study aimed to determine the prevalence and risk factors of vitamin D deficiency in patients with chronic MPS. METHODS A cross-sectional study was conducted, using a structured face-to-face interview to collect demographic information, clinical characteristics, pain duration and location, as well as the bodily pain subscale of SF36 and EQ-5D-5 L. The Elecsys vitamin D total II assay was used to measure serum total 25-hydroxyvitamin D level. RESULTS Of 120 participants, vitamin D insufficiency (20 to 29.9 ng/ml) and deficiency (< 20 ng/ml) were 47.5% (95% CI: 38.3-56.8%) and 34.2% (95% CI: 25.8-43.4%), respectively. The adjusted odds ratios for vitamin D deficiency of participants aged < 45 years and who reported having ≤ 15 min sunlight exposure per day were 3.5 (95% CI: 1.54 to 7.98) and 2.38 (95% CI: 1.05 to 5.26), respectively. The bodily pain score (r = - 0.02, P = 0.86) and EQ-5D-5 L utility (r = 0.04, P = 0.66) did not significantly correlate with vitamin D levels. CONCLUSION Approximately one third of patients with chronic MPS had vitamin D deficiency. Age < 45 years and sunlight exposure ≤ 15 min/day were identified as potential risk factors for vitamin D deficiency in MPS patients.
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Affiliation(s)
- Pimpitcha Channarong
- Department of Rehabilitation Medicine, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Chanwit Phongamwong
- Department of Rehabilitation Medicine, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand.
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Ekşi MŞ, Orhun Ö, Demir YN, Kara M, Berikol G, Özcan-Ekşi EE. Are serum thyroid hormone, parathormone, calcium, and vitamin D levels associated with lumbar spine degeneration? A cross-sectional observational clinical study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1561-1574. [PMID: 36976340 DOI: 10.1007/s00586-023-07673-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 03/11/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Low back pain (LBP) impairs the quality of life and rises healthcare costs. The association of spine degeneration and LBP with metabolic disorders have been reported, previously. However, metabolic processes related with spine degeneration remained unclear. We aimed to analyze whether serum thyroid hormones, parathormone, calcium, and vitamin D levels were associated with lumbar intervertebral disc degeneration (IVDD), Modic changes, and fatty infiltration in the paraspinal muscles. METHODS We cross-sectionally analyzed a retrospective database. Patients who visited internal medicine outpatient clinics with suspect of endocrine disorders and chronic LBP were searched. Patients with biochemistry results within 1 week before lumbar spine magnetic resonance imaging (MRI) were included. Age- and gender-matched cohorts were made-up and analyzed. RESULTS Patients with higher serum free thyroxine levels were more likely to have severe IVDD. They were also more likely to have fattier multifidus and erector spinae at upper lumbar levels, less fatty psoas and less Modic changes at lower lumbar levels. Higher PTH levels were observed in patients with severe IVDD at L4-L5 level. Patients with lower serum vitamin D and calcium levels had more Modic changes and fattier paraspinal muscles at upper lumbar levels. CONCLUSION Serum hormone, vitamin D, and calcium levels were associated with not only IVDD and Modic changes but also with fatty infiltration in the paraspinal muscles, mainly at upper lumbar levels in patients with symptomatic backache presenting to a tertiary care center. Complex inflammatory, metabolic, and mechanical factors present in the backstage of spine degeneration.
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Affiliation(s)
- Murat Şakir Ekşi
- Associate Professor of Neurosurgery, FSM Training and Research Hospital, Neurosurgery Clinic, Göztepe Mah. Mesire Sok. Tütüncü Mehmet Efendi Cad. No: 3/34 Kadıkoy, Istanbul, Turkey.
| | - Ömer Orhun
- School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Yaren Nur Demir
- School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Müjdat Kara
- Endocrinology Unit, Department of Internal Medicine, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Gürkan Berikol
- Neurosurgery Clinic, Taksim Training and Research Hospital, Istanbul, Turkey
| | - Emel Ece Özcan-Ekşi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Bahçeşehir University, Istanbul, Turkey
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Erkilic B, Dalgic GS. The preventive role of vitamin D in the prevention and management of Fibromyalgia syndrome. Nutr Health 2023; 29:223-229. [PMID: 36591895 DOI: 10.1177/02601060221144801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Aim: Vitamin D deficiency is a prevalent condition among the general population, all around the world. Vitamin D deficiency is defined as serum levels of 25-hydroxy vitamin D lower than 20 ng/ml (50 nmol/ml). It is a known actor in the skeletal system through the regulation of calcium and phosphate metabolism and bone mineralization. Still, the role of vitamin D as an immunomodulator is yet to be acknowledged by healthcare practitioners as a cause, precipitating factor, and contributor to a variety of diseases. Vitamin D is shown to be an actor in multiple sclerosis, rheumatoid arthritis, insulin-dependent diabetes mellitus, and irritable bowel syndrome. Fibromyalgia syndrome (FMS) is a chronic disorder associated with a severe pain that can affect a patient's musculoskeletal system, daily routine, and mood. The clinical presentation encapsulates other disorders such as lethargy and sleep problems, brain fog and other cognitive issues, and physical and psychiatric symptoms. Methods: We have used PubMed and ResearchGate in the reviewing process of our paper. We tried to address as many topics as we judged to be adequate and relevant for the practicing clinicians. Results: Management of fibromyalgia syndrome is both nonpharmacologic and pharmacologic, which are provided in a stepwise fashion. Yet, the management of FMS remains a challenge, heeding a multidisciplinary approach. Among the dietary interventions, we chose vitamin D and its effects on FMS. Literature shows that supplementation improves pain caused by fibromyalgia syndrome, yet specific recommendations are still to be created. Conclusions: We call on all the relevant governmental bodies, public health experts and health policy makers, healthcare practitioners, and the civil society to use novel data related to fibromyalgia syndrome, and in a broader perspective, the integral role of vitamin D.
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Affiliation(s)
| | - Gunay Sahin Dalgic
- Department of Rheumatology, 63994Faculty of Medicine, Baskent University, Ankara, Turkey
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Overstreet DS, Strath LJ, Hasan FN, Sorge RE, Penn T, Rumble DD, Aroke EN, WIggins AM, Dembowski JG, Bajaj EK, Quinn TL, Long DL, Goodin BR. Racial Differences in 25-Hydroxy Vitamin D and Self-Reported Pain Severity in a Sample of Individuals Living with Non-Specific Chronic Low Back Pain. J Pain Res 2022; 15:3859-3867. [PMID: 36514480 PMCID: PMC9741831 DOI: 10.2147/jpr.s386565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Considerable evidence suggests that there are significant ethnic/racial differences in the experience of pain among individuals suffering from chronic musculoskeletal conditions. Additionally, low levels of vitamin D have been associated with pain severity. Further, vitamin D deficiency is more prevalent in Non-Hispanic Black (NHB) individuals compared to Non-Hispanic Whites (NHW). Objective The aim of this study was to investigate the associations among race, pain severity, and serum levels of vitamin D in a sample of patients with chronic low back pain (cLBP). Methods All study participants (n = 155) self-identified their race/ethnicity as either NHB or NHW. Blood samples were collected to assess circulating levels of serum 25- hydroxy vitamin D. Vitamin D levels were categorized as optimal (≥20 ng/mL), insufficient (12-19 ng/mL) or deficient (<12 ng/mL). Participants then self-reported their pain severity using the Brief Pain Inventory - Short Form. Results Results showed that a greater proportion of NHB versus NHW participants were categorized as Vitamin D deficient (χ 2 (2, N = 155) = 16.79, p < 0.001). An analysis of covariance (ANCOVA) revealed that NHBs reported significantly greater pain severity relative to NHWs (F(1150) = 6.45) p = 0.012. Further, self-reported pain severity significantly differed according to Vitamin D clinical categories (F(2150) = 4.19, p = 0.013). Participants with deficient vitamin D reported significantly greater pain severity in comparison to participants with optimal vitamin D (F(1101) = 7.28, p = 0.008). Conclusion The findings suggest that Vitamin D deficiency may be linked to greater pain severity in a sample of individuals with cLBP, especially for those who identify as NHB.
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Affiliation(s)
- Demario S Overstreet
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Larissa J Strath
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fariha N Hasan
- School of Public Health, Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert E Sorge
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Terence Penn
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deanna D Rumble
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edwin N Aroke
- School of Nursing, Nurse Anesthesia Program, Department of Acute, Chronic, & Continuing Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Asia M WIggins
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jonas G Dembowski
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eeshaan K Bajaj
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tammie L Quinn
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - D Leann Long
- School of Public Health, Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R Goodin
- Department of Psychology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, AL, USA
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SaeidiFard N, Haeri-Mehrizi AA, Akbarzadeh Z, Janbozorgi N, Montazeri A, Yaseri M, Shab-Bidar S. Association of health literacy and nutritional literacy with sun exposure in adults using structural equation modelling. BMC Public Health 2022; 22:1162. [PMID: 35689215 PMCID: PMC9185953 DOI: 10.1186/s12889-022-13465-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/18/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Inadequate health and nutritional literacy is a common problem among adults, associated with poor health outcomes. Therefore, this study aimed to investigate the relationship between health literacy and nutritional literacy to sun exposure behaviour. METHODS We conducted a cross-sectional study on 261 adults (18-65 years) in Iran. Data was collected on knowledge, motivation, health literacy, nutritional literacy, and sun exposure behaviour using an interview-assisted questionnaire. Using the information-motivation-behavioural skills model and structural equation modeling, we tested whether health and nutritional literacy were associated with the relationships between knowledge of vitamin D, attitudes toward sun exposure, and sun exposure behaviour. Different models using structural equation modeling were performed to analyze the data. RESULTS The finding showed that health literacy (β = 0.29, p < 0.001) and nutritional literacy (β = 0.14, p = 0.02) was directly associated with sunlight exposure. Indirect relationships also existed between knowledge and sunlight exposure through health literacy (β = 0.33, p < 0.001) and nutritional literacy (β = 0.22, p = 0.01). The model had good fit (x2/df = 1.422; RMSEA = 0.040; CFI = 0.851; NFI = 0.657). There was no significant relationship between health literacy and motivation (β = 0.11, p = 0.16), nutritional literacy and motivation (β = 0.06, p = 0.42) and motivation and sun exposure (β = 0.01, p = 0.91). CONCLUSIONS The findings showed that individuals with sufficient health literacy and nutritional literacy were more likely to have exposure to sunlight. Health and nutritional literacy should be considered when educating adults about vitamin D supplements and sunlight exposure.
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Affiliation(s)
- Nasim SaeidiFard
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), No 44, Hojjat-dost Alley, Naderi St, Keshavarz Blvd, Tehran, Iran
| | - Ali Asghar Haeri-Mehrizi
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Zahra Akbarzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), No 44, Hojjat-dost Alley, Naderi St, Keshavarz Blvd, Tehran, Iran
| | - Nasim Janbozorgi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), No 44, Hojjat-dost Alley, Naderi St, Keshavarz Blvd, Tehran, Iran
| | - Ali Montazeri
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
- Faculty of Humanity Sciences, University of Science and Culture, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), No 44, Hojjat-dost Alley, Naderi St, Keshavarz Blvd, Tehran, Iran.
