Sensible advice for aches, pains & injuries

Vitamin D for Pain

Is it safe and reasonable for chronic pain patients to take higher doses of Vitamin D? And just how high is safe?

updated (first published 2010)
by Paul Ingraham, Vancouver, Canadabio
I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about memore about

Vitamin D deficiency [WebMD] (or milder insufficency) is probably more common than once suspected. It’s tough to get enough from food alone, and many people don’t get enough from sun either. Although a 2016 New England Journal of Medicine article made headlines debunking hype about a vitamin D deficiency “pandemic,” even their estimates are “of concern”: 6% of the population, more than 1 in 20 people.1 Walk down a busy street in Canada, Russia, or the UK — there’s more deficiency in the north, and in the cloudiest and smoggiest places2 — and you’ll pass someone with vitamin D deficiency every few seconds.

That’s the low estimate: other experts have declared that there is a pandemic of vitamin D deficiency (or at least that it’s extremely common) even in otherwise completely healthy people.34

An important debate about the actual prevalence and value of supplementation rages on. But most of the controversy is about healthy patients — are healthy people deficient? Do healthy people need to take vitamin D?5 What about people who actually have health problems? That’s a different kettle of fish! And people in chronic pain are a particularly special case.

The link between hypovitaminosis D and pain

Vitamin D deficiency is suspiciously common in people with chronic pain,6789 maybe because it actually causes it or at least makes it worse.10 It is probably more common in patients with specific kinds of chronic pain, most notably fibromyalgia,11 which is a common misdiagnosis.12 The symptoms that cause the diagnostic confusion include:

About the bone aching

Bone aching is often mistaken for muscle aches simply because people don’t expect their bloody bones to ache. The pain is a symptom of osteomalacia specifically, which is kind of like an evil twin of growing pains: bone weakening caused by malfunctioning bone building biology, not the same thing as osteoporosis13 The Mayo Clinic describes osteomalacia symptoms like so: “The dull, aching pain associated with osteomalacia most commonly affects the lower back, pelvis, hips, legs and ribs. The pain may be worse at night, or when you’re putting weight on affected bones.” Thus, vitamin D deficiency may be a partial explanation for the extremely common phenomenon of morning back pain.

I think it’s possible that bone aching can occur even when osteomalacia is mild.14

About the muscle aching

The connection between bone health and vitamin D is familiar to most people, but muscle is more obscure. Vitamin D actually has plenty to do with muscle, both muscle pain1516 and dysfunction (weakness).1718 This may be why some experts believe it is particularly prevalent in people with a lot of “trigger points” (muscle knots).19 Although the nature of trigger points is unclear and controversial, the role of vitamin D might actually be one of the keys to understanding them.

Vitamin B12 is quite similar

Vitamin B12 deficiency is practically a clinical clone of D deficiency: there’s major symptom overlap, it’s surprisingly common, and testing is not as reliable as you would think. But B12 symptoms tend to be more neurological in character (more tingling, more strange sensations), and it is often more ominous and difficult to treat. See Misconceptions about a B12 deficiency.

Who should be concerned?

You are more likely to have a vitamin D deficiency if several of these points describe you:

If there’s only one supplement you’re taking for your health and your diet is decent, it should probably be vitamin D.

Herman Gill, editor (Vitamin D reference page)

Does taking vitamin D treat pain? Unknown! Maybe?

We know that vitamin D deficiency and pain are probably related — see above — but that doesn’t necessarily mean that taking vitamin D is going to actually help the pain. There’s almost certainly not a benefit for any kind of pain patient, which is hardly surprising — there are many different kinds of pain, and it would be shocking if vitamin D was good for all or even most of them — and a pair of reviews in 2015 and 2016 both show this clearly.2021 (Although one of them did actually detect a slight benefit. Just sayin’!) Both reviews mainly just expose the sad state of the evidence regarding the specific kinds of chronic pain that might be more likely to benefit, such as fibromyalgia. The only studies of treating that condition with vitamin D are actually quite clearly positive.2223

But “more study needed” in a big way! Beyond these scraps of evidence, for now there is only educated guessing and clinical experience.

