Can Vitamin C prevent CRPS?

Background

The many medical benefits of Vitamin C have long been known. Indeed, many of us take daily supplements of Vitamin C for a variety of intended benefits, including boosting our immune system and fighting colds, cardiovascular disease and eye disease. It’s also said to be cosmetically beneficial for our skin.

As long ago as 1942, the important role of Vitamin C in fracture healing was reported. As well as promoting bone formation, Vitamin C has since been shown to improve the mechanical strength of the new bone (callus) that forms during the bone unification process.

Are supplements important?

Unlike most animals, humans are unable to synthesise Vitamin C in our bodies. Our only sources of this vitamin are therefore what we consume through our diet and/or supplements. The most important dietary sources of Vitamin C are from fruit and vegetables. As so many of us are so bad at ensuring that we consume our “Five a Day”, supplements can be very important.

As a result of a considerable amount of research, it is now widely accepted in the medical profession that there is a correlation between taking Vitamin C and the chance of developing CRPS following limb fractures or limb surgery.

One study* looked at the effect of taking Vitamin C on the development of CRPS in patients with wrist fractures. Of 416 patients studied, 317 received Vitamin C and 99 received a placebo. 2.4% of the group taking Vitamin C developed CRPS compared to 10.1% in the placebo group. The study concluded that Vitamin C does reduce the prevalence of CRPS following wrist fractures and the daily dose recommended was 500 mg.

Another study** turned its attention to the development of CRPS Type 1 following foot and ankle surgery. 420 feet in 392 patients were included in the study. Again, they were divided into two groups: 185 in Group I and 235 in Group II. Group I did not receive Vitamin C but Group II did. CRPS Type 1 occurred in 9.6% of Group I and 1.7% of Group II. The conclusion was that Vitamin C was effective in reducing the prevalence of CRPS Type 1 following surgery to the foot and ankle.

These studies do suggest that whilst Vitamin C does not absolutely prevent the development of CRPS following limb fractures or limb surgery, it does significantly reduce that risk.

However – a word of caution

Recently, a statistical analysis*** has been published which analysed the data from a number of studies on the use of Vitamin C to prevent CRPS in patients with distal radius (wrist) fractures. The conclusion of that analysis was that “the evidence for vitamin C to prevent CRPS in patients with distal radius fractures fails to demonstrate a significant benefit. The overall quality of the evidence is low, and these results should be interpreted in the context of clinical expertise and patient preferences.”

So are we back to square one?

Probably the best interpretation of the recent statistical analysis is that the role of Vitamin C in reducing the prevalence of CRPS following limb fractures and limb surgery needs to be investigated more closely. It is important to note that the criticism is aimed at the methodology of the studies, rather than dismissing the results altogether.

In the meantime, however, given that Vitamin C is inexpensive and its potential side effects are limited, the advice has to be that taking 500 mg of Vitamin C daily for at least 50 days following limb fracture or surgery remains a worthwhile measure.

Worryingly, however, I have been told by one CRPS sufferer who underwent surgery following her diagnosis of CRPS that at no time did either her surgeon or pain specialist recommend taking Vitamin C. Fortunately, as a result of her own research, she was aware of the potential benefits and took the supplement.