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Zareef TA, Jackson RT. Knowledge and attitudes about vitamin D and sunlight exposure in premenopausal women living in Jeddah, and their relationship with serum vitamin D levels. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:38. [PMID: 34454622 PMCID: PMC8403372 DOI: 10.1186/s41043-021-00263-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/22/2021] [Indexed: 05/12/2023]
Abstract
BACKGROUND Saudi women are at risk of vitamin D deficiency because they are fully covered by traditional clothing and because of their indoor lifestyle. The latest national study reported that vitamin D deficiency (serum 25(OH)D < 50 nmol/L) affects 72% of young Saudi women. Because little information is available regarding knowledge on vitamin D, attitudes toward sun exposure, and the vitamin D status of premenopausal women in Jeddah, more research is necessary in order to develop effective intervention programs. The purpose of this study is to explore how the relationship between knowledge of vitamin D and attitudes about sun exposure affect the serum 25(OH)D levels in premenopausal Saudi women. METHODS This cross-sectional study included 257 women aged 20-50 years attending the primary care clinic in Jeddah, Saudi Arabia. Participants completed questionnaires about socio-demographics, dietary vitamin D intake, attitudes toward sun exposure, and were tested on their knowledge of vitamin D. Serum 25(OH)D was evaluated using chemiluminescent microparticle immunoassay. RESULTS Although 99% of participants had heard of vitamin D and 91% knew that sunlight exposure is a primary source of vitamin D, they also expressed the feeling of having insufficient knowledge regarding vitamin D sources. Furthermore, the majority of participants had negative attitudes toward sun exposure. High fish consumption was associated with a higher level of knowledge regarding vitamin D. The binary logistic regression indicated that low levels of knowledge about vitamin D were associated with low education levels (odds ratio = 0.397, 95% CI = [0.206, 0.765], p = 0.019) and with being married (odds ratio = 0.522, 95% CI = [0.281, 0.971], p = 0.04). In addition, spending time outside in the sun was significantly associated with increased serum 25(OH)D levels (p = 0.006), and the wearing of colored abaya was significantly associated with increased serum 25(OH)D levels (p = 0.008). CONCLUSION Suboptimal vitamin D status and insufficient knowledge of vitamin D intake sources are common in premenopausal women in Jeddah. Based on this data, health professionals could provide medical intervention to the most vulnerable female patients, as well as offer clear guidelines and information to the general public.
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Affiliation(s)
- Tahani A Zareef
- Department of Nutrition and Food Science, University of Maryland, College Park, MD, 20742, USA.
- Department of Clinical Nutrition, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
- Department of Public Health , College of Health Sciences, Saudi Electronic University, Jeddah, Saudi Arabia.
| | - Robert T Jackson
- Department of Nutrition and Food Science, University of Maryland, College Park, MD, 20742, USA
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D'Souza RS, Lin G, Oh T, Vincent A, Orhurhu V, Jiang L, Mauck WD, Qu W. Fibromyalgia Symptom Severity and Psychosocial Outcomes in Fibromyalgia Patients with Hypovitaminosis D: A Prospective Questionnaire Study. PAIN MEDICINE 2021; 21:3470-3478. [PMID: 32022867 DOI: 10.1093/pm/pnz377] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the association between hypovitaminosis D and outcomes of symptom severity, mood disorders, fatigue, and quality of life in fibromyalgia (FM) patients. METHODS Five hundred ninety-three FM patients were surveyed from May 2012 to November 2013. Patients with serum vitamin D <25 ng/mL were considered to have hypovitaminosis D. The primary outcome was FM symptom severity (FIQ-R questionnaire). Secondary outcomes included quality of life (SF-36), fatigue (MFI-20), anxiety (GAD-7), and depression (PHQ-9). Independent t tests and chi-square tests were performed for continuous and categorical variables, respectively. Regression analysis was performed adjusting for age, gender, body mass index, ethnicity, and season. A post hoc analysis examined for correlation between outcomes and serum vitamin D (ng/mL) as a continuous variable. RESULTS One hundred twenty-two patients (20.6%) had hypovitaminosis D. In our adjusted regression analysis, the total FIQ-R score in patients with hypovitaminosis D was higher compared with control patients with adequate serum vitamin D (57.85 ± 18.09 vs 62.79 ± 18.10, P = 0.04). Adjusted regression analysis revealed higher total GAD-7 (P = 0.01) and higher total PHQ-9 scores (P = 0.04) in patients with hypovitaminosis D compared with control patients. There were no differences based on severity of depression or anxiety. No differences in fatigue or quality of life were identified. Unadjusted post hoc analysis revealed that as serum vitamin D increased, there was an association with lower total FIQ-R (β coefficient = -0.11, P = 0.02) and lower SF-36 subscale scores of role-physical (β coefficient = -0.10, P = 0.03). Adjusted post hoc analysis revealed no significant associations. CONCLUSIONS Hypovitaminosis D may be a risk factor for worse symptom severity, anxiety, and depression in FM patients.
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Affiliation(s)
- Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ge Lin
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.,Department of Rheumatology, Guang'anmen Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Terry Oh
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Ann Vincent
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Vwaire Orhurhu
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Li Jiang
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - William D Mauck
- Department of Anesthesiology, Pain Division, Mayo Clinic, Rochester, Minnesota, USA
| | - Wenchun Qu
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA.,Department of Anesthesiology, Pain Division, Mayo Clinic, Rochester, Minnesota, USA
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Kanaujia V, Yadav RK, Verma S, Jain S, Patra B, Neyaz O. Correlation between Vitamin D deficiency and nonspecific chronic low back pain: A retrospective observational study. J Family Med Prim Care 2021; 10:893-897. [PMID: 34041094 PMCID: PMC8138361 DOI: 10.4103/jfmpc.jfmpc_1478_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/17/2020] [Accepted: 10/08/2020] [Indexed: 11/16/2022] Open
Abstract
CONTEXT Chronic lower back pain (CLBP) and Vitamin D deficiency are two common conditions presenting to primary care physicians. AIMS To study the vitamin D status in North Indians presenting with nonspecific CLBP and the correlation between vitamin D levels and pain severity by the Visual Analogue Scale (VAS). SETTINGS AND DESIGN An observational study. Record of all CLBP patients presenting to the outpatient department in 2019, were analyzed, retrospectively. METHODS AND MATERIALS All the patients of age 18 to 65 and either sex with nonspecific CLBP were included. Patients were divided into two: Vitamin D deficient (Group 1) and normal (Group 2) with cut off Serum Vitamin D values at 30 ng/mL. Demographic data and Visual Analogue Scale scores (VAS) of both groups were recorded. STATISTICAL ANALYSIS USED Correlations between Vitamin D values and VAS scores were investigated using the Spearman coefficient, and the results with P of ≤ 0.05 were contemplated significant. RESULTS Of total 376 patients with nonspecific CLBP, the majority were adults, females, married, vegetarians, overweight or obese, and had a mean sun exposure time of two hours. Vitamin D deficient Group 1 had 302 (80.32%) patients with significantly lower (P < 0.0001) mean vitamin D levels compared to Group 2 (74 patients i.e., 19.68%). Spearman's rho coefficient between vitamin D and VAS, showed a negative correlation (-0.554), with a P value < 0.00001. CONCLUSIONS This study indicated a high probability of vitamin D deficiency in the nonspecific CLBP population and a negative correlation between vitamin D status and pain severity.
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Affiliation(s)
- Vinay Kanaujia
- Department of Physical Medicine and Rehabilitation (PMR), AIIMS Rishikesh, Uttarakhand, India
| | - Raj Kumar Yadav
- Department of Physical Medicine and Rehabilitation (PMR), AIIMS Rishikesh, Uttarakhand, India
| | - Shipra Verma
- Department of Anesthesia, AIIMS Rishikesh, Uttarakhand, India
| | - Sakshi Jain
- Department of Physical Medicine & Rehabilitation (PMR), VMMC & Safdarjung Hospital, New Delhi, India
| | - Binayak Patra
- Department of Physical Medicine and Rehabilitation (PMR), AIIMS Rishikesh, Uttarakhand, India
| | - Osama Neyaz
- Department of Physical Medicine and Rehabilitation (PMR), AIIMS Rishikesh, Uttarakhand, India
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12
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Mayo BC, Massel DH, Yacob A, Narain AS, Hijji FY, Jenkins NW, Parrish JM, Modi KD, Long WW, Hrynewycz NM, Brundage TS, Singh K. A Review of Vitamin D in Spinal Surgery: Deficiency Screening, Treatment, and Outcomes. Int J Spine Surg 2020; 14:447-454. [PMID: 32699770 DOI: 10.14444/7059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this review, we discuss the demonstrated value of vitamin D in bone maintenance, fracture resistance, spinal health, and spine surgery outcomes. Despite this, the effect of vitamin D levels in spine surgery has not been well described. Through this review of literature, several conclusions were drawn. First, despite the fact that a high number of spine surgery patients are vitamin D deficient, screening is not commonly performed. Second, adequate vitamin D levels will not be achieved in a majority of these patients without supplementation. Last, inadequate vitamin D levels may increase the risk of pseudarthrosis. Given these findings, we suggest that many patients undergoing spinal surgery could be treated with vitamin D supplementation prior to surgery without the need for confirmatory testing for vitamin D deficiency. This is a more cost-effective method than screening all patients. However, future randomized trials and cost-effectiveness analyses are needed to determine the ultimate effects of vitamin D supplementation on clinical morbidity and surgical outcomes.
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Affiliation(s)
- Benjamin C Mayo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Dustin H Massel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Alem Yacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Ankur S Narain
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Fady Y Hijji
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Nathaniel W Jenkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - James M Parrish
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Krishna D Modi
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - William W Long
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Nadia M Hrynewycz
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Thomas S Brundage
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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13
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Pérez-López FR, Chedraui P, Pilz S. Vitamin D supplementation after the menopause. Ther Adv Endocrinol Metab 2020; 11:2042018820931291. [PMID: 32551035 PMCID: PMC7278294 DOI: 10.1177/2042018820931291] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/10/2020] [Indexed: 12/14/2022] Open
Abstract
The purpose of this review was to assess recent evidence regarding the effects of low vitamin D levels on some highly prevalent clinical conditions of postmenopausal women. We reviewed and selected recent literature regarding menopause-related conditions associated with vitamin D deficiency and interventions to manage them. Low circulating 25-hydroxyvitamin D (25(OH)D) levels related to menopause are linked to diet, lifestyle, changes in body composition, insulin sensitivity, and reduced physical activity. Vitamin D supplementation increases serum 25(OH)D levels while normalizing parathyroid hormone and bone markers, and in women with serum 25(OH)D levels below 10 ng/ml supplementation may improve bone mineral density. Low vitamin D status has been associated with the metabolic syndrome, high triglyceride levels, and low high-density lipoprotein cholesterol levels. When compared with placebo, vitamin D supplementation may lower the risk of the metabolic syndrome, hypertriglyceridemia, and hyperglycemia. There is an inverse relationship between fat mass and serum 25(OH)D levels and, therefore, the dosage of supplementation should be adjusted according to the body mass index. Although vitamin D supplementation may improve glucose metabolism in prediabetic subjects, data regarding muscle strength are conflictive. There is evidence that vitamin D over-treatment, to reach extremely high circulating 25(OH)D levels, does not result in better clinical outcomes. The identification and treatment of vitamin D deficiency in postmenopausal women may improve their general health and health outcomes. Vitamin D supplementation should preferably be based on the use of either cholecalciferol or calcifediol.
