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Background: Fibromyalgia syndrome (FMS) is a chronic pain syndrome which presented by easy fatigability, widespread body pain, anxiety and tenderness points on specific anatomic regions. Fibromyalgia may be risk factor for vitamin D deficiency because of pain, poor mobility, or depression, potentially leading to less time of sun exposure or high rates of adiposity leading to decreased synthesis of vitamin D & there are conflicting results on the role of vitamin D in improving chronic nonspecific musculoskeletal pains 1, 2 .
Objectives: Assessment of the effectiveness of vitamin D supplements as adjuvant therapy in functional status, quality of life and psychological status in fibromyalgia patients with vitamin D insufficiency.
Methods: One hundred adult patients of primary FMS (according to the 2010 ACR criteria for FMS) associated with vitamin D insufficiency (21-29 ng/mL) were selected to participate in this study. Patients with secondary FMS were excluded; also we excluded patients with any psychiatric disorders and patients who had other chronic diseases interfering with calcium, phosphorus, and vitamin D metabolism. After written consent; the patients were randomly divided into 2 equal groups; group I received duloxetine (60 mg once daily for 6 months) plus 50,000 unit oral cholecalciferol weekly for 8 weeks then monthly for 16 weeks. Group II received duloxetine (60 mg once daily for 6 months) plus placebo. The patients were assessed at baseline and after 6 months of treatment by measuring serum levels of 25(OH)D, Fibromyalgia Impact Questionnaire (FIQ), Medical Outcomes Study Questionnaire Short Form 36 Health Survey (SF-36) & Hospital Anxiety and Depression Scale (HADS).
Results: Eighty six patients completed this study. There was no significant difference between all groups in demographic data, educational status and all baseline variants except serum levels of 25(OH) D. After 6 months; there was significant improvement (P<0.05) in group I in serum levels of 25(OH) D. There was significant improvement (P<0.05) after 6 months in FIQ, SF-36 and HADS in both groups. There was significant better improvement (P<0.05) in group I than in group II in FIQ, SF-36 and HADS. The results of the study are summarized in
Pre- and post-treatment assessment measures of the patient groups
| assessment measures | Baseline | Baseline | After 6 months | After 6 months |
|---|---|---|---|---|
| Group I | Group II | Group I | Group II | |
| 25(OH)D | 25.3 ± 4.9 ng/ml | 26.8 + 5.3 ng/ml | 36.8 + 3.9 ng/ml | 25.6 ± 3.4 ng/ml |
| FIQ | 47.5±5.4 | 46.7±6.7 | 27.5±6.1 | 38.5±7.3 |
| SF-36 (Total score ) | 47.6±10.4 | 47.0±9.9 | 61.0±5.8 | 54.8±5.3 |
| HAD anxiety | 8.2±0.6 | 8.4±0.3 | 7.1±0.7 | 7.5±1.4 |
| HADS depression | 8.6±0.3 | 8.6±0.9 | 7.3±0.8 | 7.7±1.4 |
Conclusion: Vitamin D supplement is effective as an adjuvant therapy in improving functional status, quality of life and psychological status in fibromyalgia patients with vitamin D insufficiency.
REFERENCES:
[1]Abd Elghany S E et al, Regenerative injection therapy and repetitive transcranial magnetic stimulation in primary fibromyalgia treatment: A comparative study. Journal of Back and Musculoskeletal Rehabilitation -1 (2018) 1–8
[2]Maria Helde-Frankling, Linda Björkhem-Bergman. Vitamin D in Pain Management. Int. J. Mol. Sci. 2017, 18, 2170
Disclosure of Interests : None declared