Vitamin D is probably only one of many common factors in pain

Nothing’s ever simple and chronic pain least of all: it’s usually caused by a sinister stew of factors that eat away at people for many years. Trying to solve the problem by fixing one thing — if indeed vitamin D is even a problem — may be about as feasible as trying to fix a broken engine with just one tool. Vitamin D deficiency may contribute to a chronic pain disaster over time, but by the time you’re actually in trouble the problem may be much more complicated than just vitamin D deficiency.

That’s a bleak warning not to put too much hope into vitamin D. But there are still reasons for optimism!

Vitamin D may be the most common and manageable factor in pain: the case for presumptive treatment

The only thing worse than chronic pain with six causes is … seven causes. Obviously. Anything you can do to simplify the pain equation is a good idea, and you can certainly take vitamin D. (Just consult with a doctor first, please.)

Vitamin D deficiency can be fixed. It may be tough to get enough from diet and sunshine, but supplementation is cheap, safe, and effective, so it’s an ideal candidate for presumptive treatment: going ahead and treating based on the presumption of vitamin D deficiency even if it has not been established with blood tests. By all means do that too, of course! But if a lot of healthy people take this stuff “just in case,” it’s hardly radical for pain patients to give it a shot. There’s just not much downside to this one… and chronic pain is a major bummer. So talk to your doctor, get tested, and get supplementing — it could be a big deal for you.

Why not a vitamin D rich diet?

Because you’d have to eat a lot of fish.

It’s difficult to get a meaningful amount of vitamin D from food. For pain patients, who are trying to make absolutely sure they are getting enough vitamin D, food is just not a rich enough source. Supplements and sunshine should be your main sources, but of course that doesn’t mean you shouldn’t also try to get as much as you can from food. Salmon is the best source — there’s about 600 IU in 6 ounces of salmon — followed by mackerel, tuna and other fatty fish. (Cod liver oil, if you can stand taking it, is so vitamin D rich that it’s almost like taking a vitamin D supplement.) Other than that, the foods with the most vitamin D are:

Fruits, veggies, and grains have almost no vitamin D.

How to take vitamin D supplements

Although vitamin D supplements are cheap and easy and safe, they don’t always actually do the job. The vitamin D we can absorb through the gut is a little more awkward to “work with” than the kind we make from exposure to ultraviolet radiation. Here are some tips to make it work as well as possible:

Dosage: how much Vitamin D should you take?

There’s a more detailed discussion of dosage safety below, but here’s the bottom line in two points:

  1. There’s a large margin of safety in vitamin D dosing. You can double what’s recommended to healthy people in most countries without coming anywhere close to a safety concern.
  2. But “megadosing” is silly — don’t do that!
More is not always better! Although “megadosing” Vitamin D is trendy, please beware: taking more vitamin D than you need can kill you, starting with the destruction of your kidneys. Fortunately, it takes a lot. The rest of this article focusses on addressing concerns about the efficacy and safety of supplementation.

Supplement or sunshine?

Sunshine is always preferable…if you can get it. The body is good at making vitamin D from sunshine, and even modest exposure can easily replace days of oral supplementation. Unfortunately, it’s just about impossible to get the necessary exposure in higher latitudes for large chunks of each year. Some tips and guidelines:

The Vitamin D Council website has a very detailed page about sun exposure (and much more).

What about tanning beds?

Many experts are calling for a ban on tanning beds because of serious safety concerns, and it will probably happen eventually. Until it does, the option presents chronic pain patients with a tough dilemma. Unsurprisingly, their priorities have been ignored in the debate.

Tanning definitely produces vitamin D, but not as well or reliably as natural sunlight. And it’s well-established that tanning lamps are full-blown carcinogenic, no question — just like the sun, or possibly worse.25 And so it may not be worth the risks, and at the very least it’s critical to limit your dosage. Above all, do not use tanning beds to tan! If you use them at all, use them in moderation.

