Vitamin C and its emerging role in pain management: beneficial effects in pain conditions besides post herpetic neuralgia.

TO THE EDITOR

I found the recent article by Byun highly interesting [1]. Notably, the past few years have seen the emergence of vitamin C as a potent anti-nociceptive agent in the management of a number of painful conditions in addition to postherpetic neuralgia.

For instance, Zollinger et al. [2], in a recent double blind randomized study, have demonstrated that the risk of reflex sympathetic dystrophy following wrist fractures is significantly attenuated following post-fracture administration of ascorbic acid. Similarly, pre-administration of vitamin C prior to foot and ankle surgeries decreases the risk of developing complex regional pain syndrome (CRPS) I [3]. For example, in one study, vitamin C administered at a daily dosage of 500 mg starting 2 days prior to total trapeziometacarpal joint prosthetic surgery and continued for 7 weeks post op was associated with no reported cases of CRPS I [4].

Vitamin C may also have a role to play in migraine prophylaxis [5]. In a similar way, vitamin C, by virtue of its antioxidant properties, significantly mitigates pain and increases the pain threshold in patients with chronic pancreatitis [6]. The pain-attenuating efficacy of vitamin C is further enhanced when it is used in concert with other agents such as B-carotene and methionine.

Vitamin C exerts its anti-nociceptive effects primarily as a result of its antioxidant properties. It is clear that vitamin C has a major role to play in mitigating pain in a number of clinical conditions in addition to postherpetic neuralgia.