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EDITORIALS: Bart W Koes Surgery versus intensive rehabilitation programmes for chronic low back pain BMJ 2005; 330: 1220-1221 [Full text]

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Chronic low back pain: vitamin D deficiency should be considered

Peter J Lewis   (27 May 2005)

Lower Back Pain and History of Childhood Sexual Trauma

Robert J. Powitzky, Ph.D.   (31 May 2005)

Chronic low back pain: vitamin D deficiency should be considered 27 May 2005
Peter J Lewis, integrative physician 15 South Steyne, Manly, NSW 2095, Australia Send response to journal: Re: Chronic low back pain: vitamin D deficiency should be considered	The optimal management of patients with chronic low back pain remains a big challenge for today's healthcare services (1), but the importance of vitamin D is not widely appreciated. Many studies have demonstrated the high prevalence of vitamin D deficiency in various populations. For example, Plotnikoff and Quigley reported that 93% of 150 patients presenting to a university-affiliated inner city primary care clinic in Minneapolis with persistent, non- specific musculoskeletal pain had deficient levels of vitamin D (2). A study of patients attending spinal and internal medicine clinics in Saudi Arabia over a 6-year period, who had experienced low back pain that had no obvious cause for more than 6 months, found that 83% had an abnormally low level of vitamin D (2). After treatment with vitamin D supplements, clinical improvement in symptoms was seen in all of those who had a low initial level of vitamin D. The authors concluded that screening (of patients with chronic low back pain) for vitamin D deficiency should be mandatory. A report in the Medical Journal of Australia described two patients with failed spinal fusion for chronic low back pain, who were subsequently found to have severe vitamin D deficiency (3). Both responded positively to vitamin D supplementation. The authors highlight the need for attending surgeons and physicians to be aware of the potential for vitamin D deficiency in their patients, since failure to recognise this easily reversible problem may result in complications of treatment, including failure of spinal fusion surgery, additional morbidity and the substantial costs of further surgery and hospitalisation. All patients with persistent, musculoskeletal pain are at high risk for the consequences of unrecognised and untreated hypovitaminosis D. Current clinical guidelines for managing chronic low back pain should include assessment of vitamin D status (by measuring serum 25- hydroxyvitamin D levels), together with advice on appropriate vitamin D supplementation in those found to be deficient. References 1. Koes BW. Surgery versus intensive rehabilitation programmes for chronic low back pain. BMJ 2005;330:1220-1221. 2. Plotnikoff GA, Quigley JM. Prevalence of Severe Hypovitaminosis D in Patients With Persistent, Nonspecific Musculoskeletal Pain. Mayo Clin Proc 2003;78:1463-1470. 3. Al Faraj S, Al Mutairi K. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine 2003;28(2):177-9. 4. Plehwe WE and Carey RPL. Spinal surgery and severe vitamin D deficiency. MJA 2002;176 (9): 438-439. Competing interests: None declared
Lower Back Pain and History of Childhood Sexual Trauma 31 May 2005
Robert J. Powitzky, Ph.D., Clinical Psychologist Oklahoma City, OK73112 Send response to journal: Re: Lower Back Pain and History of Childhood Sexual Trauma	In consulting with a lower pain back program in Dallas, we found that 80% of patients with persistent, chronic lower back pain had experienced sexual abuse as a child. Their recovery rates improved dramatically after participating in specialized sexual trauma therapy groups. The theory we developed was childhood trauma created additional treatment issues revolving around the powerlessness involved in lower back pain that needed to be addressed before benifitting from traditional rehabilitation treatment. Competing interests: None declared