1
|
Miniksar ÖH, Yüksek A, Göçmen AY, Katar MK, Kılıç M, Honca M. Serum vitamin D le Serum vitamin D levels are associated with acute post e associated with acute postoperative pain and opioid analgesic consumption after laparoscopic cholecystect cholecystectomy: a str omy: a strobe compliant pr obe compliant prospectiv ospective obser e observational ational study. Turk J Med Sci 2023; 53:171-182. [PMID: 36945925 PMCID: PMC10387885 DOI: 10.55730/1300-0144.5570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/20/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND In this prospective observational study, we aimed to evaluate the relationship between serum levels of vitamin D and acute postoperative pain scores, as well as opioid analgesic consumption in patients undergoing laparoscopic cholecystectomy. METHODS : The study was performed in the Medical Faculty Hospital, from April 2020 to April 2021. Postoperative visual analog scale (VAS) pain scores, total tramadol consumption, number of requests on patient-controlled analgesia (PCA) were compared between the vitamin D deficient (≤20 ng/mL; n = 25) and vitamin D nondeficient (>20 ng/mL; n = 55) groups at five time points (T0: in the recovery room, T1: 1st hour in the ward, T2: 6th hour, T3: 12th hour, and T4: 24th hour). RESULTS Postoperative VAS pain scores were similar in the vitamin D deficient group at all time points (T0-4), but differed significantly only at the T-0 time point (p = 0.020). The mean cumulative tramadol consumption was significantly higher in the vitamin D deficiency group than in the nondeficiency group (p = 0.005). Vitamin D levels were lower in patients with VAS ≥ 4 at the postoperative T-0 time point (p = 0.009). In the multivariate linear regression analysis, 15.7% of cumulative tramadol consumption was due to vitamin D deficiency (β = -0.188). DISCUSSION : Our study shows that preoperative low vitamin D level was associated with an increase in acute postoperative pain scores and consumption of opioid analgesics in patients undergoing laparoscopic cholecystectomy. Our findings may be useful for postoperative pain management in patients with vitamin D deficiency.
Collapse
Affiliation(s)
- Ökkeş Hakan Miniksar
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Ahmet Yüksek
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Ayşe Yeşim Göçmen
- Department of Biochemistry, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Mehmet Kağan Katar
- Department of General Surgery, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Mahmut Kılıç
- Department of Public Health, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turke
| | - Mehtap Honca
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| |
Collapse
|
2
|
Zeng X, Chen X, Li C, Shi H. Preoperative Vitamin D Level is Associated with Acute Pain After Video-Assisted Thoracoscopic Surgery: A Retrospective Cohort Study. J Pain Res 2022; 15:3189-3196. [PMID: 36258760 PMCID: PMC9572550 DOI: 10.2147/jpr.s382407] [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: 07/14/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose Low vitamin D levels have been associated with musculoskeletal pain, cancer pain, chronic postoperative pain, and post-traumatic pain. However, their association with postoperative pain after video-assisted thoracoscopic surgery has not been explored. The aim of this study was to examine the association between vitamin D levels and postoperative pain after video-assisted thoracoscopic surgery. Patients and Methods This study enrolled 194 adult patients who underwent elective non-cardiac thoracic surgery in Shanghai Pulmonary Hospital from February 2021 to June 2021. Following application of the exclusion criteria, 135 patients who underwent video-assisted thoracoscopic surgery were included in the final analysis. The primary outcome was the incidence of acute postoperative moderate-severe pain. Secondary outcomes included C-reactive protein (CRP), interleukin (IL)-1, IL-6, and tumor necrosis factor-α levels in the immediate postoperative (48 hours) period, as well as pain scores at 3 months after surgery. A multivariable logistic regression model was used to analyze the association between vitamin D levels and acute postoperative moderate-severe pain. Results Among 135 patients, 54.1% were categorized as having a low vitamin D level (<30 nmol/L). On multivariable analysis, patients with a low 25-hydroxy-vitamin D (25[OH]D) level had a higher risk of postoperative moderate-severe pain (odds ratio, 2.44; 95% confidence interval, 1.181-5.041; P = 0.016) when compared to patients with a sufficient 25(OH)D level. Static and dynamic pain scores at 3 months after surgery, as well as serum levels of CRP, IL-1, IL-6, and tumor necrosis factor-α were not significantly different between patients with low and sufficient 25(OH)D levels. Conclusion Patients with low vitamin D levels are at a higher risk of acute moderate-severe pain after video-assisted thoracoscopic surgery. Trial Registration http://www.chictr.org.cn, ChiCTR2100052380.