The main public health issue with tanning beds is not that they are much more dangerous than sunshine, but that people use them to overdose on UV (and even get addicted to them). It’s way too easy to get to much UV in a tanning bed, especially when used with the goal

Of course, it is possible to control the dosage and use tanning beds temporarily for shorter durations, thus hopefully reducing the risks while still being stimulated to produce large doses of completely bio-available vitamin D. This is called “safe tanning,” and some experts think it’s a myth. However, their arguments boil down to “better safe than sorry” rather than resting hard evidence that it’s actually dangerous. There are three good points to consider though:

  1. Many tanning beds are not actually as good as sunshine anyway (different kind of ultraviolent), and it’s hard to know what you’re getting.
  2. They may be more dangerous than has yet been confirmed (but no one’s totally sure of that yet).
  3. Supplements mostly work just fine.

All of that should be a deal-breaker for almost everyone. But it’s not necessarily a deal-breaker for chronic pain patients.

Tanning beds are not safe (definitely true), but neither is sunshine (also definitely true), and the stakes with chronic pain and vitamin D deficiency are extremely high (all too true). For chronic pain patients whose lives are being ruined, and more vitamin D might fix it? For those people, the limited risks of careful UV exposure in a tanning bed may “pale” in comparison to the greater danger of the pain.

If you prefer to play it safe, stick to supplementing. If you are in rough shape and desperate to rule out vitamin D deficiency as decisively as possible, do some tanning but follow these rules of thumb to minimize the risk:

Does Vitamin D prevent colds/flu?

Probably not — not to any meaningful degree. But it’s a small potential side benefit to supplementation that already makes sense for chronic pain patients for other reasons.

Vitamin D deficiency is probably associated with frequent cold/flu, and some studies have shown that it can reduce infection frequency and severity, especially in people with more greater deficiency. An early 2017 review of 25 studies had a classic damned-with-faint-praise conclusion.26 If you only read the abstract, you’d think it was good news, because apparently D supplementation “reduced the risk of acute respiratory tract infection.” Unfortunately, the abstract doesn’t say how much it was reduced. The media reported only the appearance of great news, of course, while an editorial in the same issue by Mark Bolland and Alison Avenell quietly pointed out the boring truth:

The primary result is a reduction from 42% to 40% in the proportion of participants experiencing at least one acute respiratory tract infection. It seems unlikely that the general population would consider a 2% absolute risk reduction sufficient justification to take supplements.

Could there be a more potent effect for pain patients? There’s a small possibility. Pain patients may be more likely to be more severely deficient: the population that seems to get the greatest protective effect. Or there could be something about pain patients that makes them more vulnerable to infection, which could improve if the extra D helps the pain problem. But this is just speculation, of course.

The remainder of the article is some legacy content, basically a blog post dating back to 2010 that I did on the topic of vitamin D dosage safety. As I continue to upgrade this page in late 2016, it will be revised and blended into the main article. For now, it’s a good standalone review of dosing.

A before/after experiment: my position on vitamin D dosage before and after a bunch of paranoid checking

I am getting ready to dive into a pile of Vitamin D science. I can’t begin to master it myself, and so I will rely heavily on two mentors — opinions that will almost certainly conflict. One is Dr. Tim Taylor, who authored a critical chapter of my own muscle pain book. The other is Dr. Harriet Hall, retired Air Force surgeon and regular Science-Based Medicine contributor.

Dr. Hall’s article on Vitamin D is sitting in my inbox right now, waiting for editorial attention. So are a stack of citations from Dr. Taylor. What am I going to think about Vitamin D at this time on Monday?

This is the account of my own struggle to decide what to recommend to my readers, before and after the impact of some official vitamin D recommendations from the Institute of Medicine in late 2010. (You can also skip to the punchline.) Readers concerned about the safety and efficacy of Vitamin D supplementation may find the thought process to be quite helpful.

Vitamin D for pain: BEFORE

My position to date has been that D deficiency is:

I haven’t held this position with any passion, and if challenged on the science I would admit I have been on scientific terra not-so-firma. I was taking Dr. Taylor’s word for it, basically. In the chapter he contributed to my triggers points book, Dr. Taylor recommended high doses of Vitamin D for deficient patients, and also set the threshold for deficiency lower than most official sources. Dr. Taylor defended those recommendations with some citations that seemed good enough to me at the time — good enough to publish, anyway. I cautiously took a pro-D position myself.

