VITAMIN C, RSD and CRPS
When I was in school, I remember being told that reflex sympathetic dystrophy (RSD) was the modern term for causalgia, a condition first described by doctors during the United States Civil War in the 1860’s. After graduation I recall attending a seminar and learning causalgia was the correct term to use if RSD was severe. Because of the confusion surrounding these two terms as well as others, the condition was re-named in the mid 1990's and called complex regional pain syndrome (CRPS). CRPS type 1 replaced RSD, and CRPS type 2 replaced causalgia. The differences were that the nerve dysfunction in CRPS Type 1 patients stemmed from traumas like sprains, fractures and surgeries where there was no direct nerve damage. The CRPS Type 2 label was reserved for those with a direct nerve injury. However, due to the fact that the symptoms of the two classes do not differ, many doctors and therapists continue call the condition RSD.
CRPS is most likely to occur following trauma to an extremity that requires immobilization, such as a fracture, surgery or gunshot wound. However, it can even occur after a minor sprain or even a blood draw. The hallmark symptom is intense burning pain and extreme skin sensitivity. There is also a host of skin changes listed in table 1. Joint stiffness, muscle contractions, weakness and muscle atrophy can occur after three or more months.
Table 1 – Skin changes in the area of CRPS*
Sweaty or moistness
Redness, white color, blue color
Increased temperature or decreased temperature
Increased hair growth or hair loss
*Please note that not all changes are seen in all patients.
The Quasi Experiment1
The authors called their study a “quasi experiment” because it compared the outcomes of 392 patients in successive years that had foot and ankle surgeries. The first group was between July of 2002 and June of 2003 and numbered 177 patients. From July of 2003 until June of 2004 there were 215 patients that had foot and ankle surgery. These patients were given 1000 mg of vitamin C a day for 46 consecutive days after their surgery. The results are in table 2.
Post Op Vitamin C and CRPS
|Treatment||No vitamin C||Vitamin C|
|Number of patients||177||215|
The results of this “quasi experiment” mirror an earlier study in 20072 involving wrist fractures in which there was a 10% rate of CRPS in patients given placebo, a 1.8% rate of CRPS in patients given 500 mg of vitamin C and a 1.7% incidence of CRPS in a third group given 1500 mg vitamin C for 50 days after their wrist injuries.
Based on these two studies, the simple addition of 500 mg of vitamin C a day for two months following extremity trauma appears to reduce of the incidence of CRPS by 80%. Whether you practice nutrition or not, any time you have a patient who has a upper or lower limb injury requiring casting or surgical repair, remind them to take some extra vitamin C. Not only will it help healing by its well recognized affect on collagen formation and free radical reduction, it just may prevent CRPS. And, as anyone who has had a CRPS patient will tell you, the best treatment is prevention.
1. Besse, J.L., Gadeyne, S., Galand-Desme, S., et al, Effect of Vitamin C on Prevention of Complex Regional Pain Syndrome Type 1 in Foot and Ankle Surgery. Foot and Ankle Surgery, 2009; (15)179-182.
2. Zollinger, T.E., Tuinebreijer, W.E., Breederveld, R.S., Kreis, R.W., et al, Can Vitamin C Prevent Complex Regional Pain Syndrome in Patients with Wrist Fractures? A Randomized Controlled Multicenter Dose-Reponse Study, J Bone Joint Surg Am, 2007; (89): 1424-1431.