Collapse
Affiliation(s)
- Xiaoping Zeng
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, People’s Republic of China
| | - Xue Chen
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, People’s Republic of China
| | - Caixia Li
- Department of Anesthesiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, People’s Republic of China,Correspondence: Caixia Li, Department of Anesthesiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, People’s Republic of China, Tel +86-21-65161782-3235, Email
| | - Hong Shi
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200433, People’s Republic of China,Hong Shi, Department of Anesthesiology, Shanghai Pulmonary Hospital, school of Medicine, Tongji University, Shanghai, 200433, People’s Republic of China, Tel +86-21-65115006-2060, Email
| |
Collapse
|
3
|
Anusitviwat C, Suwanno P, Suwannaphisit S. The effects of vitamin D supplementation in carpal tunnel syndrome treatment outcomes: a systematic review. J Exp Orthop 2021; 8:73. [PMID: 34490545 PMCID: PMC8421488 DOI: 10.1186/s40634-021-00393-4] [Citation(s) in RCA: 2] [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: 04/22/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Vitamin D deficiency is related to carpal tunnel syndrome symptoms. Correcting vitamin D levels by supplementation was supposed to improve carpel tunnel symptoms, though there is a lack of aggregated data about treatment outcomes. This study aimed to examine whether vitamin D supplementation could improve the treatment outcomes in carpal tunnel syndrome patients. METHODS A comprehensive search of the PubMed, Cochrane Library, Scopus, and Web of Science databases for articles on vitamin D and carpel tunnel syndrome from January 2000 to March 2021 was performed. The article screening and data extraction were performed by two investigators independently with blinding to decisions on selected studies. All included studies had assessed the quality of evidence using the Methodological Index for Non-Randomized Studies (MINORS) scoring system. RESULTS We retrieved four studies that met the eligibility criteria. The treatment outcomes were evaluated by visual analog scale (124 wrists), functional scores (176 patients), muscle strength (84 patients), and nerve conduction velocity (216 wrists). After vitamin D supplementation, two studies reported improved pain scores and nerve conduction velocity, and three studies showed enhancement of functional status. CONCLUSION Vitamin D administration could offer favorable outcomes in pain improvement, better functional status, and increased sensory conduction velocity in carpal tunnel syndrome. However, there is to date no recommendations concerning a standardized dose or duration of vitamin D administration in carpal tunnel syndrome; prescribing vitamin D at the usual appropriate dose is suggested as an additional treatment in patients with mild to moderate carpel tunnel symptoms. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
Affiliation(s)
- Chirathit Anusitviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Porames Suwanno
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Sitthiphong Suwannaphisit
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand.
| |
Collapse
|
4
|
Ammerman BM, Ling D, Callahan LR, Hannafin JA, Goolsby MA. Prevalence of Vitamin D Insufficiency and Deficiency in Young, Female Patients With Lower Extremity Musculoskeletal Complaints. Sports Health 2020; 13:173-180. [PMID: 33301353 DOI: 10.1177/1941738120953414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Low levels of vitamin D have well-known impacts on bone health, but vitamin D also has a more global role throughout many tissues, including skeletal muscle. The high prevalence of hypovitaminosis D and the vast physiological features of vitamin D have led researchers to examine the influence of vitamin D on physical performance and injury. Because of the critical role of vitamin D in maintaining musculoskeletal health and function, a high rate of hypovitaminosis D among female patients with a variety of musculoskeletal issues could be of high clinical relevance. HYPOTHESIS There is a high prevalence of low vitamin D in female patients with both acute and overuse sports-related issues of both soft tissue and bone. STUDY DESIGN Prospective cohort study. LEVEL OF EVIDENCE Level 3. METHODS Female patients, aged 16 to 40 years, presenting with lower extremity injury diagnosed within the past 4 weeks, no use of multivitamin or vitamin D supplement, and no history of malabsorption syndrome met the inclusion criteria. Vitamin D levels were assessed and categorized as normal (≥32 ng/mL) and low, which includes insufficient (20.01-31.9 ng/mL) and deficient (≤20 ng/mL). RESULTS Of the 105 patients enrolled, 65.7% had low vitamin D. Within the low vitamin D cohort, 40.6% were deficient and 59.4% were insufficient. Injuries were grouped into overuse or acute with 74 overuse injuries and 31 acute injuries, exhibiting low vitamin D prevalence of 60.8% and 77.4%, respectively. Patients with ligamentous/cartilaginous injuries exhibited the highest percentage of low vitamin D (76.5%), followed by those with patellofemoral-related complaints (71.0%), muscle/tendon injuries (54.6%), and bone stress injuries (45.5%). In univariable analysis, older age, non-White race, less physical activity, less high-intensity interval training days, less endurance training days, and more rest days showed an association with low vitamin D, but none showed an independent association in multivariable analysis. CONCLUSION The prevalence of low vitamin D in female patients with various musculoskeletal complaints was high. Clinicians should evaluate for low vitamin D in both acute and overuse injuries. CLINICAL RELEVANCE In addition to screening, this study suggests that clinicians should evaluate for low vitamin D levels beyond bone stress injuries in the setting of acute and overuse injuries.
