Can Vitamin D Deficiency Cause Extreme Pain?

January 4, 2026 •

4 min read

According to a 2018 review of studies, people with chronic widespread pain often have lower levels of vitamin D than those without these conditions. While often associated with bone health, a severe lack of this vital nutrient can manifest as widespread, intense musculoskeletal discomfort, raising the question: can vitamin D deficiency cause extreme pain?

Quick Summary

Severe vitamin D deficiency can cause extreme, chronic pain due to insufficient calcium absorption, leading to bone softening (osteomalacia) and muscle weakness. The pain can be widespread, affecting bones, muscles, and joints, and may be accompanied by fatigue and mood changes.

Key Points

Low vitamin D can cause extreme pain: Severe deficiency can lead to chronic, widespread bone, muscle, and joint pain by affecting musculoskeletal health and nerve function.
Pain is linked to osteomalacia and myopathy: A lack of vitamin D hinders calcium absorption, causing bone softening (osteomalacia) and muscle weakness (myopathy), both of which cause significant pain.
Inflammation and nerves play a role: Vitamin D influences inflammatory responses and pain-sensing nerves (nociceptors), meaning a deficiency can increase inflammation and heighten pain sensitivity.
Diagnosis requires a blood test: Confirmation of a deficiency and exclusion of other causes involves a blood test to measure 25-hydroxyvitamin D levels, guided by a healthcare provider.
Treatment involves supplementation: Supplementation with high-dose vitamin D, and sometimes calcium, is the primary treatment for pain resulting from a deficiency, followed by a maintenance dose.
Prevention includes sun and diet: Sensible sun exposure and eating vitamin D-rich foods like fatty fish and fortified products can help prevent deficiency, but supplements are often needed.

Understanding the Link Between Vitamin D and Pain

Vitamin D is a fat-soluble nutrient that plays a crucial, multifaceted role in the body, extending far beyond simply building strong bones. Its primary function involves regulating the absorption of calcium and phosphate, two minerals essential for bone strength and healthy tissues. However, vitamin D also influences muscle function, the immune system, and pain signaling pathways in the nervous system. When levels are chronically or severely low, these systems can malfunction, paving the way for significant and, in some cases, extreme pain.

The Mechanisms Behind Vitamin D-Related Pain

Several biological processes explain how a deficiency in vitamin D can lead to severe pain:

Osteomalacia: In adults with chronic vitamin D deficiency, the body cannot adequately mineralize the bone matrix. This causes the bones to soften, a condition known as osteomalacia. The resulting bone pain, often felt as a deep, throbbing ache, can be severe and widespread, commonly affecting the spine, pelvis, and legs.
Muscle Weakness and Myopathy: Vitamin D receptors are found in muscle tissue, playing a role in muscle protein synthesis and contraction. A deficiency can lead to muscle weakness and pain (myopathy), particularly affecting the larger proximal muscles of the arms and thighs. This weakness and discomfort can be a significant source of chronic pain.
Inflammation: Research suggests vitamin D has anti-inflammatory properties. Lower levels have been linked to increased inflammatory markers in the body, which can exacerbate conditions like arthritis and contribute to the sensation of pain. Chronic inflammation is a hallmark of many debilitating health issues characterized by pain.
Neurological Effects: Vitamin D influences pain-signaling pathways in the nervous system. The vitamin D receptor is present in nociceptors, the nerve cells that sense pain. By modulating these pathways, a deficiency can increase pain sensitivity and contribute to chronic pain states. Some studies have found a link between low vitamin D and conditions such as low back pain and headaches.

Symptoms and Diagnosis

Many people with vitamin D deficiency experience no symptoms or only mild, vague ones like fatigue. However, severe deficiency can lead to significant and unmistakable signs. Common symptoms include:

Persistent, non-specific bone pain, especially in the back and legs.
Muscle pain, aches, and cramps.
Widespread musculoskeletal discomfort.
General fatigue and weakness.
Mood changes, including depression.

Diagnosis requires a blood test to measure the level of 25-hydroxyvitamin D (25(OH)D). Levels below 12 ng/mL are typically considered deficient, though optimal levels can be debated. A healthcare provider can interpret the results and recommend an appropriate course of action.

Pain from Vitamin D Deficiency vs. Other Conditions

Distinguishing pain caused by vitamin D deficiency from other conditions is critical for proper treatment. The characteristics of the pain can offer clues, though a blood test is definitive.