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Affiliation(s)
| | - Peter Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador, and Facultad de Ciencias de la Salud, Universidad Católica Nuestra Señora de la Asunción, Asunción, Paraguay
| | - Stefan Pilz
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
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14
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Qvist N, Bergström I, Åkerstedt T, Persson J, Konradsen H, Forss A. From being restrained to recapturing vitality: non-western immigrant women's experiences of undergoing vitamin D treatment after childbirth. Int J Qual Stud Health Well-being 2019; 14:1632111. [PMID: 31232674 PMCID: PMC6598479 DOI: 10.1080/17482631.2019.1632111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 10/27/2022] Open
Abstract
Purpose: Vitamin D deficiency is a complex topic in human health and ill-health and has been studied in a variety of contexts and populations. Few studies examine Vitamin D deficiency among non-western immigrant women and even fewer examine women's perspective on daily life while living with low vitamin D levels after childbirth and undergoing vitamin D treatment. The aim was, therefore, to explore health and ill-health among non-western immigrant women living with low vitamin D levels after childbirth and reaching normalized levels after one year of vitamin D treatment. Method: An explorative qualitative study using qualitative content analysis. Six women aged 25 to 38 years, diagnosed with low 25-hydroxyvitamin D levels during pregnancy, were recruited after having undergone vitamin D treatment. Results: The women told about living a restrained life which gradually transformed into an experience of recaptured vitality. They also experienced a need for continuity in medication, as an interruption of treatment meant returning symptoms. Conclusion: In this study, non-western immigrant women described benefits in everyday life, increased strength, relieved pain and improved sleep quality. The findings can provide valuable knowledge for healthcare providers meeting women with physical weakness, musculoskeletal pain and/or poor sleep quality after childbirth. Further studies using a longitudinal design and larger samples are warranted.
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Affiliation(s)
- Ninni Qvist
- Osteoporosis Center, Inflammation & Infection Theme, Karolinska University Hospital Huddinge, Sweden
| | - Ingrid Bergström
- Osteoporosis Center, Inflammation & Infection Theme, Karolinska University Hospital Huddinge, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Sweden
| | - Torbjörn Åkerstedt
- Stress Research Institute, Stockholm University, Sweden
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jan Persson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Sweden
- Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Hanne Konradsen
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
| | - Anette Forss
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
- Department of Philosophy, Stony Brook University, New York, USA
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15
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Sertpoyraz FM, Kılıc Ozturk Y, Gulsen Kirbiyik E. Yaşlı kadınlarda kas-iskelet sistemi ağrısıyla D vitamini düzeyleri arasındaki ilişki. FAMILY PRACTICE AND PALLIATIVE CARE 2019. [DOI: 10.22391/fppc.456142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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16
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Hajimohammadebrahim-Ketabforoush M, Shahmohammadi M, Khoundabi B, Shariatpanahi ZV. Effect of Vitamin D Supplementation on Postcraniotomy Pain After Brain Tumor Surgery: A Randomized Clinical Trial. World Neurosurg 2019; 130:e105-e111. [PMID: 31181357 DOI: 10.1016/j.wneu.2019.05.250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine the effect of vitamin D supplementation on postoperative pain and analgesic requirement in brain tumor surgery. METHODS A total of 60 patients with vitamin D serum levels ≤20 ng/dL were randomly assigned to 2 groups equally. The study group (n = 30) received intramuscular injection of 300,000 IU vitamin D before surgery. RESULTS Preoperative serum level of vitamin D was 15.9 ± 3.8 ng/dL and 14.5 ± 3.6 ng/dL in the study and control groups, respectively (P = 0.13). Serum level of vitamin D on day 5 of surgery was 22.5 ± 4.3 and 13.7 ± 3.8 in the study and control groups, respectively (P < 0.001). A percentage of 50% had pain scores >4 on the first postoperative day, which decreased with time. The median (interquartile range) of the visual analogue scale score during the 3 postoperative days was 3 (5), 3 (5), 1 (3), and 5 (7), 2 (5), 1 (3) in the study and control groups, respectively, with no significant difference. There was no difference in analgesic consumption between the 2 groups. Analysis through the generalized estimating equation model indicated that patients who had received vitamin D for a longer time before the operative time had an insignificantly less pain score. CONCLUSIONS On the basis of the study results, one half of our patients reported moderate-to-severe pain scores on the first day after surgery. The pain in the study group was insignificantly less than that in the control group, but it seems that chronic high level of vitamin D may lead to promising results.
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Affiliation(s)
- Melika Hajimohammadebrahim-Ketabforoush
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Shahmohammadi
- Department of Neurosurgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Batoul Khoundabi
- Helal-e-Iran Applied Science Higher Education Institute (Red Crescent Society of Iran), Tehran, Iran
| | - Zahra Vahdat Shariatpanahi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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17
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Yu HM, Yao XD, Zhang RM, Zhuang HF, Wang PW, Li YZ. Repression of let-7b-5p prevents the development of multifidus muscle dysfunction by promoting vitamin D accumulation via upregulation of electron transfer flavoprotein alpha subunit in a rat model of multifidus muscle injury. J Cell Biochem 2019; 120:7458-7473. [PMID: 30387180 DOI: 10.1002/jcb.28020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/15/2018] [Indexed: 01/24/2023]
Abstract
Multifidus muscle dysfunction is associated with the multifidus muscle injury (MMI), which ultimately result in the low-back pain. Increasing evidence shows that microRNAs (miRs) may be involved in multifidus muscle dysfunction. In this study, we tested the hypothesis that downregulation of let-7b-5p may inhibit the multifidus muscle dysfunction development and progression. The target prediction program and luciferase activity determination confirmed electron transfer flavoprotein alpha subunit (ETFA) as a direct target gene of let-7b-5p. To study the mechanisms and functions of let-7b-5p in relation to ETFA in MMI progression, we prepared rats with experimental MMI, and a lentivirus-based packaging system was designed to upregulate expressions of let-7b-5p, and downregulate the expression of ETFA. ETFA was identified as a target gene of let-7b-5p. Older age, a longer duration of pain, and higher visual analog scale and Oswestry disability index scores for the patients with chronic low-back pain were linked to a more severe degree of degenerative muscle atrophy and fatty infiltration. Increased expression of let-7b-5p and decreased expression of ETFA and vitamin D receptor (VDR) were positively correlated with multifidus muscle dysfunction. Downregulated let-7b-5p could inhibit infiltration of collagen fibers, reverse the ultrastructural changes of multifidus muscle, and induce the VDR expression, thereby repair the MMI. The results provided a potential basis for let-7b-5p that could support targeted intervention in multifidus muscle dysfunction. Collectively, this study confirmed that downregulation of let-7b-5p has a potential inhibitory effect on the development of the function of the musculus myocytes by upregulating ETFA.
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Affiliation(s)
- Hai-Ming Yu
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Xue-Dong Yao
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Rong-Mou Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Hua-Feng Zhuang
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Pei-Wen Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yi-Zhong Li
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
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18
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Lakkireddy M, Karra ML, Patnala C, Iyengar R, Cherukuri N, Hussain KA, Chodavarapu LM, Kiran Kumar KK, Aluka SK, Bodla AK, Badavath RR, Peddamadyam SK. Efficiency of vitamin D supplementation in patients with mechanical low back ache. J Clin Orthop Trauma 2019; 10:1101-1110. [PMID: 31708636 PMCID: PMC6834986 DOI: 10.1016/j.jcot.2019.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Preliminary evidence suggests an association of hypovitaminosis D (hypo.D) with mechanical Low back ache (mLBA). AIM This study was designed to 1. Explore the relationship of hypovitaminosis D with mLBA in the absence of other confounding factors 2. Formulate and validate an appropriate treatment protocol and 3. Explore the differences in outcomes with various oral formulations of vitamin D available in Indian market. MATERIALS & METHODS Three randomised groups of patients with mLBA and hypo.D between 18 and 45 years of age without any co morbid conditions were studied for the effectiveness of adjunctive vit.D supplementation of 6,00,000 IUs (60,000 IUs/day for ten consecutive days) in the form of granule or nano syrup or soft gel capsule for the treatment of mLBA. Review evaluation of pain, functional disability and vit.D was done at three weeks and an additional evaluation of vit.D was done at nine months. Evaluation with 3,00,000 IUs of vit.D (60,000 IUs/day for five consecutive days) was done with nano syrup in a different cohort. RESULTS High prevalence of hypo.D (96%) was noted in patients with mLBA. Significant improvement was noted after supplementation of vit.D. The subjects of nano syrup group have shown significantly better improvement compared to others (P < 0.000). Non obese and chronic patients have shown significantly better results than their peers. Though there was significant difference in vit.D before treatment, the difference of improvement between the genders, deficiency and insufficiency, in-door and out-door, smokers and non smoker subgroups was not significant. Seasonal variation in vit.D before and after the treatment was significant. CONCLUSION Hypovitaminosis D can be a potential causative factor for mLBA in addition to the other known causes. Proper evaluation and adjunctive vit.D supplementation can effectively break the vicious cycle of low back ache with significant improvement in serum vit.D level, effective relief of pain and significant functional improvement without any adverse effects. Improvement in vit.D was not significantly related to its initial status and obese individuals have shown significantly lesser improvement. The results with nano syrup formulation were significantly better compared to others. Formulation based dosage adjustments assume significance in view of these results.
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Affiliation(s)
- Maheshwar Lakkireddy
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India,Corresponding author.
| | - Madhu Latha Karra
- Department of Biochemistry, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Chandrasekhar Patnala
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Raju Iyengar
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Nagesh Cherukuri
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - K.S. Asif Hussain
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Lalith Mohan Chodavarapu
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | | | - Sundeep Kund Aluka
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Arvind Kumar Bodla
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Raja Ramesh Badavath
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Shravan Kumar Peddamadyam
- Department of Orthopaedics, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
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19
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Brady SRE, Naderpoor N, de Courten MPJ, Scragg R, Cicuttini F, Mousa A, de Courten B. Vitamin D supplementation may improve back pain disability in vitamin D deficient and overweight or obese adults. J Steroid Biochem Mol Biol 2019; 185:212-217. [PMID: 30201225 DOI: 10.1016/j.jsbmb.2018.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 12/25/2022]
Abstract
Back pain is currently the greatest cause of disability worldwide, and there are very limited therapeutic options available. Vitamin D deficiency and obesity are both risk factors for back pain. The few randomised controlled trials examining the effects of vitamin D supplementation on back pain have methodological limitations and largely include non-vitamin D deficient participants. Thus, the aim of this study was to determine whether vitamin D supplementation improves back pain symptoms in vitamin D deficient and overweight or obese, otherwise healthy adults. Sixty-five overweight or obese adults (BMI ≥ 25 kg/m2) with vitamin D deficiency (25-hydroxyvitamin D [25(OH)D] concentrations ≤50 nmol/L) were randomised to a bolus oral dose of 100,000 IU followed by 4000 IU cholecalciferol/day or matching placebo for 16 weeks. We measured 25(OH)D concentrations (chemiluminescent immunoassays) and self-reported back pain (Chronic Pain Grade Questionnaire) before and after the intervention. Lifestyle habits including sun exposure, physical activity, and diet were collected using questionnaires. Fifty-four participants completed the study, of which 49 had complete data for back pain and were included in the present analyses (31 M/18 F; mean ± SD age: 31.8 ± 8.9 years; BMI: 31.1 ± 4.5 kg/m2). After the 16-week intervention, 25(OH)D levels increased significantly with vitamin D supplementation compared with placebo (55.7 ± 20.9 versus 3.9 ± 14.4 nmol/L, respectively, p < 0.001). There were no significant differences between vitamin D and placebo groups in change in back pain intensity or disability scores (all p > 0.05). However, in those with 25(OH)D concentrations <30 nmol/L at baseline (n = 20), there was a significantly greater reduction in back pain disability scores in the vitamin D group compared with placebo, after adjusting for important covariates known to affect vitamin D status and/or back pain (b [95%CI] = -11.6 [-22.4, -0.8], p = 0.04). Our findings suggest that vitamin D supplementation in overweight or obese and markedly vitamin D deficient adults (25(OH)D <30 nmol/L) may improve back pain disability. Although treating severe vitamin D deficiency is recommended for optimising bone health, this study suggests it may also improve back pain. Hence, testing for vitamin D deficiency in those with back pain who are overweight or obese may be warranted.
