Vitamin C for Musculoskeletal Pain

Recruiting at 1 trial location

Overseen By Martin Marquis, MSc

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Centre Integre Universitaire de Sante et Services Sociaux du Nord de l'ile de Montreal

Must not be taking: Cyclosporin, Coumadin

Disqualifiers: Opioid use, Cancer, Chronic pain, others

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 2

Duration: 2 weeks

464 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether vitamin C can reduce the need for opioids after an emergency room visit for new muscle or joint pain. Participants will take either vitamin C or a placebo (a pill with no active ingredient) twice daily for two weeks. The researchers aim to determine if those taking vitamin C require fewer opioids than those taking the placebo. Individuals treated in the emergency room for muscle or joint pain lasting less than two weeks and prescribed opioids for home use may be suitable for this study. As an unphased trial, this study provides a unique opportunity to contribute to understanding alternative pain management options.

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.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that vitamin C is generally safe for treating pain. Studies indicate it can relieve pain in some people without causing major side effects. For most, vitamin C supplements are safe when taken as recommended. However, excessive intake can cause mild issues like an upset stomach or diarrhea.

Overall, vitamin C appears well-tolerated and could be a useful option for managing pain. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Unlike traditional treatments for musculoskeletal pain, which often rely on anti-inflammatory drugs or pain relievers like NSAIDs and opioids, vitamin C offers a promising alternative. Researchers are excited because vitamin C, a natural antioxidant, may help reduce pain by combating oxidative stress, a different approach compared to standard pain medications. Additionally, vitamin C is taken orally, making it easy and non-invasive, which can be appealing to those looking for a more natural remedy with potentially fewer side effects.

What evidence suggests that vitamin C might be an effective treatment for musculoskeletal pain?

Research has shown that vitamin C might help reduce pain. One study found that vitamin C lowered the risk of Complex Regional Pain Syndrome type I (CRPS I) by more than half. Another study demonstrated that vitamin C could reduce both pain and the need for strong pain medicines, like opioids, after surgery. This trial will test vitamin C, taken orally at 1,000 mg twice a day, to see if it helps with musculoskeletal pain. Participants will receive either vitamin C or a matching placebo. The researchers aim to determine if vitamin C allows people to use fewer opioids while still managing their pain effectively. ^{1 2 6 7 8}

Who Is on the Research Team?

Raoul Daoust, MD MSc

Principal Investigator

Université de Montréal

Are You a Good Fit for This Trial?

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.

Timeline for a Trial Participant

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)

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

Group I: Vitamin C Experimental Treatment 1 Intervention

1 000 mg vitamin C taken orally twice a day

Group II: Placebo Placebo Group 1 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

Who Is Running the Clinical Trial?

Centre Integre Universitaire de Sante et Services Sociaux du Nord de l'ile de Montreal

Lead Sponsor

Trials

17

Recruited

4,600+

Hopital du Sacre-Coeur de Montreal

Lead Sponsor

Trials

52

Recruited

12,100+

Hopital de l'Enfant-Jesus

Collaborator

Trials

17

Recruited

5,800+

Published Research Related to This Trial

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.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Serum vitamin C and spinal pain: a nationwide study. Dionne, CE., Laurin, D., Desrosiers, T., et al.[2021]

In a study of 49 young adolescent boys, daily supplementation of 70 mg of ascorbic acid (vitamin C) for two months significantly increased plasma vitamin C levels and improved physical working capacity, as indicated by a rise in VO2 max.

The study found that a plasma vitamin C level of around 0.86 mg/dl is associated with optimal physical performance, suggesting that a daily intake of about 80 mg of ascorbic acid may be beneficial for enhancing aerobic capacity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vitamin C status and physical working capacity in adolescents. Suboticanec-Buzina, K., Buzina, R., Brubacher, G., et al.[2015]

In a study of 67 children with myelomeningocele, both fracture and non-fracture groups had high ascorbic acid intake, exceeding recommended allowances from food and supplements, with no significant difference between the two groups.

The findings suggest that ascorbic acid supplementation does not prevent fractures in these patients, and caution is advised regarding excessive intake due to potential harmful effects in growing children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ascorbic acid and fractures in children with myelomeningocele. Repasky, D., Rickard, K., Lindseth, R.[2013]

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.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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]

Ascorbic acid (vitamin C) has shown potential benefits in improving bone density and reducing hip fracture risk based on observational studies, although its effects in human trials remain underexplored.

