Dr. Wise - Calcium vs Pain?

[calico]

Dr. Wise, could you comment on this post? I checked with my doctor and he didn't have any info. I expect many people on this forum take or will take calcium. I know it "promotes nerve function" but I never thought about it promoting pain.

Thanks! - Calico

Gr8 Dane wrote on Feb 21st:

"Chock this up for the calcium vs. pain debate. I've tried several calcium supplements in my three years with SCI. After reading research, I determined that calcium carbonate is the best for me. (I sought it through those little tasty
Viactiv chews.) Now for the wrench in the works. I experience classic, burning neuropathic pain in my hamstrings and calves. I came across an online
research abstract that says calcium plays a key role in the body's transmission of pain signals from nerve cells to the brain. (I had this research premise verified by a doctor.) Rather than go on drugs with questionable side effects
(Neurotin), which always seems to be the HMO doctor's first intervention these days, I opt for non-pharmaceutical options when possible. On a whim, I started by eliminating my calcium supplement. While I can't say the pain
intensity has vanished, the frequency of pain episodes has been decreased dramatically. Any thoughts on this? I would welcome any additional
non-pharmaceutical ideas to address neuropathic pain. Also, I feel a bit compromised by giving up the calcium because I fear I could really be setting myself up for radical osteoporosis. On the other hand, I have a life to lead, and
can't sit around lethargic on yet another medication like Neurotin.

[alan]

In my case, taking calcium supplements had the same effect on my pains as not taking them - the pains intensify. So, I take the calcium.

I must have been one lousy person in my previous life.

[calico]

You know, Alan, another way to look at it is maybe you were an exceptional person and have taken on this suffering for others. Maybe you were in nirvana at the time and got carried away.

I'll cool it with the spiritual speculation on this forum, but just had to mention this possibility! Makes as much sense to me as anything!

Calico

Originally posted by alan:


I must have been one lousy person in my previous life.

[Wise Young]

Calico, after looking into this for a while, I have not been able to find any evidence that calcium supplements increase neuropathic pain. It is something that have been very easy to measure and to compare. I think that if it were true, there would have been many reports of calcium being elevated in patients with more severe neuropathic pain. In any case, has anybody on these forums noticed that their pain gets worse with calcium supplements? Wise.

[calico]

Dr. Wise, I wrote the pharmacologist at pain.com and he answered my question which was published on the web site today, March 29th, 2002. I've copied my question and his answer below.

I'm confused with his answer in a number of ways, but it seems like the criteria he sets out for calcium absorption are:

* co-administration w/Vit D (true in my case);
* adequate function of the parathyroid gland and related biochemical mechanisms;
* the body's need for calcium;
* glutamate opening the calcium absorption channel.

Maybe I'm wrong, but it seems these criteria would not be difficult for many people to meet, and it still begs the question, if these criteria were met, could it cause an increase in neuropathic pain?

Here is my question and the pharmacologist's answer:

"Dear Pain Doctor:

My friend and I suffer from spinal cord injury and are concerned about osteoporosis so we take calcium supplements. We both have severe neuropathic pain. I've heard that one shouldn't take calcium supplements within 3 hours of other medication because it will interfere with medication absorption.

My friend came across an online research abstract that says calcium plays a key role in the body's
transmission of pain signals from nerve cells to the brain. He verified this research premise with a doctor. He eliminated his calcium supplement and the frequency of pain episodes has decreased dramatically.

Do you believe there is or could be a connection between his pain and calcium supplements? Would
something like Evista be a suitable replacement therapy?

Thank you for your help.
Calico

Dear Calico:
You pose several important questions. Calcium generally has no effect in reducing the absorption of other medications with a couple of important exceptions. Calcium inactivates the quinolone antibiotics (such as Cipro, ciprofloxacin, Levoqin, levofloxacin, etc.) Calcium will also inactivate many of the antibiotics in the tetracycline class. Other than that, you are relatively safe.

Calcium is in fact an important ion involved in neurotransmission. It is not likely that a reduced intake would affect nerve pain. This is because the absorption of calcium depends in part on several factors; co-administration of vitamin D, adequate function of the parathyroid gland and related biochemical mechanisms, and the body's need for calcium. Also, if calcium is present at the end of a nerve fiber, it doesn't simply stimulate a nerve because it is there. There is a special channel present that opens calcium in order to stimulate a nerve. A chemical known as glutamate must first open that channel. So,
simply ingesting more calcium is not likely enough to cause neuropathic pain. It is possible that you
could have increased bone pain with the addition of calcium plus Fosamax, because you could be
feeling (what is known as) bone remodeling. This is the activity that is occurring as calcium is replaced on the bone.