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Affiliation(s)
- Sharmayne R E Brady
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Negar Naderpoor
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51, Kanooka Grove, Clayton, VIC, 3168 Australia
| | - Maximilian P J de Courten
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia; Centre for Chronic Disease Prevention, Victoria University, Melbourne, VIC, 3021, Australia
| | - Robert Scragg
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51, Kanooka Grove, Clayton, VIC, 3168 Australia
| | - Barbora de Courten
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51, Kanooka Grove, Clayton, VIC, 3168 Australia.
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20
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Withanage ND, Perera S, Peiris H, Athiththan LV. Serum 25-hydroxyvitamin D, serum calcium and vitamin D receptor (VDR) polymorphisms in a selected population with lumbar disc herniation-A case control study. PLoS One 2018; 13:e0205841. [PMID: 30356314 PMCID: PMC6200232 DOI: 10.1371/journal.pone.0205841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/02/2018] [Indexed: 12/03/2022] Open
Abstract
Background Association of Vitamin D receptor (VDR) polymorphisms with lumbar disc herniation (LDH) have been identified in several ethnic groups globally. Despite abundant sunlight, vitamin D deficiency is reported in many tropical countries. As vitamin D is a key modulator for intestinal calcium absorption, low vitamin D could contribute to low serum calcium leading to abnormalities of skeletal homeostasis. Therefore, present study was aimed to study the association of serum 25-hydroxyvitamin D (25(OH)D), serum calcium and VDR polymorphisms in a selected Sri Lankan population. Materials & methods A case control study was conducted in 119 participants (cases = 51: controls = 68). Serum 25(OH)D levels were measured using ELISA. The VDR polymorphisms (Fok I and Taq I) were detected by polymerase chain reaction followed by restriction fragment length polymorphism. Results Findings indicated a significantly low (p = 0.000) 25(OH)D levels in cases (18.7±3.7 ng/mL) compared to controls(25.5±9.8 ng/mL) while 25(OH)D in both groups were below the reference range. Mean serum calcium levels in both groups were within normal reference range and was not significantly different among groups. Statistically significant association was not observed between VDR Fok I polymorphisms among cases and controls. Although Fok I polymorphism genotypes were in Hardy-Weinberg equilibrium (HWE), Taq I genotypes in controls violated HWE. Conclusion Present study confirms that insufficient serum 25(OH)D levels in cases have major contribution to LDH. VDR Fok I polymorphisms did not have any significant association with LDH in Sri Lankan ethnicity.
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Affiliation(s)
- Niroshima Dedunu Withanage
- Department of Allied Health Sciences, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugogoda, Sri Lanka
- * E-mail:
| | | | - Hemantha Peiris
- Department of Biochemistry, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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Warraich S, Sidhu A, Hou M, Alenezi O. The impact of Middle Eastern Origin, HIV, HCV, and HIV/HCV co-infection in the development of hypovitaminosis D in adults. Mol Genet Genomic Med 2018; 6:1010-1014. [PMID: 30209895 PMCID: PMC6305679 DOI: 10.1002/mgg3.475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND A relationship between hypovitaminosis D and infection with HIV and HCV has been established in the scientific literature. Studies comparing these illnesses to other risk factors for development of hypovitaminosis D, such as being of Middle Eastern origin, have been lacking. The goals of this study were: (a) to document vitamin D levels in groups of individuals at high risk of developing its deficiency, (b) analyze the data collected to numerically determine which group had the lowest average vitamin D levels, and (c) discuss the impact of the findings and offer possible explanations. METHODS This retrospective observational study involved reviewing medical charts and documenting recent vitamin D levels. Our subgroups were: (a) individuals infected with HIV, (b) individuals infected with HCV, (c) individuals co-infected with HIV/HCV, and (d) people of Middle Eastern origin. The gathered data was subsequently subjected to statistical analysis. RESULTS People of Middle Eastern origin were found more likely to be vitamin D deficient as compared to those infected with HIV, HCV, or co-infected with both HIV and HCV. CONCLUSION This suggests that genetic and environmental factors unique to otherwise healthy Middle Eastern people are more detrimental, in terms of developing hypovitaminosis D, than being chronically infected with the aforementioned illnesses.
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Affiliation(s)
| | - Aven Sidhu
- Vancouver Virology Centre, Vancouver, BC, Canada
| | - Michelle Hou
- Vancouver Virology Centre, Vancouver, BC, Canada
| | - Osamah Alenezi
- Vancouver Virology Centre, Vancouver, BC, Canada.,CIHR HIV Clinical Trials Network, Vancouver, BC, Canada
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Albahlal JM, Alhandi AA, Aldihan KA, Alsultan OH, Alhusain FA, Alqahtani HM, Aleissa SI. Primary healthcare physicians' adherence to acute lower back pain referral guidelines in Riyadh, Saudi Arabia. Saudi Med J 2018; 39:838-841. [PMID: 30106424 PMCID: PMC6194986 DOI: 10.15537/smj.2018.8.22539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess the primary healthcare physicians' adherence to referral guidelines for acute low back pain and if there is any association with experience level. Methods: A cross-sectional study held in Tertiary care hospital, Riyadh, Kingdom of Saudi Arabia.Questionnaires were distributed in-person between October 2017 and January 2018 among 100 primary healthcare physicians, with a 79% response rate. Results: The distribution between male to female was 43%-57%. Twenty-five percent of physicians encounter 1-5 patients weekly, while 28% encounter more than 15 patients. The physicians included had a higher than expected adherence to referral guidelines with percentages ranging between 63-94% referral rates for back pain related red flags. A trend was noted where there was an increase in referral decisions with increased experience when encountering red flags. More experienced physicians were more likely to refer when encountering; pain worse after prolonged sitting, limited mobility, and pain worse while coughing or sneezing (p less than 0.05). Conclusion: Primary healthcare physicians working in one health system in Riyadh had a higher than expected adherence to referral guidelines for back pain related red flags.
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Affiliation(s)
- Jarallah M Albahlal
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Gokcek E, Kaydu A. Assessment of Relationship between Vitamin D Deficiency and Pain Severity in Patients with Low Back Pain: A Retrospective, Observational Study. Anesth Essays Res 2018; 12:680-684. [PMID: 30283175 PMCID: PMC6157211 DOI: 10.4103/aer.aer_96_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Vitamin D is associated with musculoskeletal function in our body, and its deficiency is a common health problem all over the world. Low back pain (LBP) is an important health problem in terms of low quality of life, loss of work power, and cost of diagnosis and treatment approaches. AIMS The purpose of this study is to investigate the relationship between pain severity and Vitamin D deficiency in patients who applied to pain polyclinic with LBP. SETTINGS AND DESIGN This was a retrospective, observational study. SUBJECTS AND METHODS The files of patients aged between 18 and 70 years who applied to our hospital between January and February 2018 were examined retrospectively by a specialist. Serum 25-hydroxyvitamin D (25(OH)D) level, Visual Analogue Scale (VAS), age, education level, marital status, working status, and body mass index (BMI) values recorded in patient files were included in the study. The limit value of Vitamin D was accepted as 20 ng/mL. Patients were divided into two groups according to their levels of Vitamin D. Patients with serum 25(OH)D levels below 20 ng/mL were considered as the deficiency of Vitamin D (Group 1) and patients with 20 ng/mL and over 20 ng/mL values were considered as normal in terms of Vitamin D (Group 2). STATISTICAL ANALYSIS USED Descriptive statistical data were presented as mean, standard deviation, numbers, and percentage. There was no difference between the normally distributed group and the non-normally distributed group in terms of vitamin D levels. To compare the frequencies, the Chi-square test was used. To define the linear association between independent variables and Vitamin D level, Spearman's rho correlation coefficients were calculated. RESULTS The level of Vitamin D was measured in 98 patients aged 18-70 years who applied to our hospital's polyclinic due to LBP during the study period. The deficiency of vitamin was detected in 84 (85.7%) of the patients, while Vitamin D was found in 14 (14.3%) as normal. Groups were similar in terms of age, gender, BMI, educational level, marital status and working status (p> 0.05); however, there was a statistically significant difference between the two groups in terms of VAS score and levels of Vitamin D (P < 0.001 and P < 0.001, respectively). While there was a negative correlation between D vitamin level and VAS score (r = -0.594, P < 0.001), there was no correlation between age, gender, BMI, education level, marital status, and working status (P > 0.05). CONCLUSIONS The deficiency of Vitamin D is often asymptomatic, and also, it can cause bone and muscle pain. In our study, we determined that the severity of pain increased in patients with LBP as the deficiency of Vitamin D increased. For this reason, we recommend to be evaluated the level of Vitamin D in patients with LBP.
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Affiliation(s)
- Erhan Gokcek
- Department of Anesthesiology, Diyarbakir Selahaddini Eyyübi State Hopital, Diyarbakir, Turkey
| | - Ayhan Kaydu
- Department of Anesthesiology, Diyarbakir Selahaddini Eyyübi State Hopital, Diyarbakir, Turkey
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Nageeb RS, Shehta N, Nageeb GS, Omran AA. Body mass index and vitamin D level in carpal tunnel syndrome patients. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2018; 54:14. [PMID: 29780234 PMCID: PMC5954785 DOI: 10.1186/s41983-018-0009-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 03/23/2018] [Indexed: 01/03/2023] Open
Abstract
Background Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity. The aim of this study is to evaluate the body mass index (BMI) and vitamin D levels in CTS patients. Methods The current study was conducted at Zagazig University Hospitals. It included 50 CTS patients and 50 controls. Clinical assessment was carried out to exclude symptoms and signs of neuropathy. Laboratory investigations including vitamin D levels, glycosylated hemoglobin, liver, and kidney function were carried out for every participant. All patients underwent electrodiagnostic study and completed Boston questionnaire to assess their pain sum score, symptom severity (SSS), and functional status (FSS). Results Patients had significantly higher BMI and lower vitamin D levels compared to controls (p = 0.003 and p = 0.001, respectively). Those with severe CTS had a significantly higher BMI and lower vitamin D levels than the others (p = 0.03 and p = 0.01 respectively). No significant difference was found between CTS subgroups regarding the SSS, while a higher significant FSS and pain sum score were reported in the severe CTS patients compared to the other two groups (p = 0.01 and p = 0.04 respectively). A significant negative correlation was detected between vitamin D levels and both of BMI, and Boston pain sum scores (p = 0.01 and p = 0.03 respectively). Also, an inverse correlation was detected between vitamin D levels and both of SSS and FSS (p = 0.14, p = 0.06). Furthermore, a significant positive and negative correlation between vitamin D levels and both of conduction velocity and distal motor latency respectively was observed (p = 0.02 and p = 0.01 respectively). Conclusions Carpal tunnel syndrome was significantly associated with hypovitaminosis D especially in patients with higher BMI. This highlights the importance of vitamin D supplements and weight loss regimes to minimize the severity of their pain.