Collapse
Affiliation(s)
| | - Daphne Ling
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York
| | - Lisa R Callahan
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York.,Women's Sports Medicine Center, Hospital for Special Surgery, New York, New York
| | - Jo A Hannafin
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York.,Women's Sports Medicine Center, Hospital for Special Surgery, New York, New York
| | - Marci A Goolsby
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York.,Women's Sports Medicine Center, Hospital for Special Surgery, New York, New York
| |
Collapse
|
5
|
Kim Y, Zhang F, Su K, LaRochelle M, Callahan M, Fisher D, Wharam JF, Asgari MM. Perioperative Serum 25-Hydroxyvitamin D Levels as a Predictor of Postoperative Opioid Use and Opioid Use Disorder: a Cohort Study. J Gen Intern Med 2020; 35:2545-2552. [PMID: 32583342 PMCID: PMC7459073 DOI: 10.1007/s11606-020-06001-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 06/17/2020] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Vitamin D deficiency is associated with chronic pain syndromes and higher opioid use among cancer patients, but its association with opioid use among opioid-naïve subjects following a major surgical procedure with acute pain has not been explored. OBJECTIVE To determine the association between serum 25-hydroxyvitamin D (25(OH)D) levels, opioid use, and opioid use disorder. METHODS We identified commercially insured subjects aged 18-64 years with available perioperative serum 25-hydroxyvitamin D (25D) levels who underwent one of nine major surgical procedures in 2000-2014. Primary outcomes were dose and duration of opioid use measured using pharmacy claims. Secondary outcome was opioid use disorder captured using diagnosis codes. Multivariable negative binomial models with generalized estimating equations were performed examining the association between 25D levels and postoperative opioid use measures, adjusting for age, sex, race/ethnicity, Charlson score, education, income, latitude, and season of blood draw. Adjusted Cox regression was used to examine the association with opioid use disorder. RESULTS Among 5446 subjects, serum 25(OH)D was sufficient (≥ 20 ng/mL) among 4349 (79.9%) subjects, whereas 837 (15.4%) had insufficient (12 to < 20 ng/mL) and 260 (4.8%) had deficient (< 12 ng/mL) levels. On multivariable analysis, as compared with subjects with sufficient 25(OH)D levels, subjects with deficient 25(OH)D levels had 1.7 more days (95% CI 0.76, 2.58) of opioid use per year and had 98.7 higher morphine milligram equivalent dose (95% CI 55.7, 141.8) per year. Among 11,713 study cohort, subjects with deficient 25(OH)D levels were more likely to be diagnosed with opioid use disorders (HR 2.41; 95% CI 1.05, 5.52). CONCLUSION Patients undergoing common surgical procedures with deficient 25D levels are more likely to have higher opioid use and an increased risk of opioid use disorder compared to those with sufficient levels. Serum 25D levels may serve as a biomarker to identify subjects at increased risk of opioid misuse.
Collapse
Affiliation(s)
- Yuhree Kim
- Department of Population Medicine, Harvard Medical School, , 401 Park Drive #401, Boston, MA, 02215, USA.,Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, , 50 Staniford Street, Boston, MA, USA
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School, , 401 Park Drive #401, Boston, MA, 02215, USA
| | - Katherine Su
- Department of Population Medicine, Harvard Medical School, , 401 Park Drive #401, Boston, MA, 02215, USA.,Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, , 50 Staniford Street, Boston, MA, USA
| | - Marc LaRochelle
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, , Boston, MA, USA
| | - Matthew Callahan
- Department of Population Medicine, Harvard Medical School, , 401 Park Drive #401, Boston, MA, 02215, USA
| | - David Fisher
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, , 50 Staniford Street, Boston, MA, USA
| | - J Frank Wharam
- Department of Population Medicine, Harvard Medical School, , 401 Park Drive #401, Boston, MA, 02215, USA
| | - Maryam M Asgari
- Department of Population Medicine, Harvard Medical School, , 401 Park Drive #401, Boston, MA, 02215, USA. .,Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, , 50 Staniford Street, Boston, MA, USA.
| |
Collapse
|
6
|
Saçmaci H, Tanik N, Balbaloğlu Ö, Aktürk T, Inan LE. Electrophysiological evaluation of carpal tunnel syndrome female patients after vitamin D replacement. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:224-229. [PMID: 32294751 DOI: 10.1590/0004-282x20190193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/12/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The effects of vitamin D on the central and peripheral nervous system continue to be investigated today. In the present study, we aimed to evaluate pain and electrophysiologic response in patients with carpal tunnel syndrome (CTS) who have undergone replacement therapy due to vitamin D deficiency. METHODS Fifty female patients diagnosed with mild and moderate CTS and accompanied by vitamin D deficiency were included in this study. Nerve conduction study (NCS) was performed before and after vitamin D replacement, and the patient's pain was evaluated with Visual Analogue Scale (VAS). RESULTS When NCS were compared before and after treatment, there was a statistically significant improvement in the median distal sensory onset latency (DSOL) and sensory conduction velocity (CV) and motor distal latencies (DML) values (p=0.001; p<0.001; p=0.001, respectively). At the same time, there was a decrease in the VAS values in patients (p<0.001). When the two groups were compared there was an improvement in DSOL and sensory CV in both groups, but in DML only in moderate CTS group. CONCLUSION In this study, it was shown that mild and moderate CTS patients had an improvement in pain and electrophysiological parameters after vitamin D replacement. Replacing vitamin D in early stages of CTS may be beneficial.
