Abstract
Background: Chronic low back pain (LBP) forms one of the heaviest burdens of disease. Vitamin C has shown analgesic effects in specific clinical conditions, reducing patient suffering and improving the quality of life. The aim of this study was to evaluate the efficacy of vitamin C as an adjuvant analgesic in treatment of chronic low back ache with radicular pain.
Methods: The present study was a prospective study of 100 patients aged 25-65 years with chronic low back ache with radicular pain, conducted in a tertiary care institute from 2019 to 2020. Patients were thoroughly interviewed and the radicular pain was graded according to the Numeric Rating Scale (NRS). 50 patients each were randomized into two groups, those that were given vitamin c supplementation (Group A) and those that weren't (Group B). The patients were then followed up fortnightly for 2 months and the radicular pain was graded at each follow-up.
Results: The mean improvement of the NRS scores in Group A was 51.36% whereas in Group B was 16.61%.In Group A, 64% of patients had good improvement, 14% moderate improvement while 14% had mild improvement, and 8% had no relief. In Group B, 40% of patients had moderate improvement, 28% had mild improvement, and 32% had no relief.
Conclusions: In this comparative study, we suggest that the supplementation of vitamin c to patients experiencing chronic LBP with radicular symptoms acts as an effective adjuvant analgesic giving relief of radicular symptoms with good improvement in the activities of daily living.
Keywords: Vitamin C, Chronic low backache, Radicular pain.
References
- Dionne CE, Laurin D, Desrosiers T, Abdous B, Le Sage N, Frenette J, Mondor M, Pelletier S. Serum vitamin C and spinal pain: a nationwide study. Pain. 2016 Nov 1;157(11):2527-35.
- Enke O, New HA, New CH, Mathieson S, McLachlan AJ, Latimer J, Maher CG, Lin CW. Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis. Cmaj. 2018 Jul 3;190(26):E786-93.
- Manchikanti L, Hirsch JA. Clinical management of radicular pain. Expert review of neurotherapeutics. 2015 Jun 3;15(6):681-93.
- Lu R, Kallenborn-Gerhardt W, Geisslinger G, Schmidtko A. Additive antinociceptive effects of a combination of vitamin C and vitamin E after peripheral nerve injury. Plos one. 2011 Dec 14;6(12):e29240.
- Kim HK, Park SK, Zhou JL, Taglialatela G, Chung K, Coggeshall RE, Chung JM. Reactive oxygen species (ROS) play an important role in a rat model of neuropathic pain. Pain. 2004 Sep 1;111(1-2):116-24.
- Kondo Y, Sasaki T, Sato Y, Amano A, Aizawa S, Iwama M, Handa S, Shimada N, Fukuda M, Akita M, Lee J. Vitamin C depletion increases superoxide generation in brains of SMP30/GNL knockout mice. Biochemical and biophysical research communications. 2008 Dec 5;377(1):291-6.
- Carr AC, McCall C. The role of vitamin C in the treatment of pain: new insights. Journal of translational medicine. 2017 Dec;15(1):1-4.
- Li R, Shen L, Yu X, Ma C, Huang Y. Vitamin C enhances the analgesic effect of gabapentin on rats with neuropathic pain. Life sciences. 2016 Jul 15;157:25-31.
- Chen JY, Chang CY, Feng PH, Chu CC, So EC, Hu ML. Plasma vitamin C is lower in postherpetic neuralgia patients and administration of vitamin C reduces spontaneous pain but not brush-evoked pain. The Clinical journal of pain. 2009 Sep 1;25(7):562-9.
- Zollinger PE, Tuinebreijer WE, Breederveld RS, Kreis RW. Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures?: A randomized, controlled, multicenter dose-response study. JBJS. 2007 Jul 1;89(7):1424-31.
- Buettner GR. The pecking order of free radicals and antioxidants: lipid peroxidation, α-tocopherol, and ascorbate. Archives of biochemistry and biophysics. 1993 Feb 1;300(2):535-43.
- Du J, Cullen JJ, Buettner GR. Ascorbic acid: chemistry, biology and the treatment of cancer. Biochimica et Biophysica Acta (BBA)-Reviews on Cancer. 2012 Dec 1;1826(2):443-57.
- May JM, Qu ZC, Meredith ME. Mechanisms of ascorbic acid stimulation of norepinephrine synthesis in neuronal cells. Biochemical and biophysical research communications. 2012 Sep 14;426(1):148-52.
- Mochizucki D. Serotonin and noradrenaline reuptake inhibitors in animal models of pain. Human Psychopharmacology: Clinical and Experimental. 2004 Oct;19(S1):S15-9.
- Buga S, Sarria JE. The management of pain in metastatic bone disease. Cancer Control. 2012 Apr;19(2):154-66.
- Babita Ghai MD, Dipika Bansal MD, Raju Kanukula M. High prevalence of hypovitaminosis D in Indian chronic low back patients. Pain Physician. 2015 Sep;18(E853):E853-62.
- Goon M, Ghoshal S, Chandrasekaran B, Sharma BC. Prevalence of low back pain in long distance truck drivers of mountainous terrain. na; 2010 Jan 1.
- Mohapatra A, Handoo SK, Gambhir IS, Mohapatra SC, Mohapatra SC. A study of non-communicable morbidity pattern in geriatric patients attending a referral railway hospital in allahabad, uttar pradesh. Nat J Commun Med. 2011;2(2):191-5.
- Bihari V, Kesavachandran C, Pangtey BS, Srivastava AK, Mathur N. Musculoskeletal pain and its associated risk factors in residents of National Capital Region. Indian journal of occupational and environmental medicine. 2011 May; 15(2):59.
- Banerjee A, Jadhav SL, Bhawalkar JS. Limitations of activities in patients with musculoskeletal disorders. Annals of medical and health sciences research. 2012;2(1):5-9.
- Bandyopadhyay A, Dev S, Gangopadhyay S. A study on the prevalence of musculoskeletal disorders among the coalminers of Eastern Coalfields of India. International Journal of Occupational Safety and Health. 2012 Jul 31;2(2):34-7.
- Sharma SC, Singh R, Sharma AK, Mittal R. Incidence of low back pain in workage adults in rural North India. Indian journal of medical sciences. 2003 Apr 1;57 (4):145.
Corresponding Author
Dr Mrugank A Narvekar
Department of Orthopaedics, Grant Government Medical College, Mumbai, Maharashtra, India
DOI: https://dx.doi.org/10.18535/jmscr/v9i4.12