About suitable therapy; it depends of course on your gender. I'll assume you are female, since you
mention Evista. If you have been diagnosed with osteoporosis, it is almost essential that you are taking Fosamax (alondronate). Studies have shown that this drug over time will actually increase the bone density. Each 5 years past menopause (without estrogen replacement) makes osteoporosis more difficult to treat, since the baseline bone density you can reach with treatment is reduced. Either estrogen replacement or Evista are good choices in prevention and progression of osteoporosis in postmenopausal women. Evista may also protect against uterine and breast cancer. If you don't have true osteoporosis, and you are headed in that direction (osteopenia), then estrogen (or Evista) therapy is more appropriate for prevention, than the addition of Fosamax. At the point of osteopenia, Fosamax may be used at reduced doses for prevention of the progression to osteoporosis.
Best of Health,
Jeffrey Fudin, PharmD

Read more advice on: NEUROPATHIC PAIN"


[QUOTE]Originally posted by Wise Young:

Calico, after looking into this for a while, I have not been able to find any evidence that calcium supplements increase neuropathic pain. It is something that have been very easy to measure and to compare. I think that if it were true, there would have been many reports of calcium being elevated in patients with more severe neuropathic pain. In any case, has anybody on these forums noticed that their pain gets worse with calcium supplements? Wise.[/QUOT

[Wise Young]

Calico,

My interpretation of the Dr. Jeffrey Fudin's answer is that intake of calcium is unlikely to have any effect on neuropathic pain. His emphasis is on the effects of calcium intake on serum calcium levels.

The reasons why I am skeptical that calcium levels have an effect on neuropathic pain are as follows:

1. Many people have elevated serum calcium levels after spinal cord injury (due to loss of calcium from the bone) and this is not always associated with neuropathic pain.

2. Many people take calcium and vitamin D after spinal cord injury and I have not heard of any study that suggest that these people have a higher incidence or severity of neuropathic pain.

3. If neuropathic pain is indeed greatly influenced by calcium intake, I think that we would have heard about it by now. As you know, people who are in pain have tried many ways to reduce their pain.

Do you take calcium supplements? If you stop taking them, does your pain go away?

Wise.

[calico]

I haven't tried stopping my calcium supplements to see if it has any effect on my pain, but I guess I should. Gr8Dane who originally posted the question felt that stopping the calcium had helped him, but his pain had not stopped completely. He did feel it was significantly better.

I guess there's just one way to find out http://sci.rutgers.edu/forum/images/smilies/smile.gif.

Thank you for your valuable and much appreciated insight.

Calico

Originally posted by Wise Young:


Do you take calcium supplements? If you stop taking them, does your pain go away?

Wise.

[ChristinaJames]

Well... since taking calcium on the recommendation of several health articles, my osteoarthritis pain and resteless leg syndrome have increased 100 fold.

I'm going to try not taking it and see if I have improvement.

I am doing nothing else wrong! I exercise and eat pretty darn healthy... no junk, no coffee, no alcohol, no drugs, etc.

I'll be reporting back.

I could only find a few postings on the web about increased joint pain from calcium but that was enough to make me think for me there might be a connection also.

Would love to hear back from others.

[jgrant27]

ChristinaJames - I'm wondering if you added Glucosamine supplements in addition to your calcium if the pain would be better. I know that just taking them during the rainy season helps ease the pain in my bad elbow, but that's a different matter.

[CharlotteZ]

I am experiencing nerve pain most notably with calcium carbonate. Did you have the nerve pain with the other calciums? Have you tried calcium without vitamin d? I have noticed increased nerve pain episodes when taking vitaminD even alone. My skin becomes real sensitive. Also I have intense pain in my ear drums an down both sides of my neck toward the clavicle when I take calcium carbonate. At first I thought maybe this was a parathyroid problem. I stopped taking it and took a carbonyl iron due to iron deficiency. I started with the ear drum pain though not nearly as intense. My latest stint was I tried a carbonated beverage and the ear drum pain started again though still not as severe as taking a calcium carbonate supplement. I believe there is an issue with the carbonate. One difference I did notice with the calcium carbonate was that I lost a lot of fluid, let's call it subcutaneous fluid. Its quite a puzzle to me. I have had low vitamin d3 levels with borderline high 1,25 oh. Have you ever tried a calcium channel blocker?





Dr. Wise, could you comment on this post? I checked with my doctor and he didn't have any info. I expect many people on this forum take or will take calcium. I know it "promotes nerve function" but I never thought about it promoting pain.

Thanks! - Calico

Gr8 Dane wrote on Feb 21st:

"Chock this up for the calcium vs. pain debate. I've tried several calcium supplements in my three years with SCI. After reading research, I determined that calcium carbonate is the best for me. (I sought it through those little tasty
Viactiv chews.) Now for the wrench in the works. I experience classic, burning neuropathic pain in my hamstrings and calves. I came across an online
research abstract that says calcium plays a key role in the body's transmission of pain signals from nerve cells to the brain. (I had this research premise verified by a doctor.) Rather than go on drugs with questionable side effects
(Neurotin), which always seems to be the HMO doctor's first intervention these days, I opt for non-pharmaceutical options when possible. On a whim, I started by eliminating my calcium supplement. While I can't say the pain
intensity has vanished, the frequency of pain episodes has been decreased dramatically. Any thoughts on this? I would welcome any additional
non-pharmaceutical ideas to address neuropathic pain. Also, I feel a bit compromised by giving up the calcium because I fear I could really be setting myself up for radical osteoporosis. On the other hand, I have a life to lead, and
can't sit around lethargic on yet another medication like Neurotin.

[stinamp]

hi all,
just sharing my experience with calcium,
which is that it has indeed made my nerve pain a lot worse. 4 surgeries and a lot of never damage: I have literally tried every kind, and every kind over the course of the last year and indisputably i just cant use it. when i stop it, the pain is still there but noticeably better. doesnt make a lot of sense but thats how it is...

so, i've been supplementing with magnesium and silicon and VitaminK2 which dont seem to be a problem and are good for bone health.