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Affiliation(s)
| | - Nahed Shehta
- Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | | | - Alaa A Omran
- Faculty of Medicine, Zagazig University, Sharkia, Egypt
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Effects of vitamin D optimization on quality of life of patients with fibromyalgia: A randomized controlled trial. Med J Islam Repub Iran 2018; 32:29. [PMID: 30159280 PMCID: PMC6108287 DOI: 10.14196/mjiri.32.29] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Indexed: 12/11/2022] Open
Abstract
Background: Numerous studies have been conducted to evaluate the frequency of hypovitaminosis D in patients with fibromyalgia syndrome (FMS) and its association with FMS symptoms. This study aimed at assessing the effect of hypovitaminosis D on the symptoms and quality of life of patients with fibromyalgia.
Methods: A total of 74 FMS patients with hypovitaminosis D were randomly assigned into group A (Trazodone 25 mg at bedtime + vitamin D 50 000 IU weekly) and group B (Trazodone 25 mg at bedtime + placebo). Serum vitamin D level, Widespread Pain Index (WPI), Fibromyalgia Impact Questionnaire (FIQ), Pittsburgh Sleep Quality Index (PSQI), and Short Form Health Survey (SF-36) were used at the beginning of the treatment and 4 and 8 weeks post treatment.
Results: Significant improvements were observed in WPI, FIQ, and PSQI scores in both groups. Moreover, combination of vitamin D and Trazodone resulted in significant improvement of SF-36 scores compared to Trazodone therapy. Improvement in pain-related indices including the WPI and the physical component score (PCS) fraction of SF-36 was more noticeable in vitamin D/Trazodone combination therapy.
Conclusion: This study suggests that vitamin D supplementation has significant therapeutic benefits in the management of FMS, especially in pain reduction of patients with fibromyalgia. According to our results, a combination of vitamin D supplements and a conventional antidepressant, when given to vitamin D-deficient fibromyalgia patients, could significantly improve both physical and psychological symptoms
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Sadat-Ali M, Al Essa ON, Alani FM, Al Omar HK, Ebrahim WY. Correlation of symptoms to serum vitamin D levels? Clin Nutr ESPEN 2018; 24:31-34. [DOI: 10.1016/j.clnesp.2018.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 02/08/2023]
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Englund M, Persson J, Bergström I. Lower pain and higher muscular strength in immigrant women with vitamin D deficiency following vitamin D treatment. Int J Circumpolar Health 2017; 76:1340547. [PMID: 28774221 PMCID: PMC5549824 DOI: 10.1080/22423982.2017.1340547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Vitamin D deficiency is common among immigrants in the Nordic region. It may lead to osteomalacia with severe musculoskeletal pain. There are reports that vitamin D deficiency without osteomalacia may lead to pain but little is known of the effect of treatment. OBJECTIVE To investigate whether a moderate dose of cholecalciferol and calcium improves strength and pain in a group of vitamin D deficient women. DESIGN Twentyfive immigrant women with vitamin D deficiency diagnosed during pregnancy were treated postpartum with a daily dose of 1,600 IU cholecalciferol and 1,000 mg of calcium. They were examined at the start of treatment and again after 3 months of treatement and the results were statistically compared. SETTING Southern parts of Stockholm. MAIN OUTCOME MEASURES Serum 25-hydroyvitamin D (25(OH)D), serum-parathyroid hormone (PTH), pain measured by a visual analogue scale (VAS), musculoskeletal strength by performance on a chair stand test (seconds), and bone tenderness by pressure algometer (kilo-Pascal). RESULTS Following the treatment, the 21 women attending had lowered cm in VAS, improved musculoskeletal strength, - and 25(OH)D levels were normalized. CONCLUSIONS A moderate dose of vitamin D normalized l vitamin D levels, improved muscular strength and reduced pain in this group of vitamin D deficient immigrant women.
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Affiliation(s)
- Marianne Englund
- a Department of surgery at Danderyds Hospital , Stockholm , Sweden
| | - Jan Persson
- b Department of Anaesthesia and Intensive Care , Karolinska University Hospital Stockholm , Stockholm , Sweden.,c Clinical Science, Intervention, and Technology , Karolinska Institutet , Stockholm , Sweden
| | - Ingrid Bergström
- c Clinical Science, Intervention, and Technology , Karolinska Institutet , Stockholm , Sweden.,d Department of Endocrinology, Metabolism, and Diabetes , Karolinska University Hospital , Stockholm , Sweden
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Heuch I, Heuch I, Hagen K, Mai XM, Langhammer A, Zwart JA. Is there an association between vitamin D status and risk of chronic low back pain? A nested case-control analysis in the Nord-Trøndelag Health Study. BMJ Open 2017; 7:e018521. [PMID: 29175890 PMCID: PMC5719329 DOI: 10.1136/bmjopen-2017-018521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To explore potential associations between vitamin D status and risk of chronic low back pain (LBP) in a Norwegian cohort, and to investigate whether relationships depend on the season of blood sample collection. DESIGN A nested case-control study in a prospective data set. SETTING The Norwegian community-based Nord-Trøndelag Health Study (HUNT). Data were collected in the HUNT2 (1995-1997) and HUNT3 (2006-2008) surveys. MAIN OUTCOME MEASURE Chronic LBP, defined as LBP persisting at least 3 months continuously during the past year. PARTICIPANTS Among individuals aged 19-55 years without LBP in HUNT2, a data set was generated including 1685 cases with LBP in HUNT3 and 3137 controls without LBP. METHODS Blood samples from the participants collected in HUNT2 were analysed for serum 25-hydroxyvitamin D (25(OH)D) level. Associations with LBP in HUNT3 were evaluated by unconditional logistic regression analysis with adjustment for age, sex, work status, physical activity at work and in leisure time, education, smoking, and body mass index. RESULTS No association between vitamin D status and risk of chronic LBP was found in the total data set (OR per 10 nmol/L 25(OH)D=1.01, 95% CI 0.97 to 1.06) or in individuals with blood samples collected in summer/autumn (OR per 10 nmol/L 25(OH)D=0.99, 95% CI 0.93 to 1.06). For blood samples drawn in winter/spring, associations differed significantly between women and men (p=0.004). Among women a positive association was seen (OR per 10 nmol/L 25(OH)D=1.11, 95% CI 1.02 to 1.20), but among men no significant association was observed (OR per 10 nmol/L 25(OH)D=0.90, 95% CI 0.81 to 1.01). CONCLUSIONS Overall, no association between vitamin D status and risk of LBP was demonstrated. The association suggested in women for the winter/spring season cannot be regarded as established.
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Affiliation(s)
- Ingrid Heuch
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Ivar Heuch
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Knut Hagen
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian National Headache Centre, Department of Neurology, St Olavs Hospital, Trondheim, Norway
| | - Xiao-Mei Mai
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arnulf Langhammer
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - John-Anker Zwart
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Panwar A, Valupadas C, Veeramalla M, Vishwas HN. Prevalence of vitamin D deficiency in chronic and subacute low back pain patients in India: a triple-arm controlled study. Clin Rheumatol 2017; 37:1367-1374. [PMID: 28842760 DOI: 10.1007/s10067-017-3798-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 08/12/2017] [Accepted: 08/17/2017] [Indexed: 11/26/2022]
Abstract
Vitamin D is vital for musculoskeletal health and may be associated with subacute and chronic low back pain. The objective of this study was to estimate the prevalence of vitamin D deficiency among chronic low back pain (CLBP) and subacute low back pain (SLBP), and compare the same with healthy controls. This study was designed as triple-arm case-control study comprising of CLBP, SLBP, and controls. SLBP and CLBP cases were consecutively enrolled over 3 months of winter season from November 2016 to January 2017. Serum 25- (OH) vitamin D was estimated for the study subjects and categorical comparison of severity of vitamin D deficiency was done for the cases and controls. A total of 250 CLBP, 177 SLBP cases, and 248 controls were included in the study. Mean (± SD) serum vitamin D levels among CLBP, SLBP, and controls were 20.36 (± 12.56), 21.42 (± 13.20), and 20.84 (± 6.93) ng/ml respectively, the difference being statistically insignificant. There was no significant difference in the prevalence of vitamin D deficiency among CLBP, SLBP, and controls which was 53.6, 50.8, and 51.6% respectively, in the three arms. However, the categorical analysis revealed that CLBP and SLBP cases had a significantly higher prevalence of worse categories of vitamin D deficiency. Cases had significantly larger frequency (CLBP vs. controls, 43.6 vs 20.1%, P<0.001; SLBP vs. controls, 43.5 vs 20.1%, P = 0.001) of individuals with vitamin D levels ≤ 16 ng/ml (moderate deficiency upper threshold level). Thus, the severe forms of vitamin D deficiency may be causally associated with CLBP and SLBP. The results of the present study revealed that increasing severity of vitamin D deficiency may have a pathogenetic association with chronic low back pain and subacute low back pain. These results may prove to be of significance in framing of future management guidelines for the above clinical conditions.
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Affiliation(s)
- Ajay Panwar
- Department of Neurology, Kakatiya Medical College and Mahatma Gandhi Memorial Hospital, Warangal, 506007, India.
| | - Chandrasekhar Valupadas
- Department of Medicine, Kakatiya Medical College and Mahatma Gandhi Memorial Hospital, Warangal, India
| | - Madhavarao Veeramalla
- Department of Neurology, Kakatiya Medical College and Mahatma Gandhi Memorial Hospital, Warangal, 506007, India
| | - Hunsur N Vishwas
- Department of Clinical Pharmacy, Talla Padmavathi College of Pharmacy, Warangal, India
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Albeshan SM, Mackey MG, Hossain SZ, Alfuraih AA, Brennan PC. Breast Cancer Epidemiology in Gulf Cooperation Council Countries: A Regional and International Comparison. Clin Breast Cancer 2017; 18:e381-e392. [PMID: 28781021 DOI: 10.1016/j.clbc.2017.07.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/03/2017] [Accepted: 07/09/2017] [Indexed: 01/25/2023]
Abstract
Breast cancer is the most frequently diagnosed noncutaneous malignancy in women living in Gulf Cooperation Council countries. The present report aimed to highlight the similarities and variations in breast cancer incidence, age at diagnosis, clinicopathologic features, molecular characteristics, and lifestyle factors that contribute to an increasing incidence of breast cancer compared with neighboring Arab and westernized countries. The data presented, although having important implications for policy makers, also highlights the need for further research. Such research would ensure that effective prevention and detection strategies are tailored to the specific needs of the Gulf women such that the management of breast cancer is optimized.
