Vitamin and mineral deficiencies linked to chronic pain

Low levels of certain vitamins and minerals were linked to chronic pain in a study conducted by University of Arizona Health Sciences researchers and published in Pain Practice.

This is the first study to apply a precision medicine approach to chronic pain on a large scale: it broadly examines micronutrient levels in people with and without chronic pain, and examines the incidence of chronic pain in people with and without micronutrient deficiencies. The findings could inform personalized nutrition strategies to help manage chronic pain.

“I treat patients with chronic pain, and often we can’t make a diagnosis. But just because there’s no surgery that can help doesn’t mean there’s no pain. It just means our understanding of pain is limited,” said senior author Julie Pilitsis, MD, PhD, chair of neurosurgery at the University of Arizona College of Medicine in Tucson and a member of the Comprehensive Pain and Addiction Center.

"This study represents a new way of approaching chronic pain treatment where you look at the patient holistically to figure out what might be happening systemically and what's easily modifiable - such as dietary changes rather than medications or other methods," she added.

The research team focused on five micronutrients that are often associated with chronic pain: vitamins D, B12, and C, folate, and magnesium. They looked at the status of these micronutrients in three groups: people without pain, people with mild to moderate chronic pain, and people with severe chronic pain.

People with severe deficiencies of vitamins D, B12, folate, and magnesium were found to be more likely to have severe chronic pain. In contrast, lower levels of vitamins D, B12, folate, and magnesium—and a higher incidence of those low levels—were found in people with severe chronic pain.

"What surprised us most was that women of Asian descent had higher vitamin B12 levels than expected," said co-author Deborah Morris, PhD, director of the research lab in the Department of Neurosurgery, explaining that B12 deficiencies have been observed in other genders, races, and ethnicities.

"Asian women with severe chronic pain had the highest vitamin B12 levels overall. We expected them to be lower."

Results for vitamin C differed: men with mild, moderate, and severe chronic pain were more likely to have low and borderline low vitamin C levels compared with men without chronic pain. Men with borderline and severe vitamin C deficiency were also more likely to have chronic pain.

Participant data were obtained from the National Institutes of Health (NIH) All of Us database, where the largest number of participants were recruited through the University of Arizona-Banner Health program.

“The results of complex demographic studies like this show that we can’t make the same assumptions for every patient who comes into the office,” said Pilitsis, a member of the BIO5 Institute.

"Our research across a variety of chronic pain conditions in a large, diverse population found that certain vitamin and mineral deficiencies are more common in people with chronic pain, particularly in certain racial and ethnic groups," Morris added.

"Our goal is to improve the quality of life of people with chronic pain and reduce opioid use. These findings may help achieve that goal as part of a comprehensive approach to pain management."

According to a November 2024 fact sheet from the U.S. Centers for Disease Control and Prevention (CDC), nearly 25% of American adults live with chronic pain, which is associated with decreased quality of life, opioid misuse, increased anxiety and depression, and unmet mental health needs.

Morris and Pilitsis collaborated with researchers from Florida Atlantic University, Florida International University, Grigore T. Popa University in Romania and the Free University of Brussels in Belgium.