VITAMINS

Vitamin B Complex

Supplementation with three members of the vitamin B complex--namely, thiamine, vitamin [B.sub.6], and/or vitamin [B.sub.12]--may reduce pain, especially neuropathic and musculoskeletal pain syndromes. For example, a double-blind study of 376 patients with acute pain of the lumbar vertebrae investigated supplementation with these three vitamins as an adjunct to treatment with diclofenac, a non-steroidal anti-inflammatory drug. The addition of the vitamins to the drug was found to be significantly superior for patients with severe pain. (1)

Similarly, a double-blind study of patients with chronic back pain found that, after six months, supplemented patients had a significantly better psychosomatic state, a tendency toward greater range of motion, and half the relapse rate. Of the non-relapsing patients, the clinical condition tended to improve over time in the B-vitamin group, whereas it tended to deteriorate in the placebo group. (2) The analgesic effect is attributed to increased availability and/or effectiveness of noradrenaline and 5-hydroxytryptamine acting as inhibitory transmitters in the nociceptive system. (3)

Thiamine

Massive intravenous doses of thiamine suppress the transmission of neural stimuli to skeletal muscles by producing ganglionic blockade. (4) In an open trial, one to two grams of thiamine hydrochloride was given once or twice daily to 133 pain patients who had failed to benefit from analgesics or physical therapy. There was improvement in 78% of the 69 headache patients, 71% of the 56 patients with pain in the spine and joints, and 63% of the eight patients with neuralgia. Five of the eight headache patients complained of nausea; otherwise there were no side effects. (5)

Vitamin [B.sub.6] is required in the conversion of dietary tryptophan to serotonin, a neurotransmitter that modulates pain perception, making it a serotonin-stimulating agent. Since chronic pain patients have decreased serotonin levels, the vitamin may be particularly beneficial for patients being withdrawn from analgesics as well as those with pain due to temporo-mandibular joint dysfunction. (6)

Vitamin [B.sub.12]

Oral administration of vitamin [B.sub.12] has been shown to have a dose-dependent analgesic effect in rats, (7) although other animal studies have failed to confirm its efficacy. (8) Numerous human studies attest to the efficacy of the vitamin. For example, in an open trial, daily injections of 5,000 [micro]g of hydroxo-cobalamin appeared to reduce pain in all but ten of a group of 400 patients with vertebral pain accompanied by sensory disturbances, (9) while a smaller trial reported pain relief in 60% of cancer patients following two weeks of daily injections of 10,000 [micro]g of cobamamide. (10)

In a randomized, double-blind study, 60 patients with chronic low back pain due to mechanical or irritative lumbago and with no evidence of nutritional deficiency were treated with intramuscular injections of vitamin [B.sub.12] (Tricortin 1000) or placebo. Active treatment was significantly superior to placebo in regard to pain ratings using a Visual Analog Scale as well as a Disability Questionnaire. (11)

Vitamin C

Supplementation with megadoses of vitamin C has repeatedly been shown to reduce pain. Some of these studies were done under controlled conditions. (12) Pain reduction following megadose ascorbate supplementation has been reported in patients suffering from advanced cancer, (7) Paget's disease, (13) and osteogenesis imperfecta; (14) in patients with dental (15) or lumbar disc (16) pains; and in patients with post-suxamethonium pain following procedures such as esophagoscopy, bronchoscopy, and direct laryngoscopy. (12) In a double-blind, crossover study, supplementation was shown to reduce muscle soreness after strenuous exercise. (17)

Vitamin E

Vitamin E has been shown to relieve neuropathic pain in rats, at least partly by reducing central sensitization caused by peripheral nerve injury. (18)

Moreover, blood vitamin E levels decrease in rats when they are subjected to emotionally painful stress. (19) In a randomized, double-blind study of 278 girls aged 15-17 years with primary dysmenorrhea, 200 IU of vitamin E daily was found to be effective in relieving pain as well as in reducing blood loss. (20) However, a six-month, randomized, double-blind study of 77 patients with knee osteoarthritis who received 500 IU/day of vitamin E failed to find evidence of benefit. (21) More studies are needed to better assess the range of clinical efficacy of the vitamin in reducing pain syndromes.

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