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Affiliation(s)
- Salman M Albeshan
- Medical Radiation Sciences, Medical Image Optimization and Perception Group, University of Sydney, Faculty of Health Sciences, Sydney, NSW, Australia; Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia.
| | - Martin G Mackey
- Discipline of Physiotherapy, University of Sydney, Faculty of Health Sciences, Sydney, NSW, Australia
| | - Syeda Z Hossain
- Discipline of Behavioral and Social Sciences in Health, University of Sydney, Faculty of Health Sciences, Sydney, NSW, Australia
| | - Abdulrahman A Alfuraih
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Patrick C Brennan
- Medical Radiation Sciences, Medical Image Optimization and Perception Group, University of Sydney, Faculty of Health Sciences, Sydney, NSW, Australia
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Çalık Y, Aygün Ü. Evaluation of vitamin D levels in patients with chronic low back-leg pain. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:243-247. [PMID: 28438384 PMCID: PMC6197560 DOI: 10.1016/j.aott.2017.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 11/21/2016] [Accepted: 01/31/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We aimed to examine the relationship between the levels of vitamin D and patients with chronic low back-leg pain (CLBLP) and to investigate its effects on pain and functional capacity. METHODS 145 patients (female/male:103/42) with CLBLP, aged between 35 and 65 years (mean age: 53,06 ± 8,14), participated in the study. Visual Analog Pain Scale (VAS) was used to measure the state of pain. Pain-related functional capacity was evaluated through Oswestry Disability Index (ODI). Patients were classified into three groups based on their serum vitamin D levels: normal (≥30 ng/ml), vitamin D insufficiency (21-29 ng/ml), and vitamin D deficiency (≤20 ng/ml). RESULTS We found that 22,8% of patients (n:33) had vitamin D deficiency, 42,8% (n:62) had vitamin D insufficiency, and 34,5% (n:50) had normal levels of vitamin D. VAS scores were 4,75 ± 0,93; 4,66 ± 0,97 and 4,52 ± 0,90 for patients with vitamin D deficiency, vitamin D insufficiency, and normal levels of vitamin D, respectively. We found that there was no significant relationship between vitamin D level and VAS score (p>0,05). ODI scores were 18,78 ± 7,89; 15,46 ± 5,57 and 14,52 ± 7,19 for patients with vitamin D deficiency, vitamin D insufficiency, and normal levels of vitamin D, respectively. CLBLP-related functional capacity was found to be significantly lower in patients with vitamin D deficiency when compared to other two groups (p < 0,05). CONCLUSION Vitamin D deficiency may lead to lower functional capacity, and clinically, Vit D levels should be checked in musculoskeletal pain patients at risk of Vit D deficiency. LEVEL OF EVIDENCE Level IV, Diagnostic study.
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Affiliation(s)
- Yalkın Çalık
- Abant Izzet Baysal University, İzzet Baysal Physical Medicine and Rehabilitation Training and Research Hospital, Bolu, Turkey.
| | - Ümit Aygün
- Abant İzzet Baysal University, İzzet Baysal Training and Research Hospital, Department of Orthopaedics and Traumatology, Bolu, Turkey
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Alghadir AH, Gabr SA, Al-Eisa ES. Mechanical factors and vitamin D deficiency in schoolchildren with low back pain: biochemical and cross-sectional survey analysis. J Pain Res 2017; 10:855-865. [PMID: 28442927 PMCID: PMC5396951 DOI: 10.2147/jpr.s124859] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study was designed to evaluate the role of vitamin D, muscle fatigue biomarkers, and mechanical factors in the progression of low back pain (LBP) in schoolchildren. BACKGROUND Children and adolescents frequently suffer from LBP with no clear clinical causes, and >71% of schoolchildren aged 12-17 years will show at least one episode of LBP. MATERIALS AND METHODS A total of 250 schoolchildren aged 12-16 years were randomly enrolled in this study. For all schoolchildren height, weight, percentage of daily sun exposure and and areas of skin exposed to sun, method of carrying the bag, and bag weight and type were recorded over a typical school week. Pain scores, physical activity (PA), LBP, serum vitamin 25(OH)D level, serum bone-specific alkaline phosphatase, creatine kinase (CK), and lactate dehydrogenase (LDH) activities and calcium (Ca) concentrations were estimated using prevalidated Pain Rating Scale, modified Oswestry Low Back Pain Disability Questionnaire, short-form PA questionnaire, and colorimetric and immunoassay techniques. RESULTS During the period of October 2013-May 2014, LBP was estimated in 52.2% of the schoolchildren. It was classified into moderate (34%) and severe (18%). Girls showed a higher LBP (36%) compared with boys (24%). In schoolchildren with moderate and severe LBP significantly higher (P=0.01) body mass index, waist, hip, and waist-to-hip ratio measurements were observed compared with normal schoolchildren. LBP significantly correlated with less sun exposure, lower PA, sedentary activity (TV/computer use), and overloaded school bags. In addition, schoolchildren with severe LBP showed lower levels of vitamin 25(OH)D and Ca and higher levels of CK, LDH, and serum bone-specific alkaline phosphatase compared with moderate and healthy schoolchildren. Stepwise regression analysis revealed that age, gender, demographic parameters, PA, vitamin D levels, Ca, CK, and LDH associated with ~56.8%-86.7% of the incidence of LBP among schoolchildren. CONCLUSION In children and adolescents, LBP was shown to be linked with limited sun exposure, inadequate vitamin D diets, adiposity, lower PA, sedentary lifestyles, vitamin 25 (OH) D deficiency, and lower levels of Ca, CK, and LDH.
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Affiliation(s)
- Ahmad H Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Sami A Gabr
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Anatomy, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Einas S Al-Eisa
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Rogers C, Gobbi A. The Optimization of Natural Healing. BIO-ORTHOPAEDICS 2017:3-24. [DOI: 10.1007/978-3-662-54181-4_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
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Mabey T, Singhatanadgige W, Yingsakmongkol W, Limthongkul W, Honsawek S. Vitamin D and spine surgery. World J Orthop 2016; 7:726-730. [PMID: 27900269 PMCID: PMC5112341 DOI: 10.5312/wjo.v7.i11.726] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/09/2016] [Accepted: 08/31/2016] [Indexed: 02/06/2023] Open
Abstract
Vitamin D is crucial for musculoskeletal health, maintenance, and function. Vitamin D insufficiency is common among patients undergoing spine surgery and the ideal vitamin D level for spine surgery has yet to be investigated. There is a high prevalence of hypovitaminosis D in patients with musculoskeletal pain regardless of surgical intervention. With the frequency and costs of spine surgery increasing, it is imperative that efforts are continued to reduce the impact on patients and healthcare services. Studies into vitamin D and its associations with orthopaedic surgery have yielded alarming findings with regards to the prevalence of vitamin D deficiency. Importantly, altered vitamin D status also contributes to a wide range of disease conditions. Therefore, future investigations are still essential for better understanding the relationship between vitamin D and spine surgery outcomes. Whilst further research is required to fully elucidate the extent of the effects of hypovitaminosis D has on surgical outcomes, it is strongly advisable to reduce the impacts by appropriate vitamin D supplementation of deficient and at-risk patients.
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A Survey of Vitamin D Status in Patients with Degenerative Diseases of the Spine. Asian Spine J 2016; 10:834-842. [PMID: 27790310 PMCID: PMC5081317 DOI: 10.4184/asj.2016.10.5.834] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/18/2016] [Accepted: 04/08/2016] [Indexed: 01/30/2023] Open
Abstract
STUDY DESIGN Descriptive cross-sectional study. PURPOSE To determine the prevalence of vitamin D deficiency in patients with degenerative diseases of the spine about to undergo spinal surgery and the relations between such deficiency and potential risk factors. OVERVIEW OF LITERATURE Vitamin D has a major role in musculoskeletal system health maintenance. Recently, studies on degenerative diseases of the spine have shown a high prevalence of vitamin D deficiency in patients undergoing spine surgery. METHODS Serum levels of 25(OH)D were determined by an electrochemiluminescence detection assay. The other variables were determined through relevant questionnaires, and the data was analyzed through analysis of variance, t-test, chi-square and multivariate logistic regression analysis. RESULTS A total of 110 patients were enrolled in the study. The mean serum level of 25(OH)D was 27.45±18.75 ng/mL, and 44.5% of patients showed vitamin D deficiency (25(OH)D<20 ng/mL), with an additional 17.3% of patients having a serum level of 25(OH)D that was insufficient (20≤25(OH)D<30 ng/mL). The prevalence of vitamin D deficiency was significantly higher in the younger age group compared to the older age group (p<0.001) and the ones without a history of taking vitamin D supplements (p=0.013). Compared to men, women showed significantly higher levels of vitamin D (p=0.029). CONCLUSIONS A high prevalence of vitamin D deficiency is seen in patients with degenerative diseases of the spine. On the other hand, the conventional risk factors such as old age or female sex alone did not seem to be sufficient in determining the likelihood of deficiency. Thus, it is recommended that vitamin D deficiency prevention strategies comprise a broader spectrum of the population through which such degenerative diseases and their consequences may be prevented or delayed.
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Thörneby A, Nordeman LM, Johanson EH. No association between level of vitamin D and chronic low back pain in Swedish primary care: a cross-sectional case-control study. Scand J Prim Health Care 2016; 34:196-204. [PMID: 27189389 PMCID: PMC4977943 DOI: 10.1080/02813432.2016.1183557] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Assessment of vitamin D levels and deficiency status in individuals with chronic low back pain (CLBP) in a Swedish general population, compared with controls matched for sex and age. DESIGN Cross-sectional case-control study. SETTING Primary care, southern Sweden. SUBJECTS Participants (n = 44) with self-reported low back pain for at least 3 months and individually sex- and age-matched controls without a chronic pain condition (n = 44), recruited from the general population by random letter of invitation. MAIN OUTCOME MEASURE Association between vitamin D level and CLBP when adjusting for possible confounders in a multivariate forward conditional logistic regression model. RESULTS Mean S-25-hydroxyvitamin D levels were 81 and 80 nmol/L in the CLBP and control group, respectively. The prevalence of vitamin D deficiency was low and similar in the CLBP group and the control group. Vitamin D level was not associated with CLBP when potential confounders were taken into account. CONCLUSIONS No difference in vitamin D levels between participants with CLBP and matched controls could be demonstrated in the present sample. Assessment of vitamin D level and deficiency status may be of questionable value in the management of CLBP in primary care settings at similar latitudes, unless there are additional risk factors for deficiency or specific indicators of osteomalacia. Key points Vitamin D deficiency is common and reported in many chronic pain conditions, including chronic low back pain (CLBP), but evidence for an association and causality is insufficient. • The present study found no association between vitamin D levels and CLBP in a case-control sample of 44 + 44 individuals from the Swedish general population. • Prevalence of vitamin D deficiency was low and comparable in individuals with CLBP and controls without chronic pain, matched for sex and age. • Assessment of vitamin D status, for the purpose of finding and treating an underlying cause of pain, may be of limited value in the management of CLBP in primary care settings at similar latitudes.
