464 Participants Needed

Vitamin C for Musculoskeletal Pain

MM
Overseen ByMartin Marquis, MSc
Age: 18+
Sex: Any
Trial Phase: Academic
Sponsor: Hopital du Sacre-Coeur de Montreal
Approved in 3 JurisdictionsThis treatment is already approved in other countries

Trial Summary

What is the purpose of this trial?

Recent evidence has shown that vitamin C has some analgesic properties and can therefore reduce opioids used during healing. Vitamin C analgesic effect has been explored mostly during the short-term postoperative context or in disease specific chronic pain prevention but not after acute musculoskeletal injuries, which are often seen in the emergency department (ED). The study's primary aim is to compare the total morphine 5 mg equivalent pills consumed during a two-week follow-up between patients receiving vitamin C or a placebo after ED discharge for an acute musculoskeletal pain complaint. The investigators will conduct a double-blind randomized placebo-controlled trial with 464 participants distributed in two arms, one group receiving 1 000 mg of vitamin C twice a day for 14 days and another one receiving a placebo. Participants will be ≥18 years of age, treated in ED for acute musculoskeletal pain present for less than 2 weeks, and discharged with an opioid prescription for home pain management. Total morphine 5 mg equivalent pills consumed during the two-week follow-up will be assessed via an electronic (or paper) diary. In addition, patients will report their daily pain intensity, pain relief, side effects, and other types of pain medication or other non-pharmacological approach (ice, heat, immobilization, etc.) used. Three months after the injury, participants will also be contacted to evaluate chronic pain development. The investigators hypothesized that vitamin C, compared to a placebo, will reduce opioid consumption during a 14-day follow-up for ED discharged patients treated for acute pain.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you are treated with cyclosporin or coumadin, or if you are already taking vitamin C supplements.

What data supports the effectiveness of the treatment Vitamin C for musculoskeletal pain?

Research suggests that vitamin C (ascorbic acid) may help improve collagen production and tissue healing, which are important for musculoskeletal health. Some studies have found that low levels of vitamin C are linked to increased back pain and arthritis, indicating that vitamin C might be beneficial in managing these conditions.12345

Is Vitamin C safe for humans?

Vitamin C (ascorbic acid) is generally considered safe for humans, with studies showing its potential benefits in bone health and tissue repair. However, excessive intake should be avoided, especially in children, as it may have harmful effects.23467

How does the treatment Vitamin C differ from other treatments for musculoskeletal pain?

Vitamin C is unique in treating musculoskeletal pain because it enhances collagen synthesis, which is crucial for soft tissue healing, and reduces oxidative stress, which can contribute to pain. Unlike other treatments, it also acts as a cofactor for the production of opioid peptides, potentially reducing the need for traditional pain medications.23589

Research Team

RD

Raoul Daoust, MD MSc

Principal Investigator

Université de Montréal

Eligibility Criteria

This trial is for adults over 18 who visited the emergency department (ED) with musculoskeletal pain that's been there for less than two weeks. They must have left the ED with a prescription for opioids and be able to speak French or English.

Inclusion Criteria

I speak French or English.
I was prescribed opioids when I was discharged.
I was treated in the emergency department for recent muscle or bone pain.

Exclusion Criteria

Opioid use 1 month prior to the ED visit
My cancer is currently active.
I am receiving treatment for chronic pain.
See 6 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks
1 visit (in-person)

Treatment

Participants receive 1,000 mg of vitamin C or placebo twice a day for 14 days

2 weeks
Initial visit for randomization and dispensing of medication

Follow-up

Participants are monitored for opioid consumption and pain relief via electronic or paper diary

2 weeks
Remote monitoring through diary entries

Long-term Follow-up

Participants are contacted to evaluate chronic pain development and opioid use

3 months
1 contact (remote)

