Study: Vitamin C No Impact on Complex Pain Syndrome

A group of researchers has determined that vitamin C does not reduce the incidence of Complex Regional Pain Syndrome (CRPS) and therefore facilitate recovery from distal radius fracture and that attention should be paid to reducing pain interference (nurturing more adaptive coping strategies) to facilitate patient recovery.

The results of this study were presented by Sezai Özkan, M.D., Teun Teunis, M.D., Neal Chen, M.D., and David. C. Ring, M.D. at this year’s American Academy of Orthopaedic Surgeons (AAOS) annual meeting. The presentation was titled “The Effect of Vitamin C on Finger Stiffness After Fracture of the Distal Radius: A Double-Blind Placebo-Controlled Randomized Trial.”

This pragmatic, double-blind, randomized, placebo-controlled, non-crossover study examined adult patients who presented to a level 1 trauma center in an urban city in the United States within two weeks of a distal radius fracture.

The study utilized computer-based block randomization. Patients were allocated to receive either 500 mg vitamin C or a placebo once daily. There were 67 patients in each group. All research personnel and participants were blinded to group allocation, except for the pharmacist preparing the medication.

The main outcome was distance between fingertip and distal palmar crease six weeks after the fracture. Ten patients from the vitamin C and five from the placebo group were unavailable for follow up. The researchers used strict intention-to-treat and multiple linear imputation to address missing data.

There was no significant difference in distance to distal palmar crease between people taking vitamin C or placebo. Pain interference was the only factor associated with greater functional limitations at six weeks after fracture.

OTW spoke with Neal C. Chen, M.D., interim chief, Hand & Arm Center at Massachusetts General Hospital about why the researchers decided to conduct the study. Chen told OTW, “There has been some question of whether or not the routine use of vitamin C with distal radius fractures reduces the incidence of CRPS [complex regional pain syndrome]. The issues around it are that prior studies have relied on very soft criteria for determining who has CRPS after distal radius fractures.”

Chen continued, “We decided to run a study—a prospective randomized control study—on patients who had a distal radius fracture to see if patients who received vitamin C had more stiffness than patients who did not. Stiffness being the surrogate for CRPS.”

Dr. Chen’s most important takeaway is that, “We’ve learned that vitamin C is not helpful. We want to get it out there that routine administration of vitamin C after a wrist fracture does not help. There are resources that can be allocated in different ways…. We want people to have good care, proficient care, and care that is cost-effective.”

The study has been accepted for forthcoming publication in Clinical Orthopedics and Research.