Collapse
Affiliation(s)
- Hikmet Saçmaci
- Yozgat Bozok University Faculty of Medicine, Department of Neurology, Yozgat, Turkey
| | - Nermin Tanik
- Yozgat Bozok University Faculty of Medicine, Department of Neurology, Yozgat, Turkey
| | - Özlem Balbaloğlu
- Yozgat Bozok University Faculty of Medicine, Department of Physical Therapy and Rehabilitation, Yozgat, Turkey
| | - Tülin Aktürk
- Yozgat Bozok University Faculty of Medicine, Department of Neurology, Yozgat, Turkey
| | - Levent Ertuğrul Inan
- Yozgat Bozok University Faculty of Medicine, Department of Neurology, Yozgat, Turkey
| |
Collapse
|
7
|
Kenis-Coskun O, Giray E, Gunduz OH, Akyuz G. The effect of vitamin D replacement on spinal inhibitory pathways in women with chronic widespread pain. J Steroid Biochem Mol Biol 2020; 196:105488. [PMID: 31589918 DOI: 10.1016/j.jsbmb.2019.105488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/05/2019] [Accepted: 09/30/2019] [Indexed: 12/11/2022]
Abstract
Vitamin D replacement helps in pain reduction in patients with chronic widespread pain (CWP). But the current literature lack studies that investigate its mechanism. Cutaneous silent period (CSP) is the electrophysiologic analog of the spinal inhibitory pathways and an objective method to document their involvement. This study aims to show if vitamin D replacement has an effect on the spinal inhibitory pathways through CSP parameters. Female patients who have CWP with vitamin D deficiency were included. Patients received an 8-week replacement therapy of vitamin D. Patients' pain were evaluated using the visual analog scale (VAS) and Leeds assessment of neuropathic symptoms and signs pain scale (LANSS). Quality of life with Nottingham Health Profile (NHP) and CSP parameters were also recorded before and after treatment. A total of 51 patients were included in the final analyses. The mean age of the patients was 44.3 ± 12.7 (minimum 18-maximum 65). Mean symptom duration was 13.1 ± 6.7 (minimum3-maximum 24) months. Patients' mean BMI was 21.6 ± 3.9 (minimum 18.0 maximum 29.1). Patients' median VAS and LANSS scores decreased significantly (p < 0.01) and NHP scores improved significantly in all subsets (p < 0.01). Vitamin D replacement did not significantly change CSP latency and duration (p = 0.06 and p = 0.12).Vitamin D replacement does not seem to work via modifying the spinal inhibitory pathways that are involved in the formation of the cutaneous silent period. This is the first study to objectively investigate the effect of vitamin D replacement on central sensitization mechanisms.
Collapse
Affiliation(s)
- Ozge Kenis-Coskun
- Marmara University Medical Faculty Physical Medicine and Rehabilitation Department, Turkey.
| | - Esra Giray
- Marmara University Medical Faculty Physical Medicine and Rehabilitation Department, Turkey
| | - Osman Hakan Gunduz
- Marmara University Medical Faculty Physical Medicine and Rehabilitation Department, Turkey
| | - Gulseren Akyuz
- Marmara University Medical Faculty Physical Medicine and Rehabilitation Department, Turkey
| |
Collapse
|
8
|
Farajzadeh A, Bathaie SZ, Arabkheradmand J, Ghodsi SM, Faghihzadeh S. Different Pain States of Trigeminal Neuralgia Make Significant Changes in the Plasma Proteome and Some Biochemical Parameters: a Preliminary Cohort Study. J Mol Neurosci 2018; 66:524-534. [DOI: 10.1007/s12031-018-1183-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 09/24/2018] [Indexed: 01/03/2023]
|
9
|
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: 2.0] [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.
Collapse
Affiliation(s)
| | - Nahed Shehta
- Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | | | - Alaa A Omran
- Faculty of Medicine, Zagazig University, Sharkia, Egypt
| |
Collapse
|
10
|
Pain evaluation in a sample of Turkish children with cerebral palsy and its association with dependency level, verbal abilities, and the quality of life of patients and sociodemographic status, depression, and quality of life of their caregivers. Turk J Phys Med Rehabil 2018; 64:222-229. [PMID: 31453515 DOI: 10.5606/tftrd.2018.1871] [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: 06/11/2017] [Accepted: 11/19/2017] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to evaluate pain in children with cerebral palsy (CP), to investigate its association with dependency level, verbal abilities, and the quality of life (QoL) of children and sociodemographic status, depression levels, and QoL of their caregivers. Patients and methods Between February 2016 and April 2016, a total of 85 children (56 males, 29 females; mean age 7.1±2.5 years; range, 4 to 12 years) with CP were included. Their sociodemographic data, gross motor functional levels, verbal abilities (verbal and non- verbal) were evaluated. The children were categorized as independent (Gross Motor Function Classification System [GMFCS] 1), partially dependent (GMFCS 2,3), and totally dependent (GMFCS 4,5). The Non-Communicating Children's Pain Checklist - Revised (NCCPC-R), the Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILD), the Nottingham Health Profile (NHP), and the Beck Depression Inventory (BDI) were used for the evaluation. Results A total of 50 (58.8%) of the children were verbal, while 35 (41.2%) were non-verbal. Of the patients, 47.1% were totally dependent, 37.6% were partially dependent, and 15.3% were independent. Pain was less frequent in the independent group, compared to the partially and totally dependent groups (p=0.04; p=0.013). There were no statistically significant difference in perceived pain according to the CPCHILD and NCCPC-R scores, when low and high socioeconomic status were compared (p>0.05). The QoL scores of children who were totally dependent and non-verbal were statistically significantly lower than those of the other children (p=0.0001, p=0.0001). A statistically significantly negative correlation between increased totally dependent children's QoL scores and decreased QoL scores of the caregivers was observed (r=-0.429 p=0.006). The children with pain had a decreased QoL (p=0.03). The QoL of caregivers decreased and the depression scores of caregivers increased, as the pain scores of the children increased (r=0.291, p=0.007; r=-0.455, p=0.0001). Conclusion Our study results show that pain is more frequent in children with CP who are dependent and non-verbal, and it negatively affects the QoL of both caregivers and children. Evaluation of pain and the identification of CP patients who are at high risk of experiencing pain is worthwhile, as these individuals have difficulty in verbalizing pain due to their cognitive problems, although they are at risk of experiencing pain due to chronic physical problems, such as spasticity and contracture, as well as interventions for complicated medical problems.
