The Use of High-Dose Intravenous L-Ascorbate in Pain Therapy: Current Evidence from the Literature.

IF 4.1 2区 医学 Q1 CLINICAL NEUROLOGY
Pain and Therapy Pub Date : 2024-08-01 Epub Date: 2024-06-12 DOI:10.1007/s40122-024-00622-5
Rudolf Likar, Ruth Poglitsch, Štěpán Bejvančický, Ludwig Carl, Miroslav Ferencik, Alfred Klein-Watrycz, Monika Rieger, Keveen Salirrosas Flores, Astrid Schumich, Zoe Vlamaki, Marc Werner
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引用次数: 0

Abstract

Introduction: Pain is the most common reason for seeking medical treatment. Despite extensive research efforts and effective analgesics modulating pain, there is still a major therapeutic gap in addressing the root causes of pain. Pain is associated with tissue damage induced by oxidative stress and induction of inflammatory mediators following high consumption of antioxidants. The role of antioxidants in general, and the administration of L-ascorbate in particular, is still controversially discussed and underestimated in the daily clinical practice.

Methods: The current literature on the therapeutic effect of L-ascorbate, ascorbic acid, and vitamin C on various pain conditions was evaluated against the background of evidence-based medicine. Those articles, obtained from systematic search in PubMed, were critically assessed and rated in terms of evidence level and methodological quality by two independent experts. The primary purpose of this work was to establish specific pain therapy guidance for intravenous L-ascorbate.

Results: A PubMed search revealed 14 suitable articles comprising controlled clinical trials and meta-analyses. An additional ten publications could be identified via secondary literature. There is supporting evidence for the efficacy of ascorbate treatment in inflammatory pain conditions, in the complex regional pain syndrome, in post zoster neuralgia, in neuropathic pain, in post-operative pain conditions, and in tumor-related pain. However, the considered studies differ in the type of administration, in dosage, in duration of treatment, as well as in quality of research. Despite all study heterogeneity, it became evident that research of high scientific quality is in support of the efficacy of L-ascorbate in pain treatment.

Discussion: Oxidative stress is present in almost all pain conditions. Because oral administration of most magistral formulas of vitamin C does not provide biological availability, parenteral administration should be preferred and can be supported by an oral dose with high bioavailability on days without intravenous treatment. L-ascorbate should be preferred for parenteral high dosage, rather than ascorbic acid, as it does not release acid valences under physiological conditions.

Conclusions: L-ascorbate is an effective, safe, and economically favorable integrative treatment option for various pain conditions, addressing the root cause of tissue damage and inflammatory mediator burst.

Abstract Image

在疼痛治疗中使用大剂量静脉注射 L-抗坏血酸:目前的文献证据
导言疼痛是最常见的就医原因。尽管开展了广泛的研究工作并使用了有效的镇痛药来调节疼痛,但在解决疼痛根源方面仍存在重大治疗差距。疼痛与氧化应激引起的组织损伤以及大量摄入抗氧化剂后诱发的炎症介质有关。抗氧化剂的作用,尤其是左旋抗坏血酸的作用,在日常临床实践中仍存在争议和低估:方法:在循证医学的背景下,对目前关于左旋抗坏血酸、抗坏血酸和维生素 C 对各种疼痛症状的治疗效果的文献进行了评估。两位独立专家对从 PubMed 上系统搜索到的这些文章进行了严格评估,并从证据水平和方法质量方面进行了评分。这项工作的主要目的是为静脉注射左旋抗坏血酸制定具体的疼痛治疗指南:在 PubMed 上搜索发现了 14 篇合适的文章,包括对照临床试验和荟萃分析。通过二手文献还可以找到另外 10 篇文献。有支持性证据表明,抗坏血酸治疗对炎症性疼痛、复杂性区域疼痛综合征、带状疱疹后神经痛、神经性疼痛、术后疼痛和肿瘤相关疼痛具有疗效。然而,所考虑的研究在给药类型、剂量、治疗时间以及研究质量方面都存在差异。尽管所有研究都不尽相同,但高科学质量的研究显然支持左旋抗坏血酸在疼痛治疗中的疗效:讨论:氧化应激几乎存在于所有疼痛病症中。由于大多数维生素 C 的口服配方不能提供生物利用率,因此应首选肠外给药,在没有静脉治疗的日子里,可通过口服高生物利用率的剂量来支持肠外给药。肠外大剂量给药应首选左旋抗坏血酸,而不是抗坏血酸,因为左旋抗坏血酸在生理条件下不会释放酸价:结论:L-抗坏血酸是一种有效、安全、经济的综合治疗方案,可治疗各种疼痛病症,从根本上解决组织损伤和炎症介质爆发问题。
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来源期刊
Pain and Therapy
Pain and Therapy CLINICAL NEUROLOGY-
CiteScore
6.60
自引率
5.00%
发文量
110
审稿时长
6 weeks
期刊介绍: Pain and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of pain therapies and pain-related devices. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, acute pain, cancer pain, chronic pain, headache and migraine, neuropathic pain, opioids, palliative care and pain ethics, peri- and post-operative pain as well as rheumatic pain and fibromyalgia. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports, trial protocols, short communications such as commentaries and editorials, and letters. The journal is read by a global audience and receives submissions from around the world. Pain and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.
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