751: Vitamin D and Nutritional advice for pain management (Case Reports)

Topic: Education, Societal Impact, and Others
Subtopic: Education of pain care

Background and Aims: Vitamin D deficiency has been linked to a wide range of chronic conditions, including chronic pain. In my clinical practice, I have routinely investigated vitamin D status and advised supplementation for patients found to have low 25-hydroxyvitamin D levels.
Over years of clinical experience and continued learning, I have come to understand that vitamin D is only one part of a much larger picture. It does not function in isolation. For vitamin D to work optimally, the body also requires a range of other essential micronutrients many of which are commonly neglected, depleted through modern lifestyle factors, or insufficiently obtained through diet alone.
These two case reports highlight the benefits of appropriate nutritional assessment and targeted nutritional advice.

Methods: This report describes the long-term pain journey of two patients who presented with back and leg pain, highlighting the impact of adherence to vitamin D supplementation and nutritional advice on their current clinical outcomes.
Patient A is a 53-year-old female who demonstrated poor adherence to vitamin D supplementation and broader nutritional support. In contrast, Patient B is a 43-year-old male who remained compliant with vitamin D therapy and associated nutritional advice.
These contrasting cases provide insight into the potential role of nutritional optimisation, patient adherence, and micronutrient support in the management of chronic musculoskeletal pain and overall clinical improvement.

Patient A : is a 53-year-old female who initially presented in 2010 with chronic back and leg pain, alongside a background history of depression.
Intervention, multiple injections and lumbar spine decompression with no benefits. Adviced on taking Vitamin D & Supplements
Patient B; Initial presentation September 2022with back & leg pain with history of depression,

Results: Status; Last clinical review February 2025, anxiety, depression, fibromyalgia, Diabetes, obesity, sarcoidosis, and chronic chest & ENT infections.
Current medication; Amitriptyline75, Duloxetine 120 mg, Sumatriptan 50 mg, Diclofenac 100 mg, +many more.
Patient B; 1st presentation September 2022 back & leg pain & depression,
Intervention; Sacro Iliac joint injection no benefits, Vitamin D , magnesium, Vitamin C , Boron Vitamin K2, Zinc, and gut health, water intake. Exercise.
Current status; discharged in April 2026; no medication.

Patient A
Date Vitamin D3
February 2010 21 nmol/L
October 2010 16 nmol/L
January 2011 10 nmol/L
June 2016 26 nmol/L
September 2018 29 nmol/L
December 2020 9 nmol/L
February 2021 33 nmol/L
March 2022 40 nmol/L
January 2026 50 nmol/L

Patient B
Date Vitamin D3
May 2019 27 nmol/L
July 2022 28 nmol/L
December 2022 51 nmol/L
February 2025 88 nmol/L
October 2025 132 nmol/L

Conclusions: Low vitamin D levels are commonly observed in many patients, including chronic pain patients. However, vitamin D deficiency rarely exists in isolation. Many patients also demonstrate limited awareness of broader nutritional health, lifestyle factors, and the importance macro- and micronutrient intake.
Pain is the earliest symptom recognised before tissue injury becomes evident and may persist long after apparent healing, whether assessed clinically, radiologically, or through laboratory investigations. The pain chronification is influenced not only by structural pathology, but also by complex interactions involving inflammation, immune regulation, metabolic health, psychological wellbeing, sleep, physical activity, and nutritional status.
While some patients recover fully, others continue to experience persistent pain despite no provable tissue damage. This raises an important clinical question: could improved long-term outcomes be achieved in a greater proportion of patients through a more comprehensive approach that includes attention to macro- and micronutrition, alongside optimisation of gut health and lifestyle factors?

References: [PT 066]
RETROSPECTIVE AUDIT IN TO VITAMIN D DEFICIENCY IN CHRONIC PAIN PATIENTS AT THE PAIN CLINIC IN BROOMFIELD HOSPITAL.
Subodha R. Thanthulage, MD,FRCA,FFPMRCA,FIPP, Anaesthesia & Pain Management, Broomfield Hospital.

Presenting Author: Subodha Thanthulage
Submitting Author: Subodha Thanthulage

Senior Author: Subodha Thanthulage

IASP 2026 Global Year theme of Neuropathic Pain: Yes