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Advisor(s)
Abstract(s)
Introdução: A dor crónica é uma patologia altamente prevalente na população. É
responsável por gastos avultados, é uma das maiores causas de incapacidade e funda uma
prioridade em saúde. O tratamento adequando da dor crónica constitui um direito humano,
e a suplementação com vitamina D tem ganho destaque, neste âmbito. As ações conhecidas
da vitamina D dão se por meio do seu recetor, que revela uma expressão ampla nos tecidos.
Todavia, preconiza-se que esta exerça mais papéis do que os estabelecidos na literatura. A
síntese da vitamina D compreende várias etapas e culmina na conversão de calcidiol em
calcitriol, a forma mais ativa da vitamina D, classicamente associada à manutenção da
homeostase do cálcio e fósforo, mas que conta já com evidências de participação em
processos inflamatórios, oxidativos, imunes e genéticos que podem fornecer sustentação à
hipótese de que a suplementação com vitamina D pode ser benéfica no doente com diversas
patologias, incluindo na dor crónica.
Métodos: A pesquisa de artigos foi feita na base de dados MEDLINE, usando os motores
de busca PubMed, Elsevier e Scopus, com associações entre o termo MeSH "Vitamin D" e
os termos MeSH "Chronic Pain", "Pain Perception", "Myalgia" e "Arthralgia", utilizando
os operadores booleanos “AND” e “OR” nas diversas associações. Limitou-se a pesquisa a
artigos disponíveis nos idiomas português, espanhol e inglês, e excluíram-se os artigos de
âmbito pediátrico.
Resultados: A literatura apresenta estudos efetuados sobre a influência da suplementação
com vitamina D na dor cónica isolada, assim como associada a patologias como dor crónica
musculoesquelética generalizada, fibromialgia, osteoartrite do joelho, artralgia de etiologia
desconhecida, endometriose e dor crónica como efeito adverso de fármacos específicos. A
interpretação da bibliografia demostrou que, de acordo com a maioria dos estudos, a
suplementação com vitamina D é uma medida eficaz na redução das queixas no doente com
dor crónica. Todavia, os estudos são escassos, e heterogéneos quanto às populações
estudadas, às co-variáveis inclusas, aos valores-corte para deficiência e insuficiência de
vitamina D, assim como em relação à metodologia de suplementação, o que pode justificar
a obtenção de resultados contraditórios. Não sendo sensato, atualmente, depositar
confiança na suplementação com vitamina D como tratamento de primeira linha na dor
crónica, não se descarta que possa haver lugar para a suplementação neste contexto. Conclusão: Os benefícios da suplementação com vitamina D não são transversais,
contudo, são amplamente superiores aos riscos. Conclui-se, então, que pode haver lugar
para equacionar o uso de suplementação com vitamina D na prática clínica. Cada
profissional deve fazer uma ponderação caso a caso, especialmente após estudo exaustivo
das possíveis causas, opções terapêuticas, resultados pretendidos e crenças do doente, em
relação à sua experiência de dor.
