Saadia Sultana*, Muhammad Nadim Akbar Khan** and M Saleem***
Departments of * Gynecology & Obstetrics, ** Chemical pathology and *** Anesthesia
Railway Teaching Hospital Rawalpindi
Background: The deficiency of vitamin D is unexpected in a tropical country like Pakistan, as there is abundant
sunlight available. Vitamin D deficiency leading to hypocalcaemia and low backache is common in veiled multipara
in northern areas of Pakistan. We designed a study to see the prevalence of low backache in these areas and
their response to a cost effective treatment.
Objective: To determine the prevalence and etiology of low backache in completely veiled multipara women of
northern areas of Pakistan and its response to a cost effective treatment.
Design: Prospective interventional study.
Setting: The Pain management team of Anesthesia and Obstetrics and Gynecology Departments of Railway
Teaching Hospital Rawalpindi along with other hospital Staff surveyed the earthquake affected Northern Areas
Duration of study: May 2008 to April 2009.
Subjects and methods: 160 completely veiled multipara women, of northern areas of Pakistan; aged 20-45
years, suffering from low backache were included in the study. A questionnaire was used to investigate clinical
characteristics, parity, exposure to sunlight, breast feeding, whether or not they wore the veil and menopause.
The intensity of pain was measured by using Visual Analogue Scale (VAS). X- Rays lumbosacral spine AP and
Lateral view were done. We divided them into two groups with 80 women in each group. Group A was subjected
to cost effective treatment and counselling. Group B was used as control, and they were not treated or counselled.
Group A responded miraculously to simple and cost effective empirical treatment including calcium, vitamin D,
counselling about diet, exposure to sun and an active lifestyle. The intensity of low backache was again measured
at the end of six months by the same VAS. The pain of group A women were dramatically relieved but Group B
showed little or no improvement in their symptoms. The results were statistically significant.
Conclusions: In spite of abundant sunlight, healthy individuals in Northern areas of Pakistan are vitamin D deficient
which ultimately leads to hypocalcaemia and osteoporosis. Healthy diet, change in life style like sunlight
exposure and cost effective treatment can significantly reduce the complaints of low backache.
Key words: Osteoporosis, backache, Vitamin D, sunlight, dietary calcium