We all love the sunshine, bright days and the warm feeling of the sun on our skin. We feel energized, our mood is better and in general life seems a little more feel good factor bearable, even if you have chronic pain! But why is this the case? How does sunshine exposure relate to chronic pain levels?

In the past decade, a focus of research has been done on how Vitamin D deficiency can contribute to people experiencing chronic musculoskeletal pain symptoms. As opposed to the majority of other vitamins that are primarily supplied by dietary intake, the main source of Vitamin D for humans is sunlight exposure. In some individuals reducing the exposure to sunlight by factors. There in lies the issue on one hand we avoiding sunburn and it may also contributing to keeping some individuals in pain. Certainly, the literature supports the fact that Vitamin D levels are deficient in the general population worldwide. This is referred to as hypovitaminosis (Cashman et al. 2016).

Obviously in our health-conscious society great focus has been placed on taking steps to prevent skin cancer and rightly so. Skin cancer has been directly linked to sun exposure and frequent sunburns, a number of methods have arisen to reduce these factors: high SPF level sunblock, avoiding direct sunlight exposure, etc.

How might Vitamin D influence pain?

The exact mechanism of how Vitamin D affects pain levels is unclear. Previously, Vitamin D deficiency has most closely been associated with people who develop rickets and osteoporosis. Along with calcium, Vitamin D is very important in maintaining healthy bone structure. Additionally, current scientific research has linked its deficiency with multiple sclerosis, asthma, prostate cancer, immune function (body’s ability to fight infection), and other diseases. The science behind how Vitamin D affects pain is unclear.

It may be that Vitamin D influences how some individuals ability to sense pain, whether related to increased inflammation, changing the nerve pathways that control pain, etc. Dr. Dominic Hegarty (Clinical Director Pain Relief Ireland) says that meta-analysis of observational studies have shown that pain conditions are associated with low serum 25-hydroxy vitamin D (25(OH)D) concentrations (2015) and this is the best available marker of vitamin D levels.

For example;

• 2003, a study was published in Spine evaluating 360 patients in Saudi Arabia with chronic low back pain of unknown cause. 83% of patients were noted to have low vitamin D levels. After 3 months of treatment with high dose oral supplementation, all patients with deficiency reported decreased levels of pain.
• 2004, a report was published in the Mayo Clinic Proceedings, noting higher levels of Vitamin D deficiency in patients with unexplained diffuse muscle and skeletal pain.
• 2009, scientists found that patients with Vitamin D deficiency required higher doses of pain killers to achieve relief compared to those with normal levels.
• 2012, Italian researchers reported on how a single dose of Vitamin D can provide women with significant pain relief during menstrual periods in the Archives of Internal Medicine.

However, despite this data there are several studies where providing supplemention to try and improve pain levels have provided inconsistent results. Dr. Hegarty (Clinical Director Pain Relief Ireland) says a “recent 3-year review of chronic pain patients in this months’ issue of the IASP journal Pain (2018) has not supported the use for monthly Vitamin D supplements. However, when you look at the detail the authors have bundled all chronic pain in under the one label so actually this is very unhelpful. We cannot comment on specific pain conditions and the relationship with Vitamin D from this paper alone”.

Dr. Hegarty believes that a large subgroup analysis among individuals with vitamin D deficiency with specific pain patterns are required. The number of candidates that will be need for this type of study will be very large and support from several public health organizations would be the only way this would happen.

Are sunbeds the answer?

Does this mean that sunbathing and tanning beds can be a form of pain treatment? Unfortunately, no.

What can we do now?

Here are the necessary steps to improve you Vitamin D levels and by doing so, possibly improve pain levels:

• The first step is to determine if your Vitamin D levels are low. If you are deficient, several months of high dose supplementation is required to achieve a normal level. This requires evaluation with a physician who is familiar with managing chronic pain, guidelines for Vitamin D supplementation, use of appropriate medication, etc.
• Once you achieve normal levels, sunlight is the maintenance dose for anyone under 50 (over the age of 50, daily oral medication is required).
• For people with fair skin, fifteen minutes of direct sunlight to the face and arms twice a week in the spring and summer (longer in fall and winter) is sufficient to maintain Vitamin D levels.
• For people with darker skin, less vitamin D is produced with sunlight, so one hour a day of direct sunlight exposure may be needed.
• Make sure to get direct sunlight exposure before applying sunblock, as even an SPF of 8 will reduce vitamin D production by 95%.
• Discuss the options with your GP before hand.

Enjoy the sunshine!