Micronutrient Deficiencies: A Modifiable Contributor to Chronic Pain

A cross-sectional analysis published in Pain Practice examined the relationship between serum micronutrient levels and chronic pain intensity in the extensive All of US NIH cohort. The study compared up to 93,445 US adults categorized as having no, mild to moderate, or severe chronic pain, using numeric pain rating scales to define each group. Researchers evaluated serum concentrations of vitamins D, B12, C, folate, and magnesium, classifying levels as normal, deficient, or borderline deficient per standard ranges.¹

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Findings included significantly lower mean levels of vitamins D, B12, and folate in the severe pain group compared to those with less or no pain. Male subjects with chronic pain showed an increased risk of vitamin C deficiency, and a higher incidence of magnesium deficiency was also noted in those with severe pain. In race and sex stratified analysis, both Black and White individuals suffering from severe pain had significantly lower vitamin D levels, with folate reduced across most subgroups and B12 deficiency predominantly in White participants. Female Asian and Hispanic groups also showed reduced folate levels.

Biological Mechanisms and Clinical Consequences

Micronutrients, particularly B vitamins, are essential for nerve health and neurotransmitter synthesis. They play roles in nociception modulation, neuroinflammation, and tissue repair.² Deficiencies in magnesium and vitamin D influence neuromuscular signaling and immune responses, potentially exacerbating central and peripheral sensitization underlying chronic pain syndromes.³

While this cross-sectional study cannot confirm causality, it strongly suggests that addressing micronutrient deficiencies may represent a modifiable intervention to reduce pain burden. These findings align with emerging literature on the benefits of vitamin D and B vitamin supplementation in neuropathic and musculoskeletal pain conditions.³

Role of Pharmacists in Pain Management

Pharmacists are uniquely positioned to integrate nutritional care into chronic pain management, offering expertise that extends beyond medication dispensing. They can identify patients at risk, particularly those with persistent severe pain, polypharmacy, or nutritional deficits, and recommend serum testing for key micronutrients such as vitamin D, folate, magnesium, and vitamin C to detect subclinical deficiencies.¹ Through dietary counseling, pharmacists can highlight nutrient-rich foods, such as fatty fish for vitamin D, meat and shellfish for B12, leafy greens for folate, nuts and legumes for magnesium, and fruits for vitamin C to help patients understand how deficiencies may exacerbate pain.^1-2 Upon laboratory confirmation of deficiencies, pharmacists collaborate with prescribers to initiate supplementation regimens, monitor serum levels, and manage drug nutrient interactions, for example, addressing B12 malabsorption in patients on metformin or proton pump inhibitors.³ Including micronutrient assessment in medication therapy management (MTM) programs enables pharmacists to evaluate holistic wellness, track pain outcomes using validated tools, and reinforce adherence by directly correlating symptom improvements with nutritional correction.^1-2 By anchoring nutrition within a multidisciplinary care model, pharmacists not only enhance standard pharmacologic and nonpharmacologic pain strategies but also support personalized, evidence-informed care that addresses modifiable contributors to chronic pain.

Conclusion

This large-scale study highlights a critical yet often overlooked dimension of chronic pain management: micronutrient status. Deficiencies in vitamins D, B12, C, folate, and magnesium are significantly associated with severe chronic pain, and they may be reversible contributors. Pharmacists should consider integrating nutritional assessment, education, and supplementation into their toolkit alongside pharmacologic and non-pharmacologic therapies to enhance patient outcomes.

REFERENCE

1. Goon M, Schmidt N, Deepak Berwal, et al. Micronutrients and Chronic Pain: A Cross‐Sectional Analysis. Pain Practice. 2025;25(5). doi:https://doi.org/10.1111/papr.70053

2. Micronutrient deficiency linked to chronic pain in new study. The University of Arizona Health Sciences. Published July 11, 2025. Accessed July 15, 2025. https://healthsciences.arizona.edu/news/releases/micronutrient-deficiency-linked-chronic-pain-new-study

3. Dragan S, Șerban MC, Damian G, Buleu F, Valcovici M, Christodorescu R. Dietary Patterns and Interventions to Alleviate Chronic Pain. Nutrients. 2020;12(9):2510. Published 2020 Aug 19. doi:10.3390/nu12092510