But then…

An official slamming of over-prescribing of Vitamin D

And then on November 30, 2010, the Institute of Medicine published a report strongly criticizing over-prescribing of Vitamin D and generally sneering at the idea that deficiency is common.

“Uh oh,” I thought, when these headlines arrived in my inbox.

A flurry of emails with Dr. Taylor resulted in some immediate corrections to the book. (Dr. Taylor had already revised his own recommendations for Vitamin D — still high, but a lot less high.) We then continued the discussion, agreeing that we needed more substantiating evidence to support even the reduced recommendations in the book.

Meanwhile, Harriet Hall agreed to take on this topic for her her Dec 7 post at ScienceBasedMedicine.org27 — which is waiting for my editorial attention as I write this. And I’m quite concerned that my recommendations will be slammed too.

So now what?

It’s 7:45am, the cat wants me to stop typing so she can sit on my lap. I have a new Kindle I want to try out, and three good books on the go. My wife will be awake soon, and we’ll probably go out for our favourite eggs benedict. I have chores, errands, and social events throughout the weekend. But instead I’m going to sit here and try to figure out what to say about Vitamin D by Monday!

A false alarm

I enjoy confessions and corrections of wrongness (they are cleansing for the soul, not to mention popular). Alas, I just don’t seem to have any wrongness about vitamin D to confess or correct — not today, not yet. Examining the evidence this weekend caused no earthquakes. This was a false alarm — it did give me an opportunity to really firm up my own opinion.

Vitamin D for pain: AFTER

Same as before. The new guidelines simply have almost nothing to do with the recommendations for D supplementation that I have made, and will continue to make.

The Walmart shopper looking at a sale on 5000IU vitamin D capsules is a completely different critter than the chronic pain patient wondering if, perhaps, their vitamin D deficiency could be a factor in their horrible problem. Is the average person deficient? Do they need 5000 IU per day? Probably not. That is what the IoM guidelines are concerned with.

But the pain patient might. The geometry of risk and benefit is completely different for pain patients. If you are a “hurtin’ unit” — as a colleague of mine puts it — vitamin D is worth thinking about.

Are higher dosages of Vitamin D really safe?

Again: probably, yes.

The IoM set an upper limit of 4000 IU as a safe average maximum that anyone should be taking — a little less than the popular 5000 IU pills now available.

However, there is a wide margin of error here. There is no question that excessive vitamin D can be dangerous,28 nor any question it takes a lot. Indeed, megadoses of 50,000 IU/day have failed to produce any sign of toxicity, and when supplement baron Gary Null overdosed on vitamin D in his own contaminated product — talk about poetic justice — he was taking upwards of two million IU per day. That nearly killed him, but it didn’t, and we’re talking about a dose five hundred times larger than the IoM’s upper limit — such a ridiculous number that I’m really only bringing it up as a fun example. Here’s a summary of the recent evidence from Heaney:

Both the intoxication literature and the recent controlled dosing studies have been reanalyzed by Hathcock et al. These authors show that essentially no cases of confirmed intoxication have been reported at serum 25(OH)D levels below 500 nmol/L. Correspondingly, the oral intakes needed to produce such levels are in excess of 20,000 IU/day in otherwise healthy adults and, more usually, above 50,000 IU/day. These findings led Hathcock et al to select 10,000 IU/day as the tolerable upper intake level (TUIL, or UL), with considerable confidence.

I also discussed the toxicity issue briefly with Dr. Hall. She agreed that anything under 50,000 IU is unlikely to be toxic (and again that would be especially true for temporary supplementation for deficient patients).

Mission accomplished: my job was to make sure that it still makes some sense for pain patients to consider D deficiency and that it’s safe to supplement fairly generously, and it does. The new IoM guidelines basically had absolutely nothing to at all to say about the pain connection. Ships passing in the night.

About Paul Ingraham

Headshot of Paul Ingraham, short hair, neat beard, suit jacket.

I am a science writer, former massage therapist, and I was the assistant editor at for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.

