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Vitamin C, a natural constituent of many fruits, is a powerful anti-oxidant. It helps to prevent free-radical damage that contributes to aging and degenerative disorders. Vitamin C also prevents other antioxidant vitamins from being oxidized. Eating citrus is a good way to get Vitamin C, but it may not be enough when recovering from injury or surgery to reduce pain and risk.

Specifically, for chronic pain states like Chronic Regional Pain Syndrome (CRPS), Vitamin C used preoperatively at 2 g, reduces the morphine consumption in the post-operative stage. Fifty days of use at 1g/d post-operatively may reduce the CRPS risk development.  A meta-analysis supports use of Vitamin C for reducing CRPS risk despite not finding conclusive dosage. Another study concluded that the administration of Vitamin C in preventing CRPS after distal radius fracture is low cost and has few complications. Another systematic review also supports the use of Vitamin C for foot and ankle surgery at 500mg for 45-50 days.   There are some conflicting reports on effectiveness of 500mg Vitamin C in reducing pain, and it is worth noting as it may be dose dependent.

Although the optimal dosage for Vitamin C may vary depending on the study, toxicity of Vitamin C has not been proven.  There is the potential of intestinal gas or loose stools at levels greater than 5g/day, but it is a patient specific response. Although some clinicians may have concerns about rebound scurvy following sudden withdrawal of Vitamin C, this has not been validated in the literature.  There may also be concern about potential risks associated with anesthesia/surgery. A report completed by the American Society of Plastic Surgeons gives this pre-surgical precaution for Vitamin C:
“Patients taking vitamin C supplementation do not necessarily have to stop their intake during the perioperative period.” 
For the general healthy adult, Vitamin C is safe. Specific populations that should be carefully considered are those with inadequate levels glucose-6-phosphate dehydrogenase (G6PD) (genetic disorder), pregnancy and nursing women, and individuals in renal failure.   Here is a list of potential patient populations that may have contraindications to Vitamin C supplementation:

  • Cystinuria

  • Glucose-6-phosphate dehydrogenase (G6PD) deficiency

  • Nephrolithiasis

  • Renal Failure

  • Pregnant women avoid daily doses >500mg/day

  • Chemotherapy/radiation

  • Hemodialysis

  • Sickle cell anemia

  • Risk of hemorrhage

  • Individuals allergic to corn (most supplements are derived from corn)

 Vitamin C is a powerful antioxidant and reduces the risk of developing chronic pain when dosed appropriately and used during recovery.

Remove. Replace. Restore.
Remove excess nutrient depleted foods.
Replace with fresh fruits, vegetables and appropriate supplements to boost antioxidant activity during recovery.
Restore a normal pain response.

Eat Well. Move Well. Sleep Well. Connect Well. Supplement Well.

Effect of Perioperative Vitamin C Supplementation on Postoperative Pain and the Incidence of Chronic Regional Pain Syndrome: A Systematic Review and Meta-Analysis.
Role of vitamin C in prevention of complex regional pain syndrome after distal radius fractures: a meta-analysis.
Testing the validity of preventing chronic regional pain syndrome with vitamin C after distal radius fracture.Efficacy and safety of high-dose vitamin C on complex regional pain syndrome in extremity trauma and surgery–systematic review and meta-analysis.
Herb Nutrient and Drug Interactions
The Real Vitamin and Mineral Book, 4th edition: The Definitive Guide to Designing Your Personal Supplement Program
Use of herbal supplements and vitamins in plastic surgery: a practical review.