Chronic pain, vitamin D, and magnesium

Headache, aching joints, and other types of chronic pain are typically caused by myofascial pain syndrome, which is characterized by localized pain. There can be many underlying causes of this condition, but according to a Thai study published in BMC Nutrition, lack of sunshine and too little vitamin D are quite common among patients. Magnesium therapy may also have an effect, according to a study published in BMC Oral Health.

Headache, migraines, and pain in the back, hips, shoulders, knees, and elbows are very common problems. In many cases, the pain is muscle related. Around 85 percent of all patients suffering from chronic pain have myofascial pain syndrome. The pain is caused by the formation of muscular trigger points that cause local pain and can also radiate pain to the affected areas when pressure is applied to them.
These trigger points are characterized by muscle spasms, inflammation, and poor blood supply to the affected area.
The trigger points and the pain can arise as a result of tension, overuse of muscles, and incorrect postures. Heavy lifts, nerve lesions, chronic pressure on the nerves caused by the spine, thyroid disorders, diabetes, and colds can also trigger pain. It even appears that vitamin D and magnesium play a role.

Widespread vitamin D deficiency in patients with myofascial pain syndrome

Vitamin D, which is considered a steroid hormone, is important for bones, muscles, immune defense, and for regulating inflammation. Vitamin D also regulates the nerve cell function in the signaling pathways that cause pain. Apparently, lack of vitamin D can also result in neurological hypersensitivity that is related to chronic pain. A team of scientists from Phramongkutklao Hospital in Bangkok decided to look closer at this connection.
A total of 120 people aged 18-70 years participated in the study. All participants had been diagnosed with myofascial pain syndrome more than three months earlier. Patients with other ailments or those who took vitamin D supplements were excluded from the study.
Pain level was assessed on a scale from 0 (worst) to 100 (best). The study also looked at smoking, sun exposure, physical activity, and quality of life. In addition, the scientists took blood samples to measure levels of vitamin D. Blood levels of vitamin D were categorized as follows: deficiency (below 50 nmol/L), insufficiency (50-74 nmol/L), and sufficiency (above 75 nmol/L).
It turned out that 47.5 percent of the patients had insufficient vitamin D levels, and 34.2 were deficient in the nutrient. Their vitamin D deficiency was primarily a result of inadequate sun exposure but was also linked to low dietary vitamin D intake, overweight, diabetes, and having dark skin. The scientists did not find a link between blood levels of vitamin D and pain evaluation.
A possible explanation may be that most of the patients had received some type of treatment prior to study start. Still, the study suggests that doctors and health professionals should pay attention to the widespread vitamin D deficiency problem in patients with myofascial pain syndrome. It may also be a good idea to check for magnesium deficiency.

Magnesium and treatment with injections

It has been common practice to treat trigger points with local injections of physiological saline, corticosteroids, anesthesia, and botulinum toxin. In many cases, the injections can soothe the local pain by relaxing the muscles and the tense trigger points. Myofascial pain syndrome is also commonly seen in connection with facial pain without necessarily involving tooth pain. Patients often have difficulty with opening their mouth completely. Many treated patients have relapses after a brief period of time, which means there is a need for other types of therapy with a longer effect.
In a study from 2022 that is published in BMC Oral Health, the researchers compared the effect of local injections of physiological saline and local injections of magnesium sulfate. The interest in magnesium is due to the nutrient’s role in muscle function, nerve function, and relaxation. Magnesium also helps the body activate the form of vitamin D that we get from sun exposure or from supplements.
A total of 180 patients with myofascial face pain took part in the study. They were divided into two groups. One group got 2 ml of physiological saline injected into their trigger points, while the other group got injections of magnesium sulfate in their trigger points. Evaluations were made of the patients’ pain score, maximum mouth opening (MMO), and their quality of life, prior to receiving the injections and after one, three, and six months of therapy.
During the entire follow-up period, the pain score was significantly higher in the saline group compared with the magnesium sulfate group. For up to three months, pain-free MMO was also better in the magnesium sulfate group.
After six months, however, there was no longer a statistical difference. Moreover, quality of life was significantly better in the magnesium sulfate group compared with the saline group. The researchers therefore concluded that injections of magnesium sulfate represent an effective treatment for trigger points in myofascial syndrome. They do, nonetheless, call for additional studies.

Magnesium supplementation and other treatments

Local application of magnesium oil to the muscles and trigger points several times daily may also have an effect, which is because magnesium quickly enters muscle tissue. It may also be an idea to consider magnesium supplementation with assimilable organic magnesium in therapeutic doses of 200-600 mg daily. As high-dosed magnesium supplementation may cause loose stools, it can be a good idea to gradually increase the dose to the point where digestive symptoms occur and then slowly reduce the intake to a tolerable amount.
Other types of therapy that are used to treat myofascial pain syndrome include medical osteopathy and acupuncture.

References:

Pimptcha Channarong & Chanwit Phongamwong. Prevalence and risk factors of vitamin D deficiency among patients with chronic myofascial pain syndrome: a cross-sectional study. BMC Nutrition 2023

Shaimaa Mohsen Refahee el al. Clinical efficacy of magnesium sulfate injection in the treatment of masseter muscle trigger points: a randomized clinical study. BMC Oral Health. 2022

Trigger punkter er ofte årsagen til smerte! - Osteopat - Kolding (laege-osteopat.dk)