Trigger Points & Myofascial Pain Syndrome

Myofascial trigger points — muscle knots — are increasingly recognized by all health professionals as the cause of most of the world’s aches and pains. This detailed tutorial focuses on advanced troubleshooting for patients who have failed to get relief from basic tactics, but it’s also ideal for starting beginners on the right foot, and for pros who need to stay current. 179 sections grounded in the famous texts of Drs. Travell & Simons, as well as more recent science, this constantly updated tutorial is also offered as a free bonus (2-for-1) with the low back, neck, muscle strain, or iliotibial pain tutorials. Add it to your shopping cart now ($19.95) or read the first few sections for free!

Related Reading

Dr. Stewart Leavitt of has watched the topic of vitamin D for pain closely, and written about it extensively, and he responded to the new IoM guidelines just as I did: by re-examining his position in this clear, readable article, New IOM Report Snubs Vitamin D Research. His report is much more authoritative than mine, and comes to similar conclusions. The IoM report actually “neither confirms nor refutes our prior research and advocacy for vitamin D supplementation as benefitting pain relief, particularly relating to musculoskeletal disorders” and “we do not believe it is necessary or appropriate at this time to recant our prior positions regarding vitamin D for pain.”

What’s new in this article?

Six updates have been logged for this article since publication (2010). All updates are logged to show a long term commitment to quality, accuracy, and currency. more Like good footnotes, update logging sets apart from most other health websites and blogs. It’s fine print, but important fine print, in the same spirit of transparency as the editing history available for Wikipedia pages.

I log any change to articles that might be of interest to a keen reader. Complete update logging started in 2016. Prior to that, I only logged major updates for the most popular and controversial articles.

See the What’s New? page for updates to all recent site updates.

New section: “Does Vitamin D prevent colds/flu?” Not really, no, contrary to recent headlines.

Safety update. Sterner and more detailed warnings about the risks of tanning beds, and the dilemma they present to chronic pain patients.

Major udpate. Four new short practical sections about how to get more vitamin D: food sources, supplementation tips, sunshine versus supplementing, and all about tanning beds.

Major update. Total renovation of this article continues with many additions and changes today: several citations and footnotes, some important new key points, some less important but interesting tangents, more specific recommendations, and a lot of reorganizing to continue making the page more useful to readers.

Added fun little footnote about the cloudiest places on Earth. I live in one of them…

Major update. All new introduction explaining and exploring the link between vitamin D deficiency and chronic pain, with a much greater focus on being of service to readers. Includes discussion of the recent controversy over whether or not vitamin D deficiency is a “pandemic.”

Significant science update. Added a significant new citation (Wu, plus some older ones, and upgraded the article to use popup footnotes instead of inline links.



  1. Manson JE, Patsy M B, Rosen CJ, Taylor CL. Vitamin D Deficiency — Is There Really a Pandemic? N Engl J Med. 2016.

    The claim that large proportions of North American and other populations are deficient in vitamin D is based on misinterpretation and misapplication of the Institute of Medicine reference values for nutrients — misunderstandings that can adversely affect patient care.

  2. See this beautiful satellite imagery of averaged global cloud cover, or this more utilitarian annual sunshine hours map. BACK TO TEXT
  3. Vieth R, Bischoff-Ferrari H, Boucher BJ, et al. The urgent need to recommend an intake of vitamin D that is effective. Am J Clin Nutr. 2007 Mar;85(3):649–50. PubMed #17344484. PainSci #55037. BACK TO TEXT
  4. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008 Apr;87(4):1080S–6S. PubMed #18400738. PainSci #55028.

    In one of the world’s most respected medical journals, Vitamin D activist Michael Holick writes, “Vitamin D deficiency is now recognized as a pandemic” and recommends that, “in the absence of adequate sun exposure, at least 800-1000 IU vitamin D3/d may be needed to achieve this in children and adults,” which is higher than historical upper limits.

  5. Spector TD, Levy L. Should healthy people take a vitamin D supplement in winter months? BMJ. 2016 Nov;355:i6183. PubMed #27881362. BACK TO TEXT
  6. Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003 Dec;78(12):1463–70. PubMed #14661675. PainSci #55011.

