Vitamins and Supplements for Adult Low Back Pain
For an adult patient with acute low back pain and no severe underlying conditions, vitamin and supplement recommendations are extremely limited—there is insufficient evidence to routinely recommend any vitamins or supplements for low back pain treatment. 1
Evidence-Based Supplement Recommendations
Calcium and Vitamin D: Not Recommended for Routine Low Back Pain
- Calcium and vitamin D supplementation should NOT be routinely prescribed for low back pain, as the evidence for fracture reduction or pain improvement in non-osteoporotic patients is very low to absent 1
- These supplements are only conditionally recommended for patients on chronic glucocorticoid therapy (≥2.5 mg/day prednisone for >3 months) to prevent glucocorticoid-induced osteoporosis, not for treating low back pain itself 1
- Target supplementation: 1,000-1,200 mg elemental calcium daily and 600-800 IU vitamin D daily (or more to maintain serum 25(OH)D levels ≥30-50 ng/mL) 1
Vitamin D Supplementation: Only Consider in Severe Deficiency
- Vitamin D supplementation may improve back pain disability ONLY in patients who are both markedly vitamin D deficient (25(OH)D <30 nmol/L or <12 ng/mL) AND overweight/obese (BMI ≥25 kg/m²) 2
- A 2018 systematic review and meta-analysis found very low quality evidence that vitamin D supplementation is NOT more effective than placebo for low back pain in the general population (mean difference -2.65 on 0-100 scale, 95% CI: -10.42 to 5.12, p=0.504) 3
- The single positive study used high-dose supplementation (100,000 IU bolus followed by 4,000 IU daily for 16 weeks) and showed benefit only in the subgroup with severe deficiency (<30 nmol/L) 2
Clinical Algorithm for Vitamin D Consideration
Only test and supplement vitamin D if ALL three criteria are met:
- Patient is overweight or obese (BMI ≥25 kg/m²) 2
- Patient has chronic (>12 weeks) low back pain 2, 3
- Serum 25(OH)D level is severely deficient (<30 nmol/L or <12 ng/mL) 2
If these criteria are met: Consider supplementation with 100,000 IU bolus followed by 4,000 IU daily, but counsel patients that evidence is limited and benefits are uncertain 2
What Actually Works: Evidence-Based Alternatives
First-Line Pharmacologic Treatment (Not Supplements)
- NSAIDs (ibuprofen, naproxen) are first-line with moderate-quality evidence showing small improvement in pain intensity compared to placebo 1, 4
- Acetaminophen is an alternative first-line option with more favorable safety profile, though slightly less effective than NSAIDs 1, 4
- Skeletal muscle relaxants (cyclobenzaprine 5 mg three times daily) can be added if pain persists after 2-7 days, with moderate-quality evidence for short-term relief 1, 5
Non-Pharmacologic Interventions (Superior to Supplements)
- Remain active and continue ordinary activities within pain limits—avoid bed rest 4, 6
- Application of superficial heat (heating pads) for short-term relief 4, 6
- Physical therapy, structured exercise, spinal manipulation, massage, and cognitive behavioral therapy all have better evidence than any supplement for improving outcomes 1, 5
Critical Pitfalls to Avoid
Common Mistakes with Supplements
- Do not routinely order vitamin D levels in patients with acute low back pain—testing is only warranted if the patient meets all three criteria above (obese, chronic pain, suspected severe deficiency) 2, 3
- Do not prescribe vitamin D "just in case" based on the widespread misconception that it helps back pain—the evidence shows it does not work in the general population 3
- Do not delay effective treatment (NSAIDs, physical therapy, remaining active) while waiting for vitamin D supplementation to work 1
What NOT to Recommend
- Systemic corticosteroids are NOT recommended, as low-quality evidence shows no difference in pain or function compared with placebo 4, 7
- Routine calcium supplementation is NOT recommended in adults without osteoporosis risk 1
- Multivitamins, magnesium, B vitamins, and other supplements have no evidence for low back pain treatment 1