Cai Chunbo
Department of Occupational Medicine, Kaiser Permanente Vacaville Medical Center, CA.
Perm J. 2019;23. doi: 10.7812/TPP/18.241. Epub 2019 Aug 8.
The association between vitamin D deficiency or insufficiency and pain in the musculoskeletal system, especially in the neck and/or back regions, and/or muscle spasm is not well studied. The results of the limited studies have been mixed.
The goal of this report is to examine the association between vitamin D deficiency and insufficiency and chronic neck and back pain and muscle spasm and the role of correction of vitamin D deficiency and insufficiency in the treatment of chronic pain and muscle spasm, especially in the neck and back regions. This case series reviewed medical records to identify patients with chronic pain (lasting from 6 months to 1 year) in the neck and back regions that improved significantly through the correction of the vitamin D deficiency or insufficiency. Patients were referred to the spine clinic of a tertiary hospital in a major metropolitan area in the Northwest by their primary care physicians after physical therapy and after first-tier pain medications, including nonsteroidal anti-inflammatory drugs, had failed. Some of the patients had epidural steroid injections without significant relief. The blood vitamin D level was tested at the clinical laboratory, and patients were given 50,000 IU of oral vitamin D once a week for 12 weeks. The main outcome measures were patient self-reported visual analog scale score and degree of muscle spasm. The 4 patients included in this series all had more than 70% improvement in their symptoms after taking 50,000 IU of vitamin D once a week for 12 weeks.
Vitamin D deficiency and insufficiency can cause or worsen neck and back pain and muscle spasm. The correction of vitamin D deficiency and insufficiency plays an important role in the treatment of chronic neck and back pain and muscle spasm among patients having concurrent vitamin D deficiency and insufficiency because it can be prevented and treated easily.Given the high health care expenditure on the treatment of chronic neck and back pain, prompt and accurate diagnosis and treatment of vitamin D deficiency and insufficiency not only increase the quality of care but also reduce the cost.
维生素D缺乏或不足与肌肉骨骼系统疼痛，尤其是颈部和/或背部区域的疼痛和/或肌肉痉挛之间的关联尚未得到充分研究。有限的研究结果不一。
本报告的目的是研究维生素D缺乏和不足与慢性颈肩背痛及肌肉痉挛之间的关联，以及纠正维生素D缺乏和不足在治疗慢性疼痛和肌肉痉挛，尤其是颈肩背部区域的慢性疼痛和肌肉痉挛中的作用。本病例系列回顾了病历，以确定颈肩背部区域患有慢性疼痛（持续6个月至1年）的患者，这些患者通过纠正维生素D缺乏或不足后症状有显著改善。患者在接受物理治疗以及包括非甾体抗炎药在内的一线止痛药物治疗失败后，由其初级保健医生转诊至西北部一个大城市的三级医院脊柱诊所。一些患者接受了硬膜外类固醇注射，但症状并未得到明显缓解。在临床实验室检测血液维生素D水平，患者每周口服50,000国际单位维生素D，持续12周。主要观察指标为患者自我报告的视觉模拟量表评分和肌肉痉挛程度。本系列纳入的4例患者在每周服用50,000国际单位维生素D，持续12周后，症状改善均超过70%。
维生素D缺乏和不足可导致或加重颈肩背痛及肌肉痉挛。纠正维生素D缺乏和不足在同时存在维生素D缺乏和不足的患者的慢性颈肩背痛及肌肉痉挛治疗中起着重要作用，因为它易于预防和治疗。鉴于慢性颈肩背痛的治疗费用高昂，及时、准确地诊断和治疗维生素D缺乏和不足不仅能提高医疗质量，还能降低成本。