    What is the prevalence of hypovitaminosis D in patients with nonspecific musculoskeletal pain syndrome? It’s quite striking, according to this important 2003 paper. Researchers did a cross-sectional study of 150 patients to find out and concluded (rather dramatically, emphasis mine) that “all patients with persistent, nonspecific musculoskeletal pain are at high risk for the consequences of unrecognized and untreated severe hypovitaminosis D. This risk extends to those considered at low risk for vitamin D deficiency: nonelderly, nonhousebound, or nonimmigrant persons of either sex.”

    Even watered down, these results would be of considerable interest to pain patients.

  7. Atherton K, Berry DJ, Parsons T, et al. Vitamin D and chronic widespread pain in a white middle-aged British population: evidence from a cross-sectional population survey. Ann Rheum Dis. 2009 Jun;68(6):817–22. PubMed #18697776.

    This UK study of more than six thousands Scottish and Welsh patients found an association between chronic widespread pain and vitamin D status in women. It could be partially explained by differences in lifestyle or social factors, but not fully. This data did not show the same connection in men.

  8. McBeth J, Pye SR, O'Neill TW, et al. Musculoskeletal pain is associated with very low levels of vitamin D in men: results from the European Male Ageing Study. Ann Rheum Dis. 2010 Aug;69(8):1448–52. PubMed #20498201.

    This study found a modest but clear link between vitamin D deficiency and chronic pain. Researchers look at 3000 older men. About 250 (8%) of them were suffering from chronic, widespread pain, and they had at least a 20% greater chance of having low vitamin D, less than 15ng/ml — the low end of “enough” Vitamin D. A weaker connection was also found in men with less pain. As with all studies like this, all it can tell us is that there is a connection, not what kind of connection: D deficiency might cause pain, or it might just be another side effect of the real causes of pain. Nevertheless, this is one of the best studies of its kind ever done, and the authors concluded: “These findings have implications at a population level for the long-term health of individuals with musculoskeletal pain.”

  9. Hsiao MY, Hung CY, Chang KV, Han DS, Wang TG. Is Serum Hypovitaminosis D Associated with Chronic Widespread Pain Including Fibromyalgia? A Meta-analysis of Observational Studies. Pain Physician. 2015;18(5):E877–87. PubMed #26431141.

    This review of a dozen studies of the link between vitamin D and chronic widespread pain. The identified a “crude association” between them which was “likely to remain after adjusting confounding factors.”

    (One of the best such studies, McCabe et al published a year after this review, failed to find a clear independent link: it weakened after the elimination of obese and depressed subjects, which are known risk factors for chronic pain.)

  10. It’s also possible that it’s simply associated with other known risk factors for pain, such as obesity and depression, which is what McCabe et al found: a clear link until they factored out obese and depressed patients. It’s a very complicated puzzle. BACK TO TEXT
  11. Karras S, Rapti E, Matsoukas S, Kotsa K. Vitamin D in Fibromyalgia: A Causative or Confounding Biological Interplay? Nutrients. 2016 Jun;8(6). PubMed #27271665. PainSci #53667. “Overall, although a cause and effect relationship has not been proven yet, available evidence indicates, that vitamin D is a vital bioregulator of pain pathways involved in FM pathogenesis. …  Hypovitaminosis D may be a risk factor for FM and a way of worsening the symptoms through central and peripheral pathways. The exact mechanisms however, by which vitamin D may be related with FM remain unclear.” BACK TO TEXT
  12. Fibromyalgia is overdiagnosed in general, thanks to it’s many non-specific symptoms (among other things, see Walitt). But in the case of vitamin D deficiency, the link may be so strong that it’s truly difficult to meaningfully separate them. BACK TO TEXT
  13. Osteoporosis is an erosion of bone that has already been built. Osteomalacia is a failure to build it in the first place. BACK TO TEXT
  14. I’m don’t know if that’s true, but I am personally fascinated by the idea that the human nervous system might be capable of detecting and raising an alarm about such a subtle problem; it’s also possible that we are more capable of it when pathological sensitized for other reasons, such as fibromyalgia. If you’re skeptical, that’s reasonable, but bear in mind that it’s a known phenomenon that we will get strong cravings to eat bizarre things as a response to mineral deficiencies. BACK TO TEXT
  15. Holick MF. Vitamin D deficiency: what a pain it is. Mayo Clin Proc. 2003 Dec;78(12):1457–9. PubMed #14661673. PainSci #55029.

