Marc's Musings | February 2016


Effective Perioperative Vitamin C Supplementation on Post-Operative Pain and the Incidence of Chronic Regional Pain Syndrome: A Systematic Review and Meta-Analysis, Chen et al. Clinical Journal of Pain, February 2016 32(2) pp 179-185

This meta-analysis of three CRPS studies showed a decrease in post-operative CRPS after Vitamin C supplementation 500mg bd for 50 days after extremity surgery (relative risk = 2.25).


The second meta-analysis confirms the benefit of CRPS incidence reduction with this simple therapy. In addition, there was one study that showed a reduction in post-operative Morphine utilisation after surgery with Vitamin C 2g and another study that showed no difference in outcome. The evidence here is therefore less clear as regards that.

The Effects of Various Physical Non-operative Modalities on the Pain in Osteoarthritis of the Knee. Cherian J J et al. Bone Joint Journal 2016 January 98-B (1 Supplement A) pp 89-94

This is a systematic review and meta-analysis. Four treatments were found to be of benefit. The standardised mean difference was 1.0 for insoles for the feet, 1.3 for bracing the knee, 1.8 for application of TENS, and 1.9 for neuromuscular electrical stimulation.


These four treatments can be selected based on patient relevance and preference as additional therapeutic endeavours for reducing knee pain.

Efficacy of Duloxetine in Chronic Low Back Pain with a Neuropathic Component: A Randomised Double Blind Placebo Controlled Crossover Trial Schukro RP et al. Anaesthesiology 2016 January 124(1) pp 150-158

In this study of this particular sub-group of low back pain patients, there was a 32% reduction in pain from baseline four weeks after treatment with Duloxetine. There was little difference in terms of the overall adverse event rate between Placebo and Duloxetine.


Modest partial benefit can be expected in these patients, but this is of course not applicable to those patients with chronic low back pain without a neuropathic pain component.

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