ABSTRACT
BACKGROUND: Several studies have shown that vitamin D supplementation could be useful for treating diffuse musculoskeletal (DMS) pain in adults. OBJECTIVES: The aim of this study was to evaluate the effects of correcting a vitamin D deficiency (≤ 50 nmol/l) on DMS pain and quality of life in adults. METHODS: A pragmatic prospective study was conducted in a general practice setting in the Rhone-Alps area between 1 February and 30 April 2009. Patients between the ages of 18 and 50 years old who consulted their general practitioner (GP) for DMS pain or chronic unexplained asthenia and had a deficient serum 25 (OH) D level with no signs of any other disease were enrolled in this study. The patients received high doses of vitamin D supplements (400 000 to 600 000 units). Mean pain evaluation scores were evaluated before and after vitamin D supplementation using mixed models and accounting for repeated measures. RESULTS: Before vitamin D supplementation, the adult study cohort (n = 49) had an adjusted mean serum 25 (OH) D level of 23.7 nmol/l, a mean pain evaluation score of 5.07 and a mean quality of life score of 3.55. After vitamin D supplementation, the adjusted mean serum 25 (OH) D level increased to 118.8 nmol/l (P < 0.001), the mean quality of life score increased to 2.8 nmol/l (P < 0.001) and the mean pain evaluation score decreased to 2.8 (P < 0.001). CONCLUSION: In this small before-and-after study, vitamin D supplementation decreased pain scores in adult patients with diffuse musculoskeletal pain and vitamin D deficiency. These results must be confirmed by further studies.
Subject(s)
Musculoskeletal Pain/drug therapy , Quality of Life , Vitamin D Deficiency/drug therapy , Vitamin D/analogs & derivatives , Adult , Dietary Supplements , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pain Measurement , Prospective Studies , Treatment Outcome , Vitamin D/administration & dosage , Vitamin D/blood , Vitamin D Deficiency/complications , Young AdultABSTRACT
OBJECTIVES: The objective of this study was to evaluate the effect of the correction of vitamin D deficiency (defined by a rate≤50 nmol/l) on the pain, fatigue and quality of life. METHODS: A pragmatic prospective study was conducted in Rhone-Alpes area, in general practices between February 1 and April 30, 2009. All patients aged 18 to 50 years consulting for diffuse musculoskeletal pain and/or chronic unexplained fatigue, with the only abnormality deficient serum vitamin D were enrolled in this study. They might agree to complete questionnaires on quality of life, pain assessment and control their vitamin D levels after treatment. RESULTS: Forty-nine complete records were analyzed. The deficiency was severe (mean 26 nmol/l). High doses of vitamin were necessary to correct deficiency, between 400,000 to 600,000 units. The correction of vitamin D deficiency resulted in a significant decrease in the level of pain intensity according to verbal rating scale (P=0.034) and the Digital Scale (P<0.001), consumption of analgesics (P=0.002) and discomfort in carrying out activities of daily living following: the shopping, cleaning, walking for more than a kilometer (P<0.001) and dressing (P=0.012). CONCLUSION: The correction has had a positive impact both physical, mental and social activities. Non-specific musculoskeletal pain or unexplained asthenia are common in primary care. Make a dosage of vitamin D and correct deficits is a necessity before performing complex and expensive examinations.
Subject(s)
Musculoskeletal Pain/diagnosis , Musculoskeletal Pain/drug therapy , Vitamin D Deficiency/diagnosis , Vitamin D Deficiency/drug therapy , Vitamin D/administration & dosage , Vitamin D/blood , Activities of Daily Living/psychology , Adolescent , Adult , Diagnosis, Differential , Dose-Response Relationship, Drug , Fatigue/diagnosis , Fatigue/drug therapy , Fatigue/psychology , Female , France , General Practice , Humans , Male , Middle Aged , Musculoskeletal Pain/psychology , Pain Measurement/drug effects , Pain Measurement/psychology , Prospective Studies , Quality of Life/psychology , Referral and Consultation , Surveys and Questionnaires , Vitamin D Deficiency/psychology , Young AdultABSTRACT
OBJECTIVE: To understand patients' perceptions of decision making and identify relationships among decision-making models. METHODS: This qualitative study was made up of four focus group interviews (elderly persons, users of health support groups, students, and rural inhabitants). Participants were asked to report their perceptions of decision making in three written clinical scenarios (hypertension, breast cancer, prostate cancer). The analysis was based on the principles of grounded theory. RESULTS: Most patients perceived decision making as shared decision making, a deliberative question-response interaction with the physician that allowed patients to be experts in obtaining clearer information, participating in the care process, and negotiating compromises with physician preferences. Requesting second opinions allowed patients to maintain control, even within the paternalistic model preferred by elderly persons. Facilitating factors (trust, qualitative non-verbal communication, time to think) and obstacles (serious/emergency situations, perceived inadequate scientific competence, problems making requests, fear of knowing) were also part of shared decision making. CONCLUSION AND PRACTICE IMPLICATIONS: In the global concept of patient-centered care, shared decision making can be flexible and can integrate paternalistic and informative models. Physicians' expertise should be associated with biomedical and relational skills through listening to, informing, and advising patients, and by supporting patients' choices.
