von Känel Roland, Müller-Hartmannsgruber Veronika, Kokinogenis Georgios, Egloff Niklaus
Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Clinical Research, University of Bern, Bern, Switzerland.
Pain Med. 2014 Sep;15(9):1609-18. doi: 10.1111/pme.12454. Epub 2014 Apr 14.
Low vitamin D is implicated in various chronic pain conditions with, however, inconclusive findings. Vitamin D might play an important role in mechanisms being involved in central processing of evoked pain stimuli but less so for spontaneous clinical pain.
This study aims to examine the relation between low serum levels of 25-hydroxyvitamin D3 (25-OH D) and mechanical pain sensitivity.
We studied 174 patients (mean age 48 years, 53% women) with chronic pain. A standardized pain provocation test was applied, and pain intensity was rated on a numerical analogue scale (0-10). The widespread pain index and symptom severity score (including fatigue, waking unrefreshed, and cognitive symptoms) following the 2010 American College of Rheumatology preliminary diagnostic criteria for fibromyalgia were also assessed. Serum 25-OH D levels were measured with a chemiluminescent immunoassay.
Vitamin deficiency (25-OH D < 50 nmol/L) was present in 71% of chronic pain patients; another 21% had insufficient vitamin D (25-OH D < 75 nmol/L). After adjustment for demographic and clinical variables, there was a mean ± standard error of the mean increase in pain intensity of 0.61 ± 0.25 for each 25 nmol/L decrease in 25-OH D (P = 0.011). Lower 25-OH D levels were also related to greater symptom severity (r = -0.21, P = 0.008) but not to the widespread pain index (P = 0.83) and fibromyalgia (P = 0.51).
The findings suggest a role of low vitamin D levels for heightened central sensitivity, particularly augmented pain processing upon mechanical stimulation in chronic pain patients. Vitamin D seems comparably less important for self-reports of spontaneous chronic pain.
维生素D水平低与多种慢性疼痛状况有关，然而，研究结果尚无定论。维生素D可能在诱发疼痛刺激的中枢处理机制中发挥重要作用，但对自发性临床疼痛的作用较小。
本研究旨在探讨血清25-羟基维生素D3（25-OH D）水平低与机械性疼痛敏感性之间的关系。
我们研究了174例慢性疼痛患者（平均年龄48岁，53%为女性）。应用标准化疼痛激发试验，并采用数字模拟评分法（0-10）对疼痛强度进行评分。还根据2010年美国风湿病学会纤维肌痛初步诊断标准评估了广泛性疼痛指数和症状严重程度评分（包括疲劳、醒来未恢复精力和认知症状）。采用化学发光免疫分析法测定血清25-OH D水平。
71%的慢性疼痛患者存在维生素缺乏（25-OH D<50 nmol/L）；另外21%的患者维生素D不足（25-OH D<75 nmol/L）。在对人口统计学和临床变量进行调整后，25-OH D每降低25 nmol/L，疼痛强度平均增加0.61±0.25（平均标准误）（P = 0.011）。较低的25-OH D水平也与较高的症状严重程度相关（r = -0.21，P = 0.008），但与广泛性疼痛指数（P = 0.83）和纤维肌痛（P = 0.51）无关。
研究结果表明，低维生素D水平在增强中枢敏感性方面发挥作用，尤其是在慢性疼痛患者中，机械刺激时疼痛处理增强。维生素D对自发性慢性疼痛的自我报告似乎相对不那么重要。