Feature	Vitamin D Deficiency Pain	Osteoarthritis Pain	Fibromyalgia Pain
Nature of Pain	Deep, aching, throbbing, or widespread bone and muscle pain.	Joint-specific pain, often described as a dull ache, worsened by activity.	Widespread pain throughout the body, often accompanied by heightened sensitivity to touch.
Location	Often affects the legs, spine, pelvis, and ribs. Can be generalized.	Concentrated in specific joints like the knees, hips, or hands.	Found in multiple specific tender points across the body.
Associated Symptoms	Muscle weakness, fatigue, mood changes, increased risk of fractures.	Joint stiffness, swelling, reduced range of motion.	Chronic fatigue, sleep disturbances, cognitive difficulties ('fibro fog').
Diagnostic Factor	Confirmed by a blood test showing low 25(OH)D levels.	X-rays and imaging to show joint damage and cartilage loss.	Diagnosis by exclusion, based on widespread pain and other symptoms.

Treatment and Prevention of Deficiency-Related Pain

The good news is that pain caused by vitamin D deficiency is highly treatable and often resolves with appropriate supplementation. For significant deficiency, doctors often prescribe high-dose vitamin D supplements (like D2 or D3) for a period of several weeks, followed by a lower daily maintenance dose. Calcium and other mineral supplements may also be recommended, as vitamin D helps the body absorb these nutrients.

Lifestyle Changes for Prevention

Increase Sun Exposure: Sensible sun exposure is the most natural way to produce vitamin D. Approximately 15 minutes of sun exposure to arms, legs, and face several times per week can be effective for many, depending on skin type and latitude. Always consider skin cancer risks and wear sunscreen after the initial period.
Dietary Sources: Few foods are naturally rich in vitamin D, but certain fatty fish (salmon, tuna), fish liver oils, egg yolks, and fortified foods like milk, cereal, and orange juice are good sources.
Supplements: Daily supplements are often recommended, especially during winter months or for those with limited sun exposure. Both D2 (ergocalciferol) and D3 (cholecalciferol) supplements are available, with D3 generally considered more potent.

Conclusion

Vitamin D deficiency can indeed cause extreme pain by directly affecting bone density, muscle function, and inflammatory and neurological pathways. The chronic, widespread musculoskeletal pain resulting from conditions like osteomalacia should be taken seriously. By working with a healthcare provider for diagnosis and treatment, individuals can address the root cause of their pain. A treatment plan involving safe sun exposure, dietary changes, and vitamin D supplementation can significantly alleviate symptoms and restore musculoskeletal health. If you are experiencing unexplained and persistent pain, particularly alongside fatigue, a discussion with your doctor about your vitamin D levels may be a crucial step toward finding relief.

For more information on the intricate links between vitamin D and chronic pain, consult this resource from the National Institutes of Health: Vitamin D and Pain: Vitamin D and Its Role in the Aetiology and Maintenance of Chronic Pain States.

Frequently Asked Questions

Vitamin D deficiency can cause deep, aching bone pain, often in the spine, pelvis, and legs. It can also lead to muscle pain, cramps, weakness, and generalized musculoskeletal discomfort.

While many people with a deficiency have mild or no symptoms, severe and chronic low vitamin D levels can cause extreme pain. A 2014 study found 71% of chronic pain sufferers had a deficiency.

A definitive diagnosis requires a blood test to check 25-hydroxyvitamin D levels. However, common pain from deficiency is often accompanied by muscle weakness, fatigue, or mood changes.

Yes, several studies have linked low vitamin D levels with chronic lower back pain. Deficiency can weaken bones, contributing to discomfort and pain in the back.

Treatment for significant deficiency-related pain typically involves high-dose vitamin D supplementation (like D2 or D3), prescribed by a doctor, over several weeks. Pain often subsides as levels are restored.

Pain from vitamin D deficiency is often a deep, aching pain caused by softened bones (osteomalacia) and muscle issues. Arthritis pain is typically joint-specific, caused by inflammation and cartilage damage.

Sensible sun exposure can help produce vitamin D, but many factors, including skin type, location, season, and sunscreen use, affect this. For consistent levels, dietary sources and supplements are often necessary.

Pain relief varies depending on the severity of the deficiency and individual response. Some studies show a reduction in pain scores within a few weeks, while others require longer treatment.