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Affiliation(s)
- Andreas Thörneby
- Department of Research and Development, Primary Health Care, Research and Development Center Södra Älvsborg, Region Västra Götaland, Borås, Sweden;
- Närhälsan Kinna Vårdcentral, Region Västra Götaland, Sweden;
- CONTACT Andreas Thörneby Research and Development, Primary Health Care, Research and Development Center Södra Älvsborg, Sven Eriksonsplatsen 4, SE-503 38 Borås, Sweden
| | - Lena Margareta Nordeman
- Department of Research and Development, Primary Health Care, Research and Development Center Södra Älvsborg, Region Västra Götaland, Borås, Sweden;
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Else Hellebö Johanson
- Department of Research and Development, Primary Health Care, Research and Development Center Södra Älvsborg, Region Västra Götaland, Borås, Sweden;
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Gürsoy AE, Bilgen HR, Dürüyen H, Altıntaş Ö, Kolukisa M, Asil T. The evaluation of vitamin D levels in patients with carpal tunnel syndrome. Neurol Sci 2016; 37:1055-61. [PMID: 26939675 DOI: 10.1007/s10072-016-2530-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 02/22/2016] [Indexed: 01/16/2023]
Abstract
The aim of this study was to evaluate the relationship between 25-hydroxyvitamin D (25(OH)D) levels and carpal tunnel syndrome (CTS). 25(OH)D levels were checked in 108 consecutive patients with CTS symptoms and 52 healthy controls. All patients underwent nerve conduction studies and completed Boston Carpal Tunnel Questionnaire (BQ) symptom severity and functional status scales to quantify symptom severity, pain status and functional status. There were 57 patients with electrophysiological confirmed CTS (EP+ group) and 51 electrophysiological negative symptomatic patients (EP- group). 25(OH) D deficiency (25(OH)D < 20 ng/ml) was found in 96.1 % of EP- group, in 94.7 % of EP+ group and in 73.8 % of control group. 25(0H) D level was found significantly lower both in EP+ and EP- groups compared to control group (p = 0.006, p < 0.001, respectively). Although mean vitamin D level in EP- group was lower than EP+ group, statistically difference was not significant between EP+ and EP- groups (p = 0.182). BQ symptom severity and functional status scores and BQ pain sum score were not significantly different between EP+ and EP- groups. We found no correlation with 25(OH) D level for BQ symptom severity, functional status and pain sum scores. 25(OH) D deficiency is a common problem in patients with CTS symptoms. As evidenced by the present study, assessment of serum 25(OH)D is recommended in CTS patients even with electrophysiological negative results.
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Affiliation(s)
- Azize Esra Gürsoy
- Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093, Istanbul, Turkey.
| | - Halide Rengin Bilgen
- Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093, Istanbul, Turkey
| | - Hümeyra Dürüyen
- Department of Neurology, Şişli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Özge Altıntaş
- Department of Neurology, Niğde-Bor State Hospital, Niğde, Turkey
| | - Mehmet Kolukisa
- Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093, Istanbul, Turkey
| | - Talip Asil
- Department of Neurology, Medical Faculty, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093, Istanbul, Turkey
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Wallwork RS, Chipidza FE, Stern TA. Obstacles to the Prescription and Use of Opioids. Prim Care Companion CNS Disord 2016; 18:15f01900. [PMID: 27247832 PMCID: PMC4874752 DOI: 10.4088/pcc.15f01900] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022] Open
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Grant WB. The role of geographical ecological studies in identifying diseases linked to UVB exposure and/or vitamin D. DERMATO-ENDOCRINOLOGY 2016; 8:e1137400. [PMID: 27195055 PMCID: PMC4862381 DOI: 10.1080/19381980.2015.1137400] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 12/28/2015] [Indexed: 02/06/2023]
Abstract
Using a variety of approaches, researchers have studied the health effects of solar ultraviolet (UV) radiation exposure and vitamin D. This review compares the contributions from geographical ecological studies with those of observational studies and clinical trials. Health outcomes discussed were based on the author's knowledge and include anaphylaxis/food allergy, atopic dermatitis and eczema, attention deficit hyperactivity disorder, autism, back pain, cancer, dental caries, diabetes mellitus type 1, hypertension, inflammatory bowel disease, lupus, mononucleosis, multiple sclerosis, Parkinson disease, pneumonia, rheumatoid arthritis, and sepsis. Important interactions have taken place between study types; sometimes ecological studies were the first to report an inverse correlation between solar UVB doses and health outcomes such as for cancer, leading to both observational studies and clinical trials. In other cases, ecological studies added to the knowledge base. Many ecological studies include other important risk-modifying factors, thereby minimizing the chance of reporting the wrong link. Laboratory studies of mechanisms generally support the role of vitamin D in the outcomes discussed. Indications exist that for some outcomes, UVB effects may be independent of vitamin D. This paper discusses the concept of the ecological fallacy, noting that it applies to all epidemiological studies.
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Affiliation(s)
- William B. Grant
- Sunlight, Nutrition, and Health Research Center, San Francisco, CA, USA
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Gendelman O, Itzhaki D, Makarov S, Bennun M, Amital H. A randomized double-blind placebo-controlled study adding high dose vitamin D to analgesic regimens in patients with musculoskeletal pain. Lupus 2015; 24:483-9. [PMID: 25801891 DOI: 10.1177/0961203314558676] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The current mode of therapy for many patients with musculoskeletal pain is unsatisfactory. PURPOSE We aimed to assess the impact of adding 4000 IU of vitamin D on pain and serological parameters in patients with musculoskeletal pain. MATERIALS AND METHODS This was a randomized, double-blinded and placebo-controlled study assessing the effect of 4000 IU of orally given vitamin D3 (cholecalciferol) (four gel capsules of 1000 IU, (SupHerb, Israel) vs. placebo on different parameters of pain. Eighty patients were enrolled and therapy was given for 3 months. Parameters were scored at three time points: prior to intervention, at week 6 and week 12. Visual analogue scale (VAS) scores of pain perception were recorded following 6 and 12 weeks. We also measured serum levels of leukotriene B4 (LTB4), interleukin 6 (IL-6), tumor necrosis factor alpha (TNFα) and prostaglandin E2 (PGE2) by ELISA. RESULTS The group receiving vitamin D achieved a statistically significant larger decline of their VAS measurement throughout the study compared with the placebo group. The need for analgesic 'rescue therapy' was significantly lower among the vitamin D-treated group. TNFα levels decreased by 54.3% in the group treated with vitamin D and increased by 16.1% in the placebo group. PGE2 decreased by39.2% in the group treated with vitamin D and increased by 16% in the placebo group. LTB4 levels decreased in both groups by 24% (p < 0.05). CONCLUSION Adding 4000 IU of vitamin D for patients with musculoskeletal pain may lead to a faster decline of consecutive VAS scores and to a decrease in the levels of inflammatory and pain-related cytokines.
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Affiliation(s)
- O Gendelman
- Department of Medicine 'B', Sheba Medical Center, Tel Hashomer Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - D Itzhaki
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Central Laboratory of Clalit Health Services, Tel-Aviv, Israel
| | - S Makarov
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Department of Anesthesiology, Meir Medical Center, Kfar Saba, Israel
| | - M Bennun
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Department of Anesthesiology, Meir Medical Center, Kfar Saba, Israel
| | - H Amital
- Department of Medicine 'B', Sheba Medical Center, Tel Hashomer Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Vitamin D Levels and 1-Year Fusion Outcomes in Elective Spine Surgery: A Prospective Observational Study. Spine (Phila Pa 1976) 2015; 40:1536-41. [PMID: 26165222 DOI: 10.1097/brs.0000000000001041] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective observational study. OBJECTIVE To investigate the association of perioperative vitamin D levels and nonunion rates and time to fusion in patients undergoing elective spine fusion. SUMMARY OF BACKGROUND DATA Although there is a clear link between bone mineral density and the risk of osteoporosis, it is unclear whether low vitamin D levels affect rates and timing of spinal fusion. METHODS Serum 25-OH vitamin D levels were measured perioperatively in adults undergoing elective spinal fusion between 2011 and 2012. Vitamin D levels <20 ng/mL were considered deficient. Univariate and multivariate logistic regression were performed to identify independent predictors of pseudarthrosis/nonunion within a minimum follow-up period of 12 months. Kaplan-Meier analysis was used to compare time to fusion between groups. RESULTS Of the 133 patients, 31 (23%) demonstrated vitamin D deficiency. Mean patient age was 57 ± 13 years; 44% were female and 94% were Caucasian. The cervical spine was fused in 49%, the lumbar spine in 47%, and the thoracic spine in 4%. Mean construct length was 2 levels (range 1-16). At 12-month follow-up, 112/133 (84%) patients demonstrated fusion (median time to fusion 8.4 mo). Nonunion at 12 months was associated with vitamin D deficiency (20% of patients with adequate vitamin D level vs. 38% of vitamin D-deficient patients, P = 0.063). Kaplan-Meier survival analysis demonstrated time to fusion was significantly longer in the vitamin D-deficient group (12 vs. 6 mo, P = 0.001). On multivariate analysis, vitamin D deficiency was an independent predictor of nonunion (odds ratio 3.449, P = 0.045) when adjusted for age, sex, obesity, fusion length, location, graft type, smoking, and bone morphogenetic protein use. CONCLUSION Vitamin D levels may affect nonunion rate and time to fusion. These results offer insight into the importance of the metabolic milieu for bony fusion as well as a potential avenue for therapeutic intervention. LEVEL OF EVIDENCE 3.
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Elaziz Labeeb AA, Al-Sharaki DR. Detection of serum 25(OH)-vitamin D level in the serum of women with fibromyalgia syndrome and its relation to pain severity. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2015. [DOI: 10.4103/1110-161x.168202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Merlo C, Trummler M, Essig S, Zeller A. Vitamin D Deficiency in Unselected Patients from Swiss Primary Care: A Cross-Sectional Study in Two Seasons. PLoS One 2015; 10:e0138613. [PMID: 26372355 PMCID: PMC4570784 DOI: 10.1371/journal.pone.0138613] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/01/2015] [Indexed: 12/17/2022] Open
Abstract
Background As published data on 25-hydroxy-cholecalciferol (25(OH)D) deficiency in primary care settings is scarce, we assessed the prevalence of hypovitaminosis D, potential associations with clinical symptoms, body mass index, age, Vitamin D intake, and skin type in unselected patients from primary care, and the extent of seasonal variations of serum 25(OH)D concentrations. Methodology/Principal Findings 25(OH)D was measured at the end of summer and/or winter in 1682 consecutive patients from primary care using an enzyme-linked immunosorbant assay. Clinical symptoms were assessed by self-report (visual analogue scale 0 to 10), and vitamin D deficiency was defined as 25(OH)D concentrations < 50 nmol/l. 25(OH)D deficiency was present in 995 (59.2%) patients. 25(OH)D deficient patients reported more intense muscle weakness (visual analogue scale 2.7, 95% confidence interval 2.5 to 2.9) and had a higher body mass index (25.9kg/m2, 25.5 to 26.2) than non-deficient patients (2.5, 2.3 to 2.7; and 24.2, 23.9 to 24.5, respectively). 25(OH)D concentrations also weakly correlated with muscle weakness (Spearman’s rho -0.059, 95% confidence interval -0.107 to -0.011) and body mass index (-0.156, -0.202 to -0.108). Self-reported musculoskeletal pain, fatigue, and age were not associated with deficiency, nor with concentrations. Mean 25(OH)D concentrations in patients with vitamin D containing medication were higher (60.6 ± 22.2 nmol/l) than in patients without medication (44.8 ± 19.2 nmol/l, p < 0.0001) but still below the targeted level of 75 nmol/l. Summer and winter 25(OH)D concentrations differed (53.4 ± 19.9 vs. 41.6 ± 19.3nmol/l, p < 0.0001), which was confirmed in a subgroup of 93 patients who were tested in both seasons (p = 0.01). Conclusion/Significance Nearly 60% of unselected patients from primary care met the criteria for 25(OH)D deficiency. Self-reported muscle weakness and high body mass index were associated with lower 25(OH)D levels. As expected 25(OH)D concentrations were lower in winter compared to summer.
