Vitamin C to reduce pain after an emergency department visit

Vitamin C for Acute Musculoskeletal Pain in Emergency Department Patients: A Triple-Blind Randomized Control Trial (VICAMED)

This trial tries to see if a single 900 mg dose of vitamin C, followed by 900 mg twice daily for three days, can reduce pain in adults who come to the emergency department with a new musculoskeletal injury.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 204 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Centre Integre Universitaire de Sante et Services Sociaux du Nord de l'ile de Montreal (Academic / other)
• Locations: 4 sites (Ottawa, Ontario and 3 other locations)
• Trial ID: NCT06306183 on ClinicalTrials.gov

What this trial studies

VICAMED is a multicentre, triple-blind, randomized, placebo-controlled trial conducted at three Canadian university-affiliated emergency departments. Adults (≥18 years) presenting within 48 hours of an acute musculoskeletal injury with pain ≥4/10 are randomized to receive a single 900 mg oral dose of vitamin C or placebo, with a subgroup taking 900 mg twice daily for three days for the secondary outcome. The primary outcome is pain intensity one hour after administration and the main secondary outcome is the 72-hour time-weighted sum of pain-intensity difference (SPID). Key exclusions include recent vitamin C use, active cancer, recent opioid use, chronic pain treatment, certain metabolic or liver conditions, and use of cyclosporine or warfarin.

Who should consider this trial

Good fit: Adults aged 18 or older who present to the ED within 48 hours of an acute musculoskeletal injury, are triaged to ambulatory care, report pain ≥