Collapse
|
11
|
Helde-Frankling M, Björkhem-Bergman L. Vitamin D in Pain Management. Int J Mol Sci 2017; 18:E2170. [PMID: 29057787 PMCID: PMC5666851 DOI: 10.3390/ijms18102170] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 09/29/2017] [Accepted: 10/11/2017] [Indexed: 12/12/2022] Open
Abstract
Vitamin D is a hormone synthesized in the skin in the presence of sunlight. Like other hormones, vitamin D plays a role in a wide range of processes in the body. Here we review the possible role of vitamin D in nociceptive and inflammatory pain. In observational studies, low vitamin D levels have been associated with increased pain and higher opioid doses. Recent interventional studies have shown promising effects of vitamin D supplementation on cancer pain and muscular pain-but only in patients with insufficient levels of vitamin D when starting intervention. Possible mechanisms for vitamin D in pain management are the anti-inflammatory effects mediated by reduced cytokine and prostaglandin release and effects on T-cell responses. The recent finding of vitamin D-mediated inhibition of Prostaglandin E2 (PGE2) is especially interesting and exhibits a credible mechanistic explanation. Having reviewed current literature, we suggest that patients with deficient levels defined as 25-hydroxyvitamin D (25-OHD) levels <30 nmol/L are most likely to benefit from supplementation, while individuals with 25-OHD >50 nmol/L probably have little benefit from supplementation. Our conclusion is that vitamin D may constitute a safe, simple and potentially beneficial way to reduce pain among patients with vitamin D deficiency, but that more randomized and placebo-controlled studies are needed before any firm conclusions can be drawn.
Collapse
Affiliation(s)
- Maria Helde-Frankling
- ASIH Stockholm Södra, Långbro Park, Palliative Home Care and Hospice Ward, Bergtallsvägen 12, SE-125 59 Älvsjö, Sweden.
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet and Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden.
| | - Linda Björkhem-Bergman
- ASIH Stockholm Södra, Långbro Park, Palliative Home Care and Hospice Ward, Bergtallsvägen 12, SE-125 59 Älvsjö, Sweden.
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet and Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden.
| |
Collapse
|
12
|
Gürer B, Karakoç A, Bektaşoğlu PK, Kertmen H, Kanat MA, Arıkök AT, Ergüder Bİ, Sargon MF, Öztürk ÖÇ, Çelikoğlu E. Comparative effects of vitamin D and methylprednisolone against ischemia/reperfusion injury of rabbit spinal cords. Eur J Pharmacol 2017; 813:50-60. [DOI: 10.1016/j.ejphar.2017.07.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 01/01/2023]
|
13
|
Yesil H, Sungur U, Akdeniz S, Gurer G, Yalcın B, Dundar U. Association between serum vitamin D levels and neuropathic pain in rheumatoid arthritis patients: A cross-sectional study. Int J Rheum Dis 2017; 21:431-439. [PMID: 28857474 DOI: 10.1111/1756-185x.13160] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIM Recent literature suggests that neuropathic pain (NP) and vitamin D deficiency can occur concurrently in patients with rheumatoid arthritis (RA). This study aimed to examine the development of NP in patients with RA and the relationship between NP and vitamin D. METHODS We used the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) questionnaire to evaluate NP in 93 patients with RA. Demographic and clinical data were obtained from patient files and interviews, and patients' serum vitamin D levels were recorded. Patients were requested to complete both the Short Form-36 survey and the Health Assessment Questionnaire. RESULTS Seventy-five of the eligible patients were female (80.6%), and 31 (33.3%) were diagnosed with NP according to the LANSS. There was a negative correlation between vitamin D levels and the LANSS score (P = 0.001). The prevalence of NP was 5.8 times higher among patients with serum vitamin D levels below 20 ng/mL than in patients with vitamin D levels ≥ 30 ng/mL. Based on the area under curve (AUC) values, we found that serum levels of vitamin D were a good predictor of NP diagnoses in patients with RA (AUC = 0.71). CONCLUSION We found that vitamin D deficiency was asssociated with increased NP in patients with RA. Although further research is needed to clarify the association between serum vitamin D levels and NP, our study raises awareness of the need to screen for vitamin D deficiency in RA patients with NP.
