Prevalence of Risk of Iron Deficiency

Iron deficiency (ID), a common cause of anemia, disproportionately affects women of reproductive age and is characterized by symptoms such as fatigue, cognitive fog, migraines, restless‑leg syndrome, and musculoskeletal pain. Some of these are also common to chronic pain syndromes. Iron is essential for the synthesis of multiple neurotransmitters, suggesting a mechanistic link between ID and pain perception.

This single‑center cross-sectional study assessed the prevalence of risk factors for iron deficiency among 81 women attending the Michael G. DeGroote Pain Clinic. Participants completed a validated questionnaire adapted from Dr. Toby Richards' Iron Clinic, which evaluated risk factors including heavy menstrual bleeding, prior iron‑deficiency status, and supplementation history. Patients were defined as being at high risk for ID if they endorsed two or more positive symptoms within Question 14 (menstrual‑bleeding characteristics).

Overall, 54% of participants were identified as high risk for iron deficiency. 46% reported having restless‑leg syndrome, 47% reported a history of anemia or ID, 41% had taken oral iron supplements, and 15% were receiving iron‑infusion therapy. These results indicate that a substantial proportion of women with chronic pain may also have unrecognized ID.

Since iron's role in neurotransmitter metabolism provides a plausible biological mechanism for some symptomatology, and there is overlap of the symptoms of ID and chronic pain conditions, routine screening for ID, along with patient education, dietary optimization, oral iron supplementation, and intravenous iron therapy, should be considered as part of integrative pain‑management strategies. Cost-effectiveness analyses support ferritin screening as a feasible approach in this population, highlighting the potential for improved patient outcomes.