Vitamin D Cream Rationale
Rationale for use in areas of superficial neurogenic inflammation. A potential non-injection method of treatment involves the application of vitamin D cream. The nomenclature published by a joint task force in 1982 will be utilized (IUPAC 1982). Vitamin D is the general name for a steroid like compound found in plants and animals. D3 in the only type found in humans and other animals with a backbone and has 3 forms. Pre-hydroxylated vitamin D3 is called calciol or cholecalciferol, the single hydroxylated form is called calcidiol or 25 hydroxy cholecalciferol, and the double hydroxylated form is called calcitriol or 1-25 dihydroxy cholecalciferol. Calcitriol has been considered the active form
For years the medical literature has identified a correlation between low vitamin D status and pain. (MacFarlane 2005, Serhan 99, De Torrente 2004, Al Faraj 3003, Paul 2008) High dose oral calciol has been found to resolve pain in patients with osteomalacia, (de Torrente 2004) and to reduce pain of neuropathy in type II diabetics with low vitamin D status. (Al Faraj 2003, Paul 2008) The prevailing opinion is that supplementation with oral cholecalciferol only seems to be effective in those patients with severe hypovitaminosis D associated with osteomalacia.
Effects of vitamin D on the nervous system have been under intense scientific scrutiny. Kleuff et al have proposed to identify vitamin D (calcitriol) as a neurosteroid with neuroprotective actions. (Klueff 2004) IE: Oral vitamin D has shown the ability to improve axonal regeneration after nerve injury in the rat. (Chabas 2008) It is now generally accepted that calcitriol has a regulatory effect on all phases of the progression of the cell-cycle: proliferation, differentiation and apoptosis, including cells in the neuromuscular system. (Nagakawa 2006)
Given the profound effects of calcitriol on the cell-cycle, its specific neuroprotective activities in neural tissue demonstrated in animals, and the efficiency of skin in conversion of calciol to calcidiol and then to calcitriol, the idea was formed by Dr. Lyftogt to apply calciol in a transdermal cream over the areas of neuropathic pain originating from cutaneous nerves. The idea was to use transdermal application of vitamin D as an adjunct to neurofascial prolotherapy and potentially as a stand-alone option. Calciol is biochemically a seco-steroid hormone and other steroid hormones, like progesterone have also been successfully used in transdermal creams. Calciol transdermal cream is currently made by compounding pharmacies.
Vitamin D3 has receptors on both the nucleus of the cell and on the cell membrane. (Fleet 1999) The membrane receptors are thought to be responsible for the rapid effects which are seen empirically with vitamin D3 cream, usually within 10 minutes. An effect that occurs that quickly may be too quick for conversion of calciol to calcitriol and suggests a potential direct effect of calciol on the membrane receptor for nerve cells. Case studies for use of calciol transdermal cream were reported in patients with recalcitrant plantar fasciosis in which heel pain may be related to neuropathy of the medial calcaneal branches of the tibial nerve. (Lyftogt 2008) Nearly two years of clinical experience have shown a consistent analgesic effect in conditions characterized by pain due to neurogenic inflammation. A surprisingly fast and effective analgesic (within 10 minutes) response for conditions as varied as acute shingles, osteoarthritis of the fingers and reflex sympathetic dystrophy (RSD), now classified as complex regional pain syndrome type II (CRPS II) has been noted empirically.
Chabas J, Alluin O, Rao G, Garcia S, Lavaut M, Risso J, Legre R, Magalon G, Khrestchatisky M, Marqueste T, Decherchi P, Feron F. Vitamin D2 Potentiates Axon Regeneration. Jnl Neurotrauma 2008;25:pp1247-1256.
de Torrente de la Jara G; Pecoud A; Favrat B. Musculoskeletal pain in female asylum seekers and hypovitaminosis D3. BMJ (England), Jul 17 2004, 329(7458) p156-157.
Fleet JC. Vitamin D Receptors: Not Just in the Nucleus Anymore. Nutr Rev 1999;57(2):pp 60-62.
IUPAC-IUB Joint Commission on Biochemical Nomenclature (JCBN). Nomenclature of vitamin D. Recommendations 1981. Mol Cell Biochem (Netherlands), 1982;49(3):pp 177-181.
Klueff AV, Erimin KO, Tohimaa P. Mechanisms of neuroprotective action of vitamin D3. Biochem (Mosc) 2004;69 (7): 738-41.
Lyftogt J. Treating Inferior Heel Pain with Vitamin D 3 Dermal cream. Aust J Mus Med. Nov 2008: 74-77.
Macfarlane GJ, Palmer B, Roy D, Afzal C, Silman AJ, O'Neill T An excess of widespread pain among South Asians; are low levels of vitamin D implicated? Ann Rheum Dis 2005;64(8): pp1217-1219.
Nakagawa K. Effect of Vitamin D on the nervous system and the skeletal muscle. Clin Calcium 2006;16: 1182-87.
Paul L, Chen R. Vitamin D as an analgesic for Patients with Type 2 Diabetes and Neuropathic Pain. Arch Intern Med 2008;168(7): 771-772.
Serhan E, Newton P, Ali HA, Walford S, Singh BM. Prevalence of hypovitaminosis D in Indo-Asian patients attending a rheumatology clinic. Bone 1999;25(5): pp 609-611.