    In this editorial for Mayo Clinic Proceedings, Holick explains that “Vitamin D deficiency causes muscle weakness and muscle aches and pains in both children and adults.” In reference to Plotnikoff et al, who studied the relationship between D and pain directly and produced quite dramatic data, “The association between nonspecific musculoskeletal pain and vitamin D deficiency was suspected because of a higher prevalence of these symptoms during winter than summer. The study patients ranged in age from 10 to 65 years, and all had symptoms of vitamin D deficiency. Of the more than 90% of patients who were medically evaluated for persistent musculoskeletal pain 1 year or more before screening, none had been tested previously for vitamin D deficiency.”

  16. Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003 Dec;78(12):1463–70. PubMed #14661675. PainSci #55011.

    What is the prevalence of hypovitaminosis D in patients with nonspecific musculoskeletal pain syndrome? It’s quite striking, according to this important 2003 paper. Researchers did a cross-sectional study of 150 patients to find out and concluded (rather dramatically, emphasis mine) that “all patients with persistent, nonspecific musculoskeletal pain are at high risk for the consequences of unrecognized and untreated severe hypovitaminosis D. This risk extends to those considered at low risk for vitamin D deficiency: nonelderly, nonhousebound, or nonimmigrant persons of either sex.”

    Even watered down, these results would be of considerable interest to pain patients.

  17. Zittermann A. Vitamin D in preventive medicine: are we ignoring the evidence? Br J Nutr. 2003 May;89(5):552–72. PubMed #12720576. “…vitamin D insufficiency can lead to a disturbed muscle function.” BACK TO TEXT
  18. Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ. 2009;339:b3692. PubMed #19797342. PainSci #55598.

    Can taking vitamin D prevent falls? Apparently so: these researchers set out to “test the efficacy of supplemental vitamin D … in preventing falls among older individuals” and found that a “high dose” (700-1000 IU a day) actually reduced falling by a whopping 19%. That’s quite a substantial effect! It’s also a rare example of research actually confirming that vitamin supplementation does something helpful — most similar research in the last decade has come up quite empty-handed.

    More to the point for how does vitamin D reduce falls? The authors explain: “Vitamin D has direct effects on muscle strength modulated by specific vitamin D receptors present in human muscle tissue.” Muscles like vitamin D, and “these benefits translated into a reduction in falls.”


  19. “Nearly all my pain patients have low blood serum vitamin D,” writes Dr. Tim Taylor, a myofascial pain syndrome specialist, and my co-author of a chapter on this topic in our muscle pain book. And of course that’s another clinical opinion that there’s a link between D deficiency and pain. BACK TO TEXT
  20. Straube S, Derry S, Straube C, Moore RA. Vitamin D for the treatment of chronic painful conditions in adults. Cochrane Database Syst Rev. 2015 May;(5):CD007771. PubMed #25946084. “…a large beneficial effect of vitamin D across different chronic painful conditions is unlikely. Whether vitamin D can have beneficial effects in specific chronic painful conditions needs further investigation.” BACK TO TEXT
  21. Wu Z, Malihi Z, Stewart AW, Lawes CM, Scragg R. Effect of Vitamin D Supplementation on Pain: A Systematic Review and Meta-analysis. Pain Physician. 2016;19(7):415–27. PubMed #27676659. PainSci #53675.

    There are good reasons (including some evidence, e.g. see Schreuder) to hope that vitamin D supplementation is valuable for some kinds of pain patients, but it remains speculative. This is the first “major” meta-analysis of trials, but arguably it’s premature: just not enough data to meta-analyze meaningfully. Although 19 studies and 3,436 participants might seem like plenty, that includes studies of a wide variety of conditions — too wide, everything from fibromyalgia to osteoarthritis to migraine. It would be surprising if any treatment had a consistent effect on such different problems! This isn’t just a “limitation” of the meta-analysis, it’s a sucking chest wound. Although the authors did compare results in two meaningful categories (regional pain versus widespread pain), there were still too many different kinds of conditions within those categories. (Diabetic neuropathy definitely does not work the same way as rheumatoid arthritis.)