Collapse
Affiliation(s)
- Hilal Yesil
- Department of Physical Medicine and Rehabilitation, Afyon Kocatepe University Faculty of Medicine, Afyon, Turkey
| | - Ulas Sungur
- Department of Physical Medicine and Rehabilitation, Ege University Faculty of Medicine, Izmir, Turkey
| | - Sedef Akdeniz
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Adnan Menderes University Faculty of Medicine, Aydin, Turkey
| | - Gulcan Gurer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Adnan Menderes University Faculty of Medicine, Aydin, Turkey
| | - Basak Yalcın
- Department of Physical Medicine and Rehabilitation, Afyon Kocatepe University Faculty of Medicine, Afyon, Turkey
| | - Umit Dundar
- Department of Physical Medicine and Rehabilitation, Afyon Kocatepe University Faculty of Medicine, Afyon, Turkey
| |
Collapse
|
14
|
Helde-Frankling M, Höijer J, Bergqvist J, Björkhem-Bergman L. Vitamin D supplementation to palliative cancer patients shows positive effects on pain and infections-Results from a matched case-control study. PLoS One 2017; 12:e0184208. [PMID: 28859173 PMCID: PMC5578640 DOI: 10.1371/journal.pone.0184208] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 08/21/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND We previously showed an association between low vitamin D levels and high opioid doses to alleviate pain in palliative cancer patients. The aim of this case-controlled study was to investigate if vitamin D supplementation could improve pain management, quality of life (QoL) and decrease infections in palliative cancer patients. METHODS Thirty-nine palliative cancer patients with levels of 25-hydroxyvitamin D < 75 nmol/L were supplemented with vitamin D 4000 IE/day, and were compared to 39 untreated, matched "control"-patients from a previous study at the same ward. Opioid doses, antibiotic consumption and QoL-scores measured with the Edmonton Symptom Assessment Scale (ESAS) were monitored. The primary endpoint was the change from baseline after 1 and 3 months compared between the groups using linear regression with adjustment for a potential cofounding factor. RESULTS After 1 month the vitamin D treated group had a significantly decreased fentanyl dose compared to the untreated group with a difference of 46 μg/h; 95% CI 24-78, which increased further at 3 months to 91 μg/h; 95% CI 56-140 μg/h. The ESAS QoL-score improved in the Vitamin D group the first month; -1.4; 95% CI -2.6 - (-0.21). The vitamin D-treated group had significantly lower consumption of antibiotics after 3 months compared to the untreated group, the difference was -26%; 95%CI -0.41%-(-0.12%). Vitamin D was well tolerated by all patients and no adverse events were reported. CONCLUSION Vitamin D supplementation to palliative cancer patients is safe and improvement in pain management is noted as early as 1 month after treatment. Decreased infections are noted 3 months after vitamin D treatment. The results from this pilot-study have been used for the power-calculation of a future randomized, placebo-controlled, double-blind study called "Palliative-D" that will start in Nov 2017 and will include 254 palliative cancer patients.
Collapse
Affiliation(s)
- Maria Helde-Frankling
- ASIH Stockholm Södra, Långbro Park, Palliative Home Care and Hospice Ward, Älvsjö, Sweden
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet and Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Jonas Höijer
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jenny Bergqvist
- Department of Surgery, Breast Centre, Capio St Gorans Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Linda Björkhem-Bergman
- ASIH Stockholm Södra, Långbro Park, Palliative Home Care and Hospice Ward, Älvsjö, Sweden
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet and Karolinska University Hospital, Huddinge, Stockholm, Sweden
- * E-mail:
| |
Collapse
|
15
|
The effect of vitamin D supplementation on pain, quality of life, and nerve conduction studies in women with chronic widespread pain. Int J Rehabil Res 2017; 40:76-83. [PMID: 28030514 DOI: 10.1097/mrr.0000000000000211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of this study was to investigate the effects of vitamin D supplementation on pain, quality of life, and nerve conduction studies (NCSs) in women with chronic widespread pain (CWP) diagnosed with Vitamin D insufficiency. Thirty-three female participants with CWP and vitamin D insufficiency were included in this open-label trial. They were evaluated by routine NCSs in upper and lower limbs, pain scales, and the Nottingham Health Profile before and 8 weeks after starting vitamin D supplementation therapy. The P-value was adjusted to account for the number of comparisons performed in each assessment. After 8 weeks of treatment, participants reported significantly lower pain scores (P=0.000). The total Nottingham Health Profile score and subscores for pain, emotional reactions, and physical activity domains were significantly lower (0.000≤P≤0.008). However, no statistically significant changes in NCSs were detected, except trends toward increases in the amplitudes of left median and ulnar sensory nerve potentials and a decrease in the distal latency of the right median sensory potential (0.01≤P≤0.04). Vitamin D supplementation therapy decreased pain and increased quality of life without significantly affecting nerve conduction in patients with CWP.
