When I was at medical school and subsequently once I started working as a junior doctor, I encountered a number of patients who complained of ‘hurting all over’. These individuals were almost always of Indian subcontinent heritage, and were usually female. On examination, these patients generally claimed to feel pain wherever you touched them. In medicine, specific problems tend to produce pain in specific areas. Generalised pain is generally harder to diagnose. I’m afraid to say that many individuals with generalised pain did not seem to get the time and attention afforded to individuals with more defined symptoms.
My experience with these patients came back to me this week when I saw a patient in practice suffering from ‘fibromyalgia’ ” essentially muscular pain for which there is no generally recognised cause. Her symptoms are long-standing, and severe enough for her to need to take antidepressants (to help her sleep) and painkillers.
In the last couple of years, I’ve come to recognise that one relatively common but under-recognised cause of generalised pain/fibromyalgia is vitamin D deficiency. As most of our requirements for vitamin D come from the action of sunlight on the skin, vitamin D deficiency tends to be common in regions that don’t get a load of sunshine (like the UK). Also, the darker someone’s skin, the more sunlight they need to make a given amount of vitamin D. In other words, dark-skinned individuals tend to be prone to vitamin D deficiency. It is perhaps noteworthy that Monday’s patient was of Afro-Caribbean stock. Another thing that was noteworthy was that her symptoms resolved more or less completely after a few days in the sunshine when on holiday.
Needless to say, we’re in the process of getting this individual’s vitamin D levels checked. If it comes up low, then there’s a good chance her symptoms are caused, at least in part, by vitamin D deficiency. If that’s the case, then my experience is that’s there’s a good chance that boosting her vitamin D levels will help to relieve her symptoms.
I suppose I wouldn’t be writing about this were it not for an experience I had yesterday. I was just about to deliver a lecture to a group of general practitioners in the North of England. Before starting, I got chatting to a GP and the subject of vitamin D deficiency came up. He too had come across a lot of Asian patients who complained of generalised pain and tenderness, and some months ago had put two and two together and come to the conclusion that vitamin D deficiency was a likely factor in such individuals. Not only that, but he said he was getting good results with vitamin D.
Another reason for writing about this is that in the UK we are now well into winter, and the relatively contracted daylight hours will mean that our potential for sun exposure is severely curtailed. For this reason, those prone for vitamin D deficiency will tend to find that their symptoms are worst in the winter.
Individuals who suffer from generalised pain and/or fibromyalgia may want to consider vitamin D deficiency as a potential underlying cause. Vitamin D levels can be checked by measuring the level of 25-hydroxy-cholecalciferol (also known as 25(OH)D) in the bloodstream. I generally consider levels of 50 nmol/L or less as evidence of deficiency. If you are going to have your vitamin D levels check then I recommend working, if at all possible, with a practitioner who has access to such tests and can monitor treatment should this be deemed appropriate.
Getting vitamin D levels up in the body can be achieved through sun exposure and/or supplementation. While the recommended daily amount of vitamin D is 400 IU in the UK, I usually recommend much higher doses (usually in the region of 2000 IU per day) where there is evidence of deficiency. Such dosages are believed to be safe, though I do recommend monitoring, partly for safety reasons, and partly because we want to be sure that the dosage and form of vitamin D being used is having the desired effect in terms of vitamin D levels in the body.