Treatment Details

Interventions

  • Placebo
  • Vitamin C
Trial Overview The study tests if taking vitamin C reduces opioid use after an ED visit for acute musculoskeletal pain. Participants will either receive 1000 mg of vitamin C twice daily or a placebo, over two weeks, and track their opioid intake and pain levels.
Participant Groups
2Treatment groups
Experimental Treatment
Placebo Group
Group I: Vitamin CExperimental Treatment1 Intervention
1 000 mg vitamin C taken orally twice a day
Group II: PlaceboPlacebo Group1 Intervention
Matching placebo

Vitamin C is already approved in United States, European Union, Canada for the following indications:

🇺🇸
Approved in United States as Vitamin C for:
  • Scurvy
  • Dietary supplement
🇪🇺
Approved in European Union as Vitamin C for:
  • Scurvy
  • Dietary supplement
🇨🇦
Approved in Canada as Vitamin C for:
  • Scurvy
  • Dietary supplement

Find a Clinic Near You

Who Is Running the Clinical Trial?

Hopital du Sacre-Coeur de Montreal

Lead Sponsor

Trials
52
Recruited
12,100+

Hopital de l'Enfant-Jesus

Collaborator

Trials
17
Recruited
5,800+

Findings from Research

In a study of 58 patients with chronic widespread musculoskeletal pain and vitamin D deficiency, treatment with 50,000 IU/week of vitamin D3 for 3 months significantly increased vitamin D levels and improved pain, fatigue, and quality of life measures.
The treatment led to a reduction in the number of patients meeting the criteria for fibromyalgia from 52% to 34%, indicating that vitamin D replacement can effectively alleviate symptoms associated with chronic pain conditions.
Efficacy of vitamin D replacement therapy on patients with chronic nonspecific widespread musculoskeletal pain with vitamin D deficiency.Yilmaz, R., Salli, A., Cingoz, HT., et al.[2017]
A study of 4,742 adults from the U.S. National Health and Nutrition Examination Survey found that low serum vitamin C levels are associated with an increased prevalence of neck and low back pain, suggesting a potential link between vitamin C deficiency and spinal pain.
The findings indicate that suboptimal vitamin C concentrations may contribute to functional limitations and self-reported diagnoses of arthritis/rheumatism, highlighting the need for further research into vitamin C's role in back pain treatment.
Serum vitamin C and spinal pain: a nationwide study.Dionne, CE., Laurin, D., Desrosiers, T., et al.[2021]
Preclinical studies suggest that vitamin C supplementation can accelerate bone healing and enhance collagen synthesis in tendon injuries, with no reported adverse effects, indicating it may be a safe option for recovery after musculoskeletal injuries.
However, clinical evidence is limited, as one study found no significant differences in fracture healing rates or functional outcomes after vitamin C supplementation, highlighting the need for more research before widespread use in clinical settings.
Efficacy of Vitamin C Supplementation on Collagen Synthesis and Oxidative Stress After Musculoskeletal Injuries: A Systematic Review.DePhillipo, NN., Aman, ZS., Kennedy, MI., et al.[2022]

References

Efficacy of vitamin D replacement therapy on patients with chronic nonspecific widespread musculoskeletal pain with vitamin D deficiency. [2017]
Serum vitamin C and spinal pain: a nationwide study. [2021]
Efficacy of Vitamin C Supplementation on Collagen Synthesis and Oxidative Stress After Musculoskeletal Injuries: A Systematic Review. [2022]
Ascorbic Acid and Its Clinical Role in Orthopaedic Surgery. [2019]
Effects of vitamin C on oxidative stress, inflammation, muscle soreness, and strength following acute exercise: meta-analyses of randomized clinical trials. [2022]
Vitamin C status and physical working capacity in adolescents. [2015]
Ascorbic acid and fractures in children with myelomeningocele. [2013]
Oxidative Stress Contributes to Fracture/Cast-Induced Inflammation and Pain in a Rat Model of Complex Regional Pain Syndrome. [2020]
The role of vitamin C in the treatment of pain: new insights. [2022]
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