Collapse
|
16
|
Parker VJ, Rudinsky AJ, Chew DJ. Vitamin D metabolism in canine and feline medicine. J Am Vet Med Assoc 2017; 250:1259-1269. [DOI: 10.2460/javma.250.11.1259] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
17
|
Wåhlén K, Olausson P, Carlsson A, Ghafouri N, Gerdle B, Ghafouri B. Systemic alterations in plasma proteins from women with chronic widespread pain compared to healthy controls: a proteomic study. J Pain Res 2017; 10:797-809. [PMID: 28435317 PMCID: PMC5388344 DOI: 10.2147/jpr.s128597] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Chronic widespread pain (CWP) is a complex pain condition that is difficult to treat. The prevalence of CWP approximates ~10% of the general population, with higher prevalence in women. Lack of understanding of molecular mechanisms has been a challenge for diagnosis and treatment of chronic pain. The aim of this study was to explore the systemic protein changes in CWP compared to those in healthy controls (CON). By applying 2-dimensional gel electrophoresis, we analyzed the protein pattern of plasma samples from women with CWP (n=16) and healthy women (n=23). The proteomic data were analyzed using multivariate statistical models, and altered proteins were identified using mass spectrometry. The proteome analysis was further validated by gel-free Western blot. Multivariate statistical data analysis of quantified proteins revealed 22 altered proteins in women with CWP, compared to CON group. Many of the identified proteins are previously known to be involved in different parts of the complement system and metabolic and inflammatory processes, e.g., complement factor B, vitamin D-binding protein, ceruloplasmin, transthyretin and alpha-2-HS-glycoprotein. These results indicate that important systemic protein differences exist between women with CWP and healthy women. Further, this study illustrates the potential use of proteomics to detect biomarkers that may provide new insights into the molecular mechanism(s) of chronic pain. However, further larger investigations are required in order to confirm these findings before it will be possible to identify proteins as potential pain biomarkers for clinical use.
Collapse
Affiliation(s)
- Karin Wåhlén
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Patrik Olausson
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anders Carlsson
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Nazdar Ghafouri
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Björn Gerdle
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Bijar Ghafouri
- Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
18
|
Jamall OA, Feeney C, Zaw-Linn J, Malik A, Niemi MEK, Tenorio-Jimenez C, Ham TE, Jilka SR, Jenkins PO, Scott G, Li LM, Gorgoraptis N, Baxter D, Sharp DJ, Goldstone AP. Prevalence and correlates of vitamin D deficiency in adults after traumatic brain injury. Clin Endocrinol (Oxf) 2016; 85:636-44. [PMID: 26921561 PMCID: PMC5053278 DOI: 10.1111/cen.13045] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 02/06/2016] [Accepted: 02/22/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Traumatic brain injury (TBI) is a major cause of long-term disability with variable recovery. Preclinical studies suggest that vitamin D status influences the recovery after TBI. However, there is no published clinical data on links between vitamin D status and TBI outcomes. The aim was to determine the (i) prevalence of vitamin D deficiency/insufficiency, and associations of vitamin D status with (ii) demographic factors and TBI severity, and with (iii) cognitive function, symptoms and quality of life, in adults after TBI. DESIGN Retrospective audit of patients seen between July 2009 and March 2015. Serum vitamin D (25-hydroxy-cholecalciferol) was categorized as deficient (<40 nmol/l), insufficient (40-70 nmol/l) or replete (>70 nmol/l). PATIENTS A total of 353 adults seen in tertiary hospital clinic (75·4% lighter skinned, 74·8% male, age median 35·1 year, range 26·6-48·3 year), 0·3-56·5 months after TBI (74·5% moderate-severe). MEASUREMENTS Serum vitamin D concentrations; Addenbrooke's Cognitive Examination (ACE-R), Beck Depression Inventory-II (BDI-II), SF-36 Quality of Life, Pittsburgh Sleep Quality Index. RESULTS In total, 46·5% of patients after TBI had vitamin D deficiency and 80·2% insufficiency/deficiency. Patients with vitamin D deficiency had lower ACE-R scores than those of vitamin D replete (mean effect size ± SEM 4·5 ± 2·1, P = 0·034), and higher BDI-II scores than those of vitamin D insufficient (4·5 ± 1·6, P = 0·003), correcting for age, gender, time since TBI and TBI severity. There was no association between vitamin D status and markers of TBI severity, sleep or quality of life. CONCLUSION Vitamin D deficiency is common in patients after TBI and associated with impaired cognitive function and more severe depressive symptoms.
Collapse
Affiliation(s)
- Omer A Jamall
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Claire Feeney
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
- Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - Joanna Zaw-Linn
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Aysha Malik
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Mari E K Niemi
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Carmen Tenorio-Jimenez
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
- Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - Timothy E Ham
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Sagar R Jilka
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Peter O Jenkins
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Gregory Scott
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Lucia M Li
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Nikolaos Gorgoraptis
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - David Baxter
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - David J Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK
| | - Anthony P Goldstone
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK.
- Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK.
- Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, Hammersmith Hospital, London, UK.
| |
Collapse
|
19
|
Björkhem-Bergman L, Bergman P. Vitamin D and patients with palliative cancer. BMJ Support Palliat Care 2016; 6:287-91. [PMID: 27084421 DOI: 10.1136/bmjspcare-2015-000921] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 03/30/2016] [Indexed: 01/13/2023]
Abstract
Vitamin D is a hormone that is synthesised in the skin in the presence of sunlight. Sufficient vitamin D levels are important-not only for a healthy skeleton-but also for a healthy immune system. Many patients with cancer have insufficient vitamin D levels, and low vitamin D levels are associated with increased 'all-cause mortality' and especially mortality due to cancer. Low vitamin D levels have also been associated with increased risk of infections, increased pain, depressive disorders and impaired quality of life. We review the role of vitamin D in the immune system, in relation to cancer disease, pain and depression. We have recently performed an observational study in 100 patients with palliative cancer in Sweden. The main result was that low vitamin D levels were associated with higher opioid dose, that is, more pain. We also describe a case report where vitamin D supplementation resulted in radically decreased opioid dose, less pain and better well-being. Vitamin D supplementation is not connected with any adverse side effects and is easy to administrate. Thus, we hypothesise that vitamin D-supplementation to patients with palliative cancer might be beneficial and could improve their well-being, decrease pain and reduce susceptibility to infections. However, more clinical studies in this field are needed before firm conclusions can be drawn.
