Vitamin D Supplements May Reduce Pain-related Emergency Room Visits in Children with SCD

Taking vitamin D supplements may lower the number of visits to the emergency department due to vaso-occlusive pain episodes in African American children with sickle cell disease (SCD), a study found.

The findings also showed that 45% of these children with SCD have vitamin D deficiency.

The study, “Vitamin D supplementation and pain-related emergency department visits in children with sickle cell disease,” was published in the journal Complementary Therapies in Medicine.

Vaso-occlusive pain episodes are the most common reason for SCD patients to visit the emergency department. Such episodes can be caused by specific factors — such as dehydration, infection or cold weather — but also may occur without warning.

Vitamin D deficiency in SCD patients leads to changes in the neural and immune processes that are involved with pain. Increasing evidence indicates that vitamin D deficiency is considered common in children and adults with SCD. That can be attributed to factors such as higher nutritional requirements, impaired kidney function, and lower levels of a protein called vitamin D binding protein that is involved with vitamin D metabolism.

One large-scale study of nearly 1,500 adult SCD patients determined that those with severe vitamin D deficiency had more than 10 emergency department visits per year, on average, compared with fewer than two visits per year for patients with sufficient vitamin D levels.

Many medications and methods exist to help SCD patients manage their pain. However, even though vitamin D supplementation emerges as a potential candidate to reduce pain episodes in SCD patients, further research is needed to investigate the value of this method in pediatric SCD patients.

To this end, researchers used data from 110 children with SCD ages 8–16, who had visited the emergency department of the Cincinnati Children’s Hospital Medical Center from July 2012 to July 2018. All children identified as African American. Notably, research has shown that African Americans are at significant risk of vitamin D deficiency.

All patients had at least one recorded measurement of vitamin D levels in the blood, specifically of 25-hydroxyvitamin D (25-OHD) — a product of vitamin D metabolism.

While there are no established standards, 25-OHD levels at or above 30 nanograms (ng)/milliliter (mL) of blood are generally considered normal, levels between 20–30 ng/mL are considered insufficient, and levels below 20 ng/mL are considered deficient.

Patients were split into three groups, including one with 31 who had not taken any supplements, one with 33 patients who were given supplements but did not have sufficient vitamin D levels, and one with 46 patients who were given supplements and did have at least one measurement with sufficient vitamin D levels.

Results showed that 45% of the total patients (48 of 110) were vitamin D deficient. That percentage increased to 55% (17 of 31) when looking solely at children who had not been given supplements.

The researchers found no significant difference in the number of emergency department visits comparing the three vitamin D groups. They attributed the low number of emergency department visits in children not receiving supplementation to the home pain management program implemented by the hospital’s Comprehensive Sickle Cell Center to help patients manage their pain.

However, when analyzing children who took supplements and reached sufficient levels of vitamin D, the investigators found that a higher blood level of 25OHD correlated with lower emergency department visits. They also found that children were less likely to visit the emergency department once they had reached sufficient vitamin D levels.

“This observation highlights the importance of achieving optimal serum [blood] 25−OHD levels to reduce the number of pain-related [emergency department] visits in the pediatric SCD population,” the researchers wrote. “It is therefore recommended that serum 25−OHD screening and supplementation become part of routine care for pediatric patients with SCD.”