Vitamin C as an emerging alterative treatment for attenuating post-herpetic neuralgia pain

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Vitamin C as an emerging alterative treatment for attenuating post-herpetic neuralgia pain

Herpes zoster (HZ), commonly called as  shingles, is a localized disease causing reactivation of the varicella-zoster virus that persists in a latent form in the dorsal root ganglia. It is characterized by vesicular eruptions in the dermatome distribution followed by a painful neuralgia. Herpes zoster may progress to post-herpetic neuralgia (PHN) which is defined as a pain along the cutaneous nerves persisting for more than 30 days after the lesions have healed. Post-herpetic neuralgia is often difficult to manage and hence hampers the quality of life.

Recent studies have shown that the infusion of vitamin C is effective in zoster-associated neuralgia. Moreover, it was also reported that intravenous infusion of vitamin C is more effective for post-herpetic pain. In this study,  researchers described patients with PHN who reported an immediate reduction in pain after intravenous administration of vitamin C.

The current study aimed to evaluate the efficacy of intravenously administrated vitamin C on acute pain and its preventive effects on PHN in patients with HZ. The study included around 128 patients diagnosed with HZ and hospitalized in the Department of Dermatology, Chosun University Hostpital (Gwangju, Korea) between September 2011 and May 2013.. A randomized controlled study was conducted, 87 patients  were randomly divided into a ascorbic acid treatment group and a control group. Each patient received normal saline infusion with or without 5 g of ascorbic acid on days 1, 3, and 5. Following the treatment, participants answered questionnaires that included questions on side effects and pain severity using visual analogue scale on days 1, 2, 3, 4, and 5. After the discharge, the severity of pain was obtained at out-patient clinic or by telephonic conversation on weeks 2, 4, 8, and 16.

They found that these reactive oxygen species/free radicals can cause problems in the nervous system causing neuropathic pain. Thus, oxygen free radicals are thought to play a role in the development and maintenance of PHN, and pain is anticipated to be reduced by injecting scavengers of oxygen free radicals.  Vitamin C is an anti-oxidant, and thus has an ability to lower the amount of free radicals produced from oxidation.

Results showed the occurrence of PHN in 14 patients (31.1%) in the vitamin C treatment group and 24 patients (57.1%) in the control group. The incidences of PHN significantly differed between the two groups. The pain decreased over time in both the groups. Generally, the pain for the control group was scored low in the early part, but increased after the second week of follow up, whereas the pain score in the vitamin C treatment group continuously decreased.

In this study, the results did not reflect a significant decrease in acute pain, but the treatment was effective in preventing PHN. Also, because of the significant changes in pain over time, it is a safe treatment for preventing PHN and pain due to HZ, without major side effects.

Therefore, the study concluded that vitamin C plays a role in post-herpetic neuralgia, and that intravenous vitamin C helps relieve spontaneous pain in these neuropathic pain patients. Clearly, vitamin C has a significant potential in mitigating postherpetic neuralgia, especially when administered intravenously. The use of the vitamin C appears to be an interesting component of alternative therapeutic strategies in the treatment of HZ. Especially for the therapy-resistant cases of PHN,  vitamin C administration should be examined as an additional option.

Source:

Annals of dermatology

Link to the source:

http://anndermatol.org/DOIx.php?id=10.5021/ad.2016.28.6.677

Original title of article:

A Study of Intravenous Administration of Vitamin C in the Treatment of Acute Herpetic Pain and Postherpetic Neuralgia

Authors:

Min Sung Kim, Dong Jin Kim, Chan Ho Na and Bong Seok Shin

Annals of dermatology
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