Collapse
Affiliation(s)
- Linda Björkhem-Bergman
- Department of Palliative Home Care and Hospice Ward, ASIH Stockholm Södra, Älvsjö, Sweden Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Peter Bergman
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
20
|
Bergman P, Sperneder S, Höijer J, Bergqvist J, Björkhem-Bergman L. Low vitamin D levels are associated with higher opioid dose in palliative cancer patients--results from an observational study in Sweden. PLoS One 2015; 10:e0128223. [PMID: 26018761 PMCID: PMC4446094 DOI: 10.1371/journal.pone.0128223] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 04/24/2015] [Indexed: 01/13/2023] Open
Abstract
Background Vitamin D deficiency is common among palliative cancer patients and has been connected to an increased risk for pain, depressions and infections. Therefore we wanted to test the hypothesis that low 25-hydroxyvitamin D (25OHD) levels are associated with higher opioid dose, higher infectious burden and impaired quality of life in palliative cancer patients. The secondary aim was to investigate the association between 25OHD-levels and survival time. Method In this prospective, observational study in palliative cancer-patients (n = 100) we performed univariate and multiple linear regression analysis to assess the association of 25OHD levels with opioid dose, infectious burden (antibiotic consumption), quality of life (Edmonton Symptom Assessment Scale, ESAS) and survival time, controlling for potential confounding factors. Results The median 25OHD level was 40 nmol/L (range 8-154 nmol/L). There was a significant association between 25OHD levels and opioid dose, beta coefficient -0.67; p=0.02; i.e. a low 25OHD level was associated with a higher opioid dose. This association remained significant after adjustment for stage of the cancer disease in a multivariate analysis, beta coefficient -0.66; p = 0.04. There was no association between 25OHD levels and antibiotic use or quality of life. Univariate cox regression analysis showed a weak correlation between survival time and 25OHD levels (p<0.05). However, decreased albumin levels and increased CRP levels were superior markers to predict survival time; p<0.001 for both analyses. Conclusion Low 25OHD-levels are associated with increased opioid consumption in palliative cancer patients. Future interventional studies are needed to investigate if pain can be reduced by vitamin D supplementation in these patients. In addition, this study confirms previous findings that low albumin and increased CRP levels are useful markers for survival time in palliative cancer patients.
Collapse
Affiliation(s)
- Peter Bergman
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet and Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Susanne Sperneder
- ASIH Stockholm Södra, Långbro Park, Palliative Home Care and Hospice Ward, Bergtallsvägen, Älvsjö, Sweden
| | - Jonas Höijer
- Institute of Environmental Medicine, Unit of Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jenny Bergqvist
- ASIH Stockholm Södra, Långbro Park, Palliative Home Care and Hospice Ward, Bergtallsvägen, Älvsjö, Sweden
- Department of Oncology/Pathology, Karolinska Institutet and Stockholms Sjukhem, Unit for Palliative Care, Stockholm, Sweden
| | - Linda Björkhem-Bergman
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet and Karolinska University Hospital, Huddinge, Stockholm, Sweden
- ASIH Stockholm Södra, Långbro Park, Palliative Home Care and Hospice Ward, Bergtallsvägen, Älvsjö, Sweden
- * E-mail:
| |
Collapse
|
21
|
Mourgues C, Malochet-Guinamand S, Soubrier M. Refractory rheumatic disorder: atypical postpregnancy osteoporosis. Case Rep Rheumatol 2015; 2015:327965. [PMID: 25785219 PMCID: PMC4346694 DOI: 10.1155/2015/327965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/22/2015] [Indexed: 11/24/2022] Open
Abstract
This is a case report on a young patient with severe osteoporosis that was initially revealed when she presented with polyarthralgia during her second pregnancy. Postpartum, the pain increased and her X-ray did not show any abnormalities. A bone scintigraphy was performed. It indicated an inflammatory rheumatic disorder. Six months after partum, an investigation of right coxalgia revealed a spontaneous basicervical fracture. Given the persistent polyarthralgia, the patient underwent a new scintigraphy, which revealed areas of what looked to be old rib and L1 fractures. A subsequent full body magnetic resonance imaging (MRI) scan revealed signal abnormalities that could indicate multiple lower limb bone fractures. Despite exhaustive biological, radiological, and histological testing, no secondary cause for the osteoporosis was found. The patient was started on teriparatide. We finally concluded that, despite the atypical presentation, the patient was suffering from postpregnancy osteoporosis. It is possible that the frequency of occurrence of this still poorly understood disease is underestimated.
Collapse
Affiliation(s)
- Cindy Mourgues
- CHU Gabriel Montpied, Service de Rhumatologie, 58 rue Montalembert, 63000 Clermont-Ferrand, France
| | | | - Martin Soubrier
- CHU Gabriel Montpied, Service de Rhumatologie, 58 rue Montalembert, 63000 Clermont-Ferrand, France
| |
Collapse
|