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.
Thank you for the study and your recommendations. However, given the existence of other studies that suggest the efficacy of Vitamin C, and the negligible down side, why not prescribe 500mg /day for 2 months
Seems like a valuable hedge to me .
This is because the vast majority of cases with diagnosis of CRPS don’t actually exist. It is because of sloppy exams, loose application of criteria and fear of antagonizing difficult patients and their enablers in the form of plaintiff attorneys. In other words, passing the buck on to “Pain Centers” where months of expensive and fruitless additional procedures go on further raising the ante because someone has to pay the bill in the end
It serves few in this sad scenario because at the end of the day the patient is seldom better and has wholly accepted the label of “totally, irrevocably disabled”
Read the elegant lifetime peer reviewed work of Robert Barth for insight into this issue
Where is the link to this study?
All I’m able to find in following up on the study are reports of study findings that were presented, not the actual study itself.
Is this the only study of it’s kind to produce these results? Have others reproduced the same results in other double blind study scenarios conducted after these study results were released?
Has this study been conducted where the determination of those diagnosed with the disease meet current accepted criteria for diagnosis (outlining diagnosis criteria used for the study for study inclusion in future ones), not accepting the diagnosis simply based on the patient having received the diagnosis from their doctor, to exclude potential misdiagnosed cases of RSD/CRPS from the study?
As far as using finger stiffness, a single symptom not experienced by ALL RSD/CRPS patients who’ve had surgery on their hands. Using this as your basis to infer RSD/CRPS is a poor measure of who has or does not have the disease to base any study related to RSD/CRPS on.
Unless it’s a study to identify the percentage of patients with finger stiffness who later are dx with the disease experienced that as an early indicator of later dx. Again not as an inclusionary or exclusionary symptom, because NOT everyone with RSD/CRPS has had finger stiffness after hand surgery. I’m one for example.
Previous studies on the efficiency of Vitamin C having a beneficial effect have been reproduced in subsequent studies. Until future studies result in the same conclusion what is the purpose of a specific field of medicine promoting these results?
If future studies using a more precise representation for disease identification as the factor used to identify end result are conducted, reproducing the same results then it’s important to get the information to doctors.
However, based on the knowledge learned from current reproducible studies, why aren’t surgeons given this information to include in post-op treatment instructions, instead of only surgeons who come across the information having it, with the ability to disregard it?
I also ask why isn’t it required to notify patients of the possibility of the disease occuring in the form Orienta are required to sign prior to surgery notifying them of possible negative events of undergoing surgery. I’ve only done across A SINGLE DOCTOR, in 27 years, who warns of RSD/CRPS as a possible result of surgery. A podiatrist.