    Despite this major flaw, Vitamin D still seemed to work on average, at least a little bit. They detected a small improvement, about a half point (on a 10-point pain scale). Would you bother taking a pain-killer for a 5% improvement? Probably not: that is a classic example of a clinically trivial benefit, the bare minimum required for better-than-nothing, but still right at the edge of giving-a-crap, and of detectability. But it probably worked better for some patients, and not at all for others.

    Also completely missing from this study is any hint of whether more is better. Or whether D2 or D3 is better. Or whether a longer course of supplementation is better. Or whether any improvement was related to blood serum D levels.

    The main thing this study tells us is that the evidence is far too limited and still can’t really tell us the value of vitamin D for any specific kind of pain patient.

    This is the same conclusion reached by Straube et al in 2016.

  22. Schreuder F, Bernsen RM, van der Wouden JC. Vitamin D supplementation for nonspecific musculoskeletal pain in non-Western immigrants: a randomized controlled trial. Ann Fam Med. 2012;10(6):547–55. PubMed #23149532. PainSci #54533.

    This test of the effect of Vitamin D supplementation on nonspecific chronic musculoskeletal pain showed that pain modestly improved within 6 weeks. Musculoskeletal strength (stair climbing ability) also improved somewhat. See a thorough analysis of this study by Dr. Steven Leavitt for “a most remarkable aspect of this study is that, even though patients probably received fundamentally inadequate vitamin D supplementation and for a relatively brief period of time, there were still strongly beneficial outcomes … significant enough to realize meaningful differences in everyday clinical practice.”

  23. Wepner F, Scheuer R, Schuetz-Wieser B, et al. Effects of vitamin D on patients with fibromyalgia syndrome: A randomized placebo-controlled trial. Pain. 2014 Feb;155(2):261–8. PubMed #24438771. “Optimization of calcifediol levels in FMS had a positive effect on the perception of pain. This economical therapy with a low side effect profile may well be considered in patients with FMS.” BACK TO TEXT
  24. Mulligan GB, Licata A. Taking vitamin D with the largest meal improves absorption and results in higher serum levels of 25-hydroxyvitamin D. J Bone Miner Res. 2010 Apr;25(4):928–30. PubMed #20200983. BACK TO TEXT
  25. Woo DK, Eide MJ. Tanning beds, skin cancer, and vitamin D: An examination of the scientific evidence and public health implications. Dermatol Ther. 2010;23(1):61–71. PubMed #20136909.

    Indoor tanning has become increasingly popular over the past decades, despite evidence of an increased risk of melanoma and, possibly, nonmelanoma skin cancer. Tanning bed proponents cite the health benefits of vitamin D to support indoor tanning, including concerns that reduced vitamin D levels or certain vitamin D receptor polymorphisms may be associated with increased incidence of various cancers, including cutaneous melanoma. However, most tanning devices primarily emit ultraviolet A, which is relatively ineffective in stimulating vitamin D synthesis. Health benefits can be fully dissociated from the ultraviolet exposure risks with vitamin D supplementation, although optimal levels remain to be established. Indoor tanning represents an avoidable risk factor for skin cancer, and education of the general public as well as the enactment and stricter enforcement of indoor tanning legislation are a public health imperative.

  26. Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017 Feb;356:i6583. PubMed #28202713. BACK TO TEXT
  27. Hall, Harriet. New Recommendations for Calcium and Vitamin D Intake. Dec 7, 2010. Last accessed 2016-11-11. BACK TO TEXT
  28. Durup D, Jørgensen HL, Christensen J, et al. A Reverse J-Shaped Association of All-Cause Mortality with Serum 25-Hydroxyvitamin D in General Practice: The CopD Study. J Clin Endocrinol Metab. 2012 Aug;97(8):2644–52. PubMed #22573406.

    “I think the message is pretty clear: think twice before you megadose.” — Alex Hutchinson (Sweat Science). Amen. The low to nil risks of “high“ doses of D may be justified by the evidence for the specific case of patients with chronic pain. But “mega” doses? Not sure that was ever a good idea for anyone.