Aches and pains in primary care (2024)

GPs can do very positive things for some patients with aches and pains as many such patients are Vitamin D deficient. Vitamin D deficiency commonly presents with widespread aches, weakness, and tiredness, and can also present with focal symptoms. If a patient has several musculoskeletal diagnoses over time (for example plantar fasciitis, hip pain, back pain, and knee pain) then Vitamin D deficiency should be suspected. Deficiency can be confirmed biochemically by checking Vitamin D levels. Expert consensus suggests that optimal Vitamin D status requires serum levels of 25 OH Vitamin D of 75 nmol/l (that is, 30 mg/l) or more (repeat levels 3 months after initial treatment to ensure patients are replete). Recent work shows ‘no credible evidence’ for hypercalcaemia at treatment doses of Vitamin D.¹ Treatment must be with adequate doses (for example, 400 000 iu in the first 2 weeks and then 20 000 weekly) as low dose supplements containing calcium will not restore Vitamin D levels, nor give symptom relief. This condition is common in all ethnic groups, especially in the north and west of the country, and is often forgotten or missed.

I received this comment recently, after treatment (of a white middle-aged man). ‘I feel 10 years younger with fewer aches and pains. Mood and energy levels are much improved. I can get about to go fishing much more easily’. Many patients have similar positive experiences.

Moreover, treatment may improve general health as it is now well recognised that Vitamin D deficiency is a risk factor for many other conditions including cardiovascular disease, diabetes, cancer, and infections.²

Finally, patients may approach exercise with more equanimity if the hopeful phrase ‘wear and repair’ is used instead of the sinister ‘wear and tear’.

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