The American Academy of Orthopaedic Surgeons supports the use of ascorbic acid as an adjunct treatment to potentially reduce the incidence of complex regional pain syndrome after distal radius fractures, highlighting its safety and low cost for musculoskeletal injury management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Ascorbic Acid and Its Clinical Role in Orthopaedic Surgery. Luo, TD., Marois, AJ., Smith, TL., et al.[2019]

Vitamin C supplementation significantly reduces oxidative stress markers, specifically lipid peroxidation, immediately and up to 2 hours after exercise, based on a meta-analysis of 18 randomized clinical trials involving 313 participants.

It also attenuates the inflammatory response, particularly interleukin-6 (IL-6) levels, after exercise, but does not appear to affect muscle soreness, strength, or other inflammatory markers like creatine kinase and C-reactive protein.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of vitamin C on oxidative stress, inflammation, muscle soreness, and strength following acute exercise: meta-analyses of randomized clinical trials. Righi, NC., Schuch, FB., De Nardi, AT., et al.[2022]

Vitamin C treatment significantly reduced pain and other symptoms associated with complex regional pain syndrome (CRPS) in a rat model, showing reductions in allodynia by 64-78% and muscle hyperalgesia by 34-40%.

The study suggests that oxidative stress plays a role in CRPS development, as Vitamin C not only alleviated pain but also decreased oxidative stress markers and inflammatory mediators in the affected tissues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Oxidative Stress Contributes to Fracture/Cast-Induced Inflammation and Pain in a Rat Model of Complex Regional Pain Syndrome. Guo, TZ., Wei, T., Huang, TT., et al.[2020]

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.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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]

Vitamin C administration has been shown to reduce pain in various conditions, including chronic regional pain syndrome and cancer-related pain, suggesting its potential as an effective adjunctive therapy for pain relief.

A proposed mechanism for vitamin C's analgesic properties is its role as a cofactor in the biosynthesis of amidated opioid peptides, which may help decrease the need for opioid analgesics in patients receiving high doses of vitamin C.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of vitamin C in the treatment of pain: new insights. Carr, AC., McCall, C.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5391567/

The role of vitamin C in the treatment of pain: new insights - PMC We have shown a complete decrease in pain in a patient with rheumatoid arthritis following administration of twice weekly infusions of high-dose ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11166896/

Exploring Ascorbic Acid's Role in Orthopedic Practices The majority of both laboratory and human studies link the usage of ascorbic acid to enhanced bone health and improved tendon healing.

3. clinicaltrials.gov clinicaltrials.gov/study/NCT06306183

Effect of Vitamin C on Pain Reduction After an Emergency ... The investigators hypothesized that vitamin C will reduce pain intensity during a seven-day follow-up for ED discharged patients treated for acute MSK pain.

4. nature.com nature.com/articles/s41598-021-88864-7

A meta-analysis of randomized clinical trials on the impact ... Pooled analysis showed that vitamin C treatment reduced the risk of CRPS I regardless of dosage (RR = 0.46, 95% CI 0.25 to 0.85, 1143 patients).

5. journals.plos.org journals.plos.org/plosone/article?id=10.1371/journal.pone.0316450

Impact of vitamin C on the reduction of opioid consumption for ... The literature suggests that administering vitamin C can reduce both pain and opioid consumption in the context of immediate postoperative acute pain (24 to 72 ...

6. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1297319X0400048X

Musculoskeletal manifestations of scurvy Overall, vitamin C appears to be a safe and effective adjunctive therapy for acute and chronic pain relief in specific patient groups.

7. clinicaltrials.gov clinicaltrials.gov/ct2/show/NCT06306183

Effect of Vitamin C on Pain Reduction After an Emergency ... The investigators hypothesized that vitamin C will reduce pain intensity and chronic pain development at three months. This research could provide a safe ...

8. mayoclinic.org mayoclinic.org/drugs-supplements-vitamin-c/art-20363932

Vitamin C Safety and side effects. When taken at suggested doses by mouth, vitamin C supplements are mostly safe. Taking too much vitamin C can cause side ...