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.

Cayetano Heredia Medical Clinic Lima Peru

Clinic for Naturopathy and Integrative Medicine Evangelische Kliniken Essen Mitte GmbH Essen Germany

Department of Algesiology SZU F D Roosevelt University Hospital Banska Bystrica Slovakia

Department of Anesthesiology and Intensive Care Medicine Klinikum Klagenfurt Am Wörthersee Chair of Palliative Medicine SFU Vienna Klagenfurt am Wörthersee Austria

Department of Anesthesiology and Intensive Care Medicine Klinikum Mutterhaus Trier Johannes Gutenberg University Mainz Germany

Department of Anesthesiology and Intensive Care Medicine University Hospital Pilsen Pilsen Czech Republic

General Surgery and Breast Oncoplastic Surgery NMC Royal Hospital Khalifa City Abu Dhabi United Arab Emirates

Institute of Physical Medicine and Rehabilitation Hospital Mistelbach Mistelbach Austria

Medical Institute Dr Poglitsch Pain Medicine Graz Austria

Pain Therapy Practice Rieger Bingen am Rhein Germany

Private Practice for General Medicine Orthopaedics Orthopaedic Surgery and Functional Myodiagnostics Vienna Austria

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