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Practice Therapeutics

Pregabalin and gabapentin for pain

BMJ 2020; 369 doi: (Published 28 April 2020) Cite this as: BMJ 2020;369:m1315

Rapid Response:

Vitamin C can decrease pain

Dear Editor

It was interesting to read in the Journal the article by Mathieson et al., on “Pregabalin and Gabapentin for Pain”, [1] but surprising to find no mention of the use of vitamin C as it has been shown to enhance the analgesic effect of gabapentin with neuropathic pain, at least in rats. [2] In other studies of post-operative treatment of patients with vitamin C showed that it helped to reduce requirements for an analgesic, to improve VAS scores, and to achieve better functional outcomes following foot and ankle trauma surgery. [3] The Lancet published a clinical trial in 1999 showing the analgesic effect of vitamin C on reflex sympathetic dystrophy (or complex regional pain syndrome) following wrist fractures alone. [4] And these results were confirmed in subsequent publications. [5,6] Furthermore, plasma levels of vitamin C are lower in postherpetic neuralgia patients and administration of vitamin C was shown to reduce spontaneous pain. [7]

In their detailed review of the role of vitamin C in the treatment of pain, Carr and McCall [8] reported mainly human studies on the association of low plasma levels of vitamin C and increased pain, as well as the use of vitamin C (ranges 0.5 to 2g) as an analgesic in various painful medical conditions pre and post-surgery. They reported also its use to decrease opioid treatment. With the considerable concerns on the “opioid crisis of unprecedented proportions” dealing with ‘prescription opioid overuse’ it appears that vitamin C should be an appropriate, necessary, and relatively cheap, additional analgesic treatment, to both reduce pain and perhaps to reduce patient dependence on opioids.

I declare no competing interests.

Simon N. Thornton

Université de Lorraine and INSERM U_1116, Vandoeuvre les Nancy, France

1. Mathieson S, Lin CWC, Underwood M, Eldabe S. Pregabalin and Gabapentin for Pain. BMJ 2020 28;369:m1315. doi: 10.1136/bmj.m1315.
2. Li R, Shen L, Yu X, Ma C, Huang Y. Vitamin C enhances the analgesic effect of gabapentin on rats with neuropathic pain. Life Sci. 2016 157:25-31. doi: 10.1016/j.lfs.2016.05.035.
3. Jain SK, Dar MY, Kumar S, et al. Role of anti-oxidant (vitamin-C) in post-operative pain relief in foot and ankle trauma surgery: A prospective randomized trial. Foot Ankle Surg 2018 pii: S1268-7731(18)30159-0.
4. Zollinger PE, Tuinebreijer WE, Kreis RW, Breederveld RS. Effect of vitamin C on frequency of reflex sympathetic dystrophy in wrist fractures: a randomized trial. Lancet 1999 354 (9195):2025–8.
5. 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. J Bone Joint Surg Am 2007 89:1424–31.
6. Cazeneuve JF, Leborgne JM, Kermad K, Hassan Y. Vitamin C and prevention of reflex sympathetic dystrophy following surgical management of distal radius fractures. Acta Orthop Belg 2002 68:481–4.
7. 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. Clin J Pain. 2009 25(7):562-9. doi: 10.1097/AJP.0b013e318193cf32.
8. Carr AC, McCall C. The role of vitamin C in the treatment of pain: new insights. J Transl Med 2017 15: 77.

Competing interests: No competing interests

15 May 2020
Simon N. Thornton
Université de Lorraine
Université de Lorraine, U_1116 INSERM, Faculté de Médecine, 9 Avenue de la forêt de Haye, CS 50184, 54505 VANDŒUVRE Les Nancy cedex, France