Introduction: Chronic pain is highly prevalent in the population. It is a pathological entity that creates elevated health expenses, that is responsible for disability, and so, must be taken as a health priority. Adequate treatment of chronic pain is a human right, and vitamin D supplementation has gained prominence in this context. Vitamin D acts through its receptor, which has proven to have a wide expression in the tissues of the body, however it is stated that vitamin D may play more roles than those established in the literature. The synthesis of vitamin D comprises several steps and culminates in the conversion of calcidiol to calcitriol, the most active form of vitamin D, classically associated with the maintenance of calcium and phosphorus homeostasis, although there are already evidences of this hormone’s participation in inflammatory, oxidative, immune and genetic pathways which may support the hypothesis that vitamin D supplementation may be beneficial in patients with various pathologies, including chronic pain. Methods: Article search was performed in the MEDLINE database, using the search engines PubMed, Elsevier and Scopus, with associations between the MeSH term "Vitamin D" and the MeSH terms "Chronic Pain", "Pain Perception", "Myalgia" and "Arthralgia", using the Boolean operators “AND” and “OR” in the various associations. The search was limited to articles available in Portuguese, Spanish and English, and pediatric articles were excluded. Results: The literature presents studies carried out to assess the influence of vitamin D supplementation on isolated chronic pain, as well as on chronic pain associated with different comorbidities such as chronic generalized musculoskeletal pain, fibromyalgia, knee osteoarthritis, arthralgia of unknown etiology, endometriosis and chronic pain as an adverse effect of specific drugs. The interpretation of the bibliography showed that, according to most studies, vitamin D supplementation is an effective way of reducing symptoms in patients with chronic pain. However, the studies are scarce and heterogeneous in terms of the populations studied, the covariates included, the cutoff values for vitamin D deficiency and insufficiency, as well as in relation to the supplementation methodology, which can justify the obtaining of contradictory results. It may not be wise, currently, to place confidence in vitamin D supplementation as a first-line treatment for chronic pain, but it cannot be ruled out that there may be a place for supplementation in this context Conclusion: The benefits of vitamin D supplementation are not transverse, however, they are far greater than the risks. In this regard, there may be indication for vitamin D supplementation in patients with chronic pain. Each professional must, cautiously, consider the use of vitamin D supplementation, especially after exhaustive study of the causes, therapeutic options, intended results and patient beliefs in relation to his pain experience.
Introduction: Chronic pain is highly prevalent in the population. It is a pathological entity that creates elevated health expenses, that is responsible for disability, and so, must be taken as a health priority. Adequate treatment of chronic pain is a human right, and vitamin D supplementation has gained prominence in this context. Vitamin D acts through its receptor, which has proven to have a wide expression in the tissues of the body, however it is stated that vitamin D may play more roles than those established in the literature. The synthesis of vitamin D comprises several steps and culminates in the conversion of calcidiol to calcitriol, the most active form of vitamin D, classically associated with the maintenance of calcium and phosphorus homeostasis, although there are already evidences of this hormone’s participation in inflammatory, oxidative, immune and genetic pathways which may support the hypothesis that vitamin D supplementation may be beneficial in patients with various pathologies, including chronic pain. Methods: Article search was performed in the MEDLINE database, using the search engines PubMed, Elsevier and Scopus, with associations between the MeSH term "Vitamin D" and the MeSH terms "Chronic Pain", "Pain Perception", "Myalgia" and "Arthralgia", using the Boolean operators “AND” and “OR” in the various associations. The search was limited to articles available in Portuguese, Spanish and English, and pediatric articles were excluded. Results: The literature presents studies carried out to assess the influence of vitamin D supplementation on isolated chronic pain, as well as on chronic pain associated with different comorbidities such as chronic generalized musculoskeletal pain, fibromyalgia, knee osteoarthritis, arthralgia of unknown etiology, endometriosis and chronic pain as an adverse effect of specific drugs. The interpretation of the bibliography showed that, according to most studies, vitamin D supplementation is an effective way of reducing symptoms in patients with chronic pain. However, the studies are scarce and heterogeneous in terms of the populations studied, the covariates included, the cutoff values for vitamin D deficiency and insufficiency, as well as in relation to the supplementation methodology, which can justify the obtaining of contradictory results. It may not be wise, currently, to place confidence in vitamin D supplementation as a first-line treatment for chronic pain, but it cannot be ruled out that there may be a place for supplementation in this context Conclusion: The benefits of vitamin D supplementation are not transverse, however, they are far greater than the risks. In this regard, there may be indication for vitamin D supplementation in patients with chronic pain. Each professional must, cautiously, consider the use of vitamin D supplementation, especially after exhaustive study of the causes, therapeutic options, intended results and patient beliefs in relation to his pain experience.
Description
Keywords
Dor Crónica Suplementação Vitamina D