Researchers link micronutrient deficiencies to chronic pain

People with severe chronic pain have a greater incidence of severe deficiencies in vitamins D and B12, folate, and magnesium, according to researchers from the University of Arizona Health Sciences, US. The authors say their study is the first to take a large-scale precision medicine approach to chronic pain and could inform personalized nutritional strategies to help manage pain.

The team examined micronutrient levels of people with and without chronic pain and explored the incidence of chronic pain in people with or without micronutrient deficiencies. 

According to a November 2024 data brief from the US Centers for Disease Control and Prevention, nearly 25% of US adults live with chronic pain. This is associated with decreased quality of life, opioid misuse, increased anxiety and depression, and unmet mental health needs. 

“I treat chronic pain patients, and oftentimes we don’t come up with a diagnosis. But just because there isn’t a surgery that will help you doesn’t mean you’re not in pain. It just means that our understanding of pain is limited to date,” says senior author Julie Pilitsis, MD, Ph.D., head of the university’s College of Medicine, Tucson Department of Neurosurgery. 

“This study is a novel way to approach chronic pain treatment, where you are looking at the patient holistically to see what could be going on systemically that is easily modifiable — changes in diet as opposed to medications or other things.”

Micronutrient deficiencies

For the study, published in Pain Practice, the researchers focused on five micronutrients commonly associated with chronic pain: vitamins D, B12, and C, folate, and magnesium. They examined the micronutrient status in people without pain, mild-to-moderate chronic pain, and severe pain. 

The team used participant data from the National Institutes of Health’s All of Us research database. The researchers examined the variations of findings based on sex and race/ethnicity. 

The number of enrolled subjects varied per micronutrient, from 656 for vitamin C to 93,445 for magnesium. The team classified participants as normal, deficient, or borderline deficient based on reference ranges. 

The researchers note their findings may help improve quality of life for people with chronic pain, in a holistic approach to pain management.The results varied for vitamin C. Males with mild-to-moderate and severe chronic pain were likelier to have low and borderline low levels of vitamin C than those without chronic pain. Moreover, men with borderline and severe vitamin C deficiency were also more likely to have chronic pain.

In addition to an impact on pain, micronutrient deficiencies can compromise the immune system, disrupt childhood growth and brain development, and accelerate aging and non-communicable diseases. The Zero Hidden Hunger EU project aims to estimate the prevalence of micronutrient deficiencies in the EU and their associated health costs. 

Diverse population differences

Co-author Deborah Morris, Ph.D., a research laboratory manager in the university’s Department of Neurosurgery, highlights that the study found different vitamin and mineral deficiency levels in specific racial and ethnic groups. 

Black and White participants with severe pain had lower levels of vitamin D and folate, but lower vitamin B12 was only found in White subjects. Asian and Hispanic females also had lower folate levels. 

“The finding that surprised us the most was that Asian females had higher vitamin B12 levels than expected,” says Morris. “Asian females with severe chronic pain had the highest vitamin B12 levels overall. We were expecting it to be lower.”

“Our goal is to improve the quality of life for people with chronic pain and reduce opioid usage, and these findings have the potential to do that as part of a holistic approach to pain management.”

Pilitsis concludes: “The findings from complex demographic studies such as this show that we can’t just make assumptions for every patient who walks in the office.”