Department of Internal Medicine, Bassett Medical Center and Columbia University College of Physicians and Surgeons, 1 Atwell Road, Cooperstown, NY, 13326, USA.
Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Clin Rheumatol. 2017 Dec;36(12):2825-2833. doi: 10.1007/s10067-017-3754-y. Epub 2017 Aug 15.
Chronic non-specific widespread pain (CWP) including fibromyalgia (FMS) is characterized by widespread pain, reduced pain threshold, and multiple tender points on examination, causing disability and decreased quality of life. Vitamin D has been proposed as an associated factor in CWP. This meta-analysis aimed to explore the benefit of vitamin D supplementation in the management of CWP. A comprehensive search of the CENTRAL, MEDLINE, and Embase databases was performed from inception through January 2017. The inclusion criterion was the randomized clinical trials' evaluating the effects of vitamin D treatment in adult subjects with CWP or FMS. CWP was defined as chronic recurrent musculoskeletal pain without secondary causes; FMS patients met the American College of Rheumatology criteria for FMS. Study outcome was assessed using visual analog scale (VAS) of pain intensity. Pooled mean difference (MD) of VAS and 95% confidence interval (CI) were calculated using a random-effect meta-analysis. Meta-regression analysis using a random-effects model was performed to explore the effects of change in vitamin D in the treatment group on difference in the mean of VAS. Sensitivity analysis was performed to evaluate the robustness of results. The between-study heterogeneity of effect size was quantified using the Q statistic and I . Data were extracted from four randomized controlled trials involving 287 subjects. Pooled result demonstrated a significantly lower VAS in CWP patients who received vitamin D treatment compared with those who received placebo (MD = 0.46; 95% CI 0.09-0.89, I = 48%). Meta-regression analysis revealed no significant relationship between the changes of vitamin D and VAS (coefficient = 0.04 (95% CI -0.01 to 0.08), p = 0.10). In this meta-analysis, we conclude that vitamin D supplementation is able to decrease pain scores and improve pain despite no significant change in VAS after increasing serum vitamin D level. Further studies need to be conducted in order to explore the improvement of functional status, quality of life, and the pathophysiological change that improves chronic widespread pain.
慢性非特异性广泛性疼痛（CWP）包括纤维肌痛（FMS），其特征为广泛疼痛、痛觉阈值降低以及检查时有多个压痛点，导致残疾和生活质量下降。维生素 D 被认为是 CWP 的相关因素。本荟萃分析旨在探讨维生素 D 补充剂在 CWP 管理中的作用。从建库到 2017 年 1 月，对 CENTRAL、MEDLINE 和 Embase 数据库进行了全面检索。纳入标准为评估维生素 D 治疗对 CWP 或纤维肌痛患者的影响的随机临床试验。CWP 定义为无继发原因的慢性复发性肌肉骨骼疼痛；纤维肌痛患者符合美国风湿病学会纤维肌痛标准。使用视觉模拟量表（VAS）评估疼痛强度来评估研究结果。使用随机效应荟萃分析计算 VAS 的汇总均数差值（MD）和 95%置信区间（CI）。使用随机效应模型进行荟萃回归分析，以探讨治疗组中维生素 D 变化对 VAS 均值差异的影响。进行敏感性分析以评估结果的稳健性。使用 Q 统计量和 I 来量化效应量的研究间异质性。从四项随机对照试验中提取 287 名受试者的数据。汇总结果表明，接受维生素 D 治疗的 CWP 患者的 VAS 明显低于接受安慰剂的患者（MD=0.46；95%CI 0.09-0.89，I = 48%）。荟萃回归分析显示，维生素 D 的变化与 VAS 之间无显著关系（系数=0.04（95%CI -0.01 至 0.08），p=0.10）。在这项荟萃分析中，我们得出结论，尽管增加血清维生素 D 水平后 VAS 无显著变化，但维生素 D 补充能够降低疼痛评分并改善疼痛。需要进一步研究以探讨改善慢性广泛性疼痛的功能状态、生活质量和病理生理变化。
