Vitamin C and Complex regional pain syndrome (CRPS) type I

Ross Hauser, MD

This article is a companion piece to our other articles on Complex regional pain syndrome.

Does oral vitamin C supplementation help prevent incidence of Complex Regional Pain Syndrome?

The concept behind vitamin C oral supplementation is that it can help fight off oxidative stress and work as an anti-inflammatory and tissue regenerator. However, there is still a lot of debate as to how vitamin C actually works in preventing Complex Regional Pain Syndrome and some debate if it works at all. The research below gives endorsement to oral supplementation of 500 – 1000 mg for a period of 40 – 50 days post-surgery.

Distal radius, wrist, foot, and ankle surgeries

In August 2022, doctors writing in The Journal of Foot and Ankle Surgery (1) examined the effect of pre-surgery Vitamin C doses on the incidence of Complex Regional Pain Syndrome. In this study, the doctors noted: Controversy exists regarding the effectiveness of vitamin C in reducing the incidence of complex regional pain syndrome. To help add science to the controversy the doctors and researchers conducted this systematic review and meta-analysis of past published data to better assess the preventive role of vitamin C on CRPS-I and functional outcomes after distal radius, wrist, foot, and ankle surgeries.

Data taken from eight studies were included. The average time frame for vitamin C administration in each study ranged from 42 to 50 days post-injury and/or surgical fixation. Vitamin C dose was 500 mg or 1000 mg.)

The data showed that vitamin C was associated with a decreased rate of CRPS-1 when compared to a placebo.
No significant difference was found between vitamin C and placebo in terms of complications, functional outcomes, and pain scores.
Overall, vitamin C was associated with a decreased rate of CRPS-I than placebo, while no significant difference was found regarding complications, functional outcomes, and pain scores. These results hold true when stratifying fracture type (distal radius, ankle, and foot surgeries) and vitamin C dose Vitamin C dose was 500 mg or 1000 mg.)

Foot and ankle surgery

In September 2021, doctors writing in the journal International Orthopaedics (2) looked for answers to help people who develop complex regional pain syndrome after foot and ankle surgery which impacted their ability to walk. Here is what they wrote: “As the symptomatic treatment of this disaster complication is poor and has low efficacy, a preventive treatment would be beneficial. Vitamin C has been reported to be efficient in preventing CRPS in elective scheduled surgery.” In their study among the 329 patients included (232 women and 97 men), 121 patients were included in the vitamin C group and 208 in the control group (without vitamin C).

Subacromial shoulder surgery

Results: Taking 1000 mg (1 g) per day of vitamin C for 40 days after a foot or ankle surgery reduces the risk of CRPS. In the same group, alcoholism and cast immobilization were increased risk factors for CRPS.

A February 2020 study in the European Journal of Orthopaedic Surgery & Traumatology (3) looked to see if oral vitamin C reduced the incidence of CRPS-I after subacromial shoulder surgery

A group of 542 patients who had subacromial shoulder surgery was divided into two groups. One group received no vitamin C the other group received (500 mg/day of oral vitamin C for 50 days postoperatively). The relationship between vitamin C administration and the development of CRPS-I was assessed.

The incidence of CRPS-I was significantly different between the two groups (36 (13% of patients in the non-vitamin C group) vs 18 (7% in the vitamin C group). Further analysis revealed that vitamin C reduced the risk of CRPS-I after subacromial shoulder surgery by more than 50%.
Secondary findings revealed that patients undergoing open surgery were more likely to develop CRPS-I postoperatively.
The authors recommend preventive management with vitamin C and arthroscopic approaches when possible for subacromial shoulder surgery.

References

1 Seth I, Bulloch G, Seth N, Siu A, Clayton S, Lower K, Roshan S, Nara N. Effect of Perioperative Vitamin C on the Incidence of Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis. The Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons. 2021 Nov 21. [Google Scholar]
2 Hernigou J, Labadens A, Ghistelinck B, Maes R, Bhogal H, Callewier A, Bath O, Chahidi E, Safar A. Vitamin C prevention of complex regional pain syndrome after foot and ankle surgery: a prospective randomized study of three hundred and twenty nine patients. International Orthopaedics. 2021 Aug 4. [Google Scholar]
3 Laumonerie P, Martel M, Tibbo ME, Azoulay V, Mansat P, Bonnevialle N. Influence of vitamin C on the incidence of CRPS-I after subacromial shoulder surgery. European Journal of Orthopaedic Surgery & Traumatology. 2020 Feb;30(2):221-6. [Google Scholar]