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Affiliation(s)
- Christoph Merlo
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Luzern, Switzerland
| | - Michael Trummler
- Laboratories Bioanalytica, Maihofstrasse 95A, 6006, Luzern, Switzerland
| | - Stefan Essig
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Luzern, Switzerland
- Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207, Nottwil, Switzerland
- * E-mail:
| | - Andreas Zeller
- Center for Primary Health Care, University of Basel, Rheinstrasse 26, 4410, Liestal, Switzerland
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Al-Saleh Y, Al-Daghri NM, Khan N, Alfawaz H, Al-Othman AM, Alokail MS, Chrousos GP. Vitamin D status in Saudi school children based on knowledge. BMC Pediatr 2015; 15:53. [PMID: 25943362 PMCID: PMC4427983 DOI: 10.1186/s12887-015-0369-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 04/24/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The prevalence of vitamin D deficiency in the kingdom of Saudi Arabia is rising unexpectedly in every age group. Apart from several risk factors, the lack of awareness is posing a serious threat for low vitamin D levels in children as well. The aim of our study was to compare the knowledge and status of vitamin D in Saudi school children. METHODS Saudi students, 1188 boys (15.1 ± 2.2 years) and 1038 girls (15.1 ± 2.0 years), were recruited and a pre-designed questionnaire with regards to knowledge about vitamin D was administered. Blood samples were collected and serum 25hydroxyvitamin D (25(OH)D was measured. RESULTS A significantly higher percentage of boys answered correctly than girls regarding knowledge questions as sun exposure (p = 0.002, and 0.011), breastfeeding (p < 0.001) and diseases (p < 0.001). The percentage of girls was significantly higher who thought that fruits and vegetables are not rich sources of vitamin D (24.7% girls vs. 15.4% boys; p < 0.001and 29.6% girls vs. 20.9% boys p < 0.001), respectively. Boys had a higher prevalence and frequency of sun exposure than girls (p < 0.001 for both). Girls showed a significantly higher percentage of sunscreen use and full covering during sun exposure (p = 0.001 for both).Vitamin D deficiency was significantly higher in girls than boys (47.0% versus 19.4.0%; p < 0.001). Vitamin D status in boys was significantly higher than girls (p < 0.001). In girls, those who answered correctly about vitamin D related disease (p = 0.03) and sources (p = 0.015), demonstrated significantly higher vitamin D levels. CONCLUSIONS The awareness of vitamin D and sunlight in children needs to be improved by provision of trained physicians and school teachers. Creating more areas where girls can uncover freely during routine works and outdoor activities will help increase their vitamin D levels.
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Affiliation(s)
- Yousef Al-Saleh
- King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, 11426, Saudi Arabia.
- Prince Mutaib Bin Abdullah Chair on Osteoporosis, Biochemistry Department, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Kingdom of Saudi Arabia.
| | - Nasser M Al-Daghri
- Prince Mutaib Bin Abdullah Chair on Osteoporosis, Biochemistry Department, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Kingdom of Saudi Arabia.
- Biomarkers Research Program Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.
| | - Nasiruddin Khan
- Prince Mutaib Bin Abdullah Chair on Osteoporosis, Biochemistry Department, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Kingdom of Saudi Arabia.
- Biomarkers Research Program Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.
| | - Hanan Alfawaz
- Prince Mutaib Bin Abdullah Chair on Osteoporosis, Biochemistry Department, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Kingdom of Saudi Arabia.
- Department of Food Science and Nutrition, College of Food Science and Agriculture, King Saud University, Riyadh, Saudi Arabia.
| | - Abdulaziz M Al-Othman
- Prince Mutaib Bin Abdullah Chair on Osteoporosis, Biochemistry Department, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Kingdom of Saudi Arabia.
- College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Majed S Alokail
- King Abdulaziz Medical City, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, 11426, Saudi Arabia.
- Prince Mutaib Bin Abdullah Chair on Osteoporosis, Biochemistry Department, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Kingdom of Saudi Arabia.
| | - George P Chrousos
- Prince Mutaib Bin Abdullah Chair on Osteoporosis, Biochemistry Department, College of Science, King Saud University, PO Box, 2455, Riyadh, 11451, Kingdom of Saudi Arabia.
- First Department of Pediatrics, Athens University Medical School, Athens, 11527, Greece.
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Vitamin D and Pain: Vitamin D and Its Role in the Aetiology and Maintenance of Chronic Pain States and Associated Comorbidities. PAIN RESEARCH AND TREATMENT 2015; 2015:904967. [PMID: 26090221 PMCID: PMC4427945 DOI: 10.1155/2015/904967] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 03/15/2015] [Indexed: 12/25/2022]
Abstract
The emergence of new data suggests that the benefits of Vitamin D extend beyond healthy bones. This paper looks at Vitamin D and its role in the aetiology and maintenance of chronic pain states and associated comorbidities. The interfaces between pain and Vitamin D and the mechanisms of action of Vitamin D on pain processes are explored. Finally the association between Vitamin D and pain comorbidities such as sleep and depression is investigated. The paper shows that Vitamin D exerts anatomic, hormonal, neurological, and immunological influences on pain manifestation, thereby playing a role in the aetiology and maintenance of chronic pain states and associated comorbidities. More research is necessary to determine whether Vitamin D is useful in the treatment of various pain conditions and whether or not the effect is limited to patients who are deficient in Vitamin D.
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Bose S, Khanna A, You J, Arora L, Qavi S, Turan A. Low serum vitamin D levels are not associated with increased postoperative pain and opioid requirements: a historical cohort study. Can J Anaesth 2015; 62:770-6. [DOI: 10.1007/s12630-015-0357-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 02/25/2015] [Indexed: 02/08/2023] Open
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de Divitiis O, De Angelis M, Turgut AT. Vitamin D Deficiency in Spinal Surgery: Can It Compromise the Outcome? World Neurosurg 2015; 83:1044-5. [PMID: 25725162 DOI: 10.1016/j.wneu.2015.01.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 01/28/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Oreste de Divitiis
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Università degli Studi di Napoli Federico II, Italy.
| | - Michelangelo De Angelis
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, School of Medicine and Surgery, Università degli Studi di Napoli Federico II, Italy
| | - Ahmet Tuncay Turgut
- Department of Radiology, Ankara Training and Research Hospital, 06100 Ankara, Turkey
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Abdel-Gayoum AA. Serum vitamin D and parathyroid hormone profiles in patients with various stages of renal disease. Australas Med J 2015; 8:33-40. [PMID: 25810785 DOI: 10.4066/amj.2015.2252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prevalence of vitamin D deficiency among Saudi population has increased recently. The social and pathological factors, including kidney disease that may have influenced the vitamin status have not been investigated in the Hail population. AIMS The present study aims to: (1) investigate changes in the serum vitamin D, parathyroid hormone, serum calcium, and phosphate levels in Saudi patients with kidney disease; and (2) elucidate the other possible physiological factors that may have influence on the vitamin status. METHODS A cross-sectional study was carried out in King Khalid Hospital in Hail, Saudi Arabia. The database of kidney disease patients that attended the Kidney Unit between September 2012 and June 2013 was searched and data classified according to the estimated glomerular filtration rate into stages 1-4. Beside the kidney function parameters, serum calcium, phosphorus, vitamin D, and parathyroid hormone were measured. RESULTS Out of the 167 patients who visited the kidney unit, the data of 96 patients was included in the study. The results exhibited significant reductions in serum vitamin D level in stage 4 patients by 52.05 per cent with significant increase in the serum PTH level amounting to 3.5-fold. Kidney impairment at stage 4 caused significant increase in the serum phosphate level by 15.74 per cent and the serum calcium by 8.17 per cent. Significant correlations were observed between serum creatinine and Log PTH (r=0.704, p<0.0001) and a negative correlation between creatinine and log vitamin D (r=-0.373, p=0.001). CONCLUSION The results exhibited depletion of serum vitamin D concentration accompanied with the development of severe secondary hyperparathyroidism with the progression in kidney disease. The vitamin D deficiency was more prominent in females, older ages, and advanced kidney disease.
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Affiliation(s)
- Abdelgayoum A Abdel-Gayoum
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
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Sedighi M, Haghnegahdar A. Role of vitamin D3 in treatment of lumbar disc herniation--pain and sensory aspects: study protocol for a randomized controlled trial. Trials 2014; 15:373. [PMID: 25257359 PMCID: PMC4190421 DOI: 10.1186/1745-6215-15-373] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 09/04/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Vitamin D receptors have been identified in the spinal cord, nerve roots, dorsal root ganglia and glial cells, and its genetic polymorphism association with the development of lumbar disc degeneration and herniation has been documented. Metabolic effects of active vitamin D metabolites in the nucleus pulposus and annulus fibrosus cells have been studied. Lumbar disc herniation is a process that involves immune and inflammatory cells and processes that are targets for immune regulatory actions of vitamin D as a neurosteroid hormone. In addition to vitamin D's immune modulatory properties, its receptors have been identified in skeletal muscles. It also affects sensory neurons to modulate pain. In this study, we aim to study the role of vitamin D3 in discogenic pain and related sensory deficits. Additionally, we will address how post-treatment 25-hydroxy vitamin D3 level influences pain and sensory deficits severity. The cut-off value for serum 25-hydroxy vitamin D3 that would be efficacious in improving pain and sensory deficits in lumbar disc herniation will also be studied. METHODS/DESIGN We will conduct a randomized, placebo-controlled, double-blind clinical trial. Our study population will include 380 cases with one-level and unilateral lumbar disc herniation with duration of discogenic pain less than 8 weeks. Individuals who do not have any contraindications, will be divided into three groups based on serum 25-hydroxy vitamin D3 level, and each group will be randomized to receive either a single-dose 300,000-IU intramuscular injection of vitamin D3 or placebo. All patients will be under conservative treatment. Pre-treatment and post-treatment assessments will be performed with the McGill Pain Questionnaire and a visual analogue scale. For the 15-day duration of this study, questionnaires will be filled out during telephone interviews every 3 days (a total of five times). The initial and final interviews will be scheduled at our clinic. After 15 days, serum 25-hydroxy vitamin D3 levels will be measured for those who have received vitamin D3 (190 individuals). TRIAL REGISTRATION Iranian Registry for Clinical Trials ID: IRCT2014050317534N1 (trial registration: 5 June 2014).
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Affiliation(s)
- Mahsa Sedighi
- Department of Neurosurgery, Shiraz Medical School, Shiraz University of Medical Sciences, PO Box 71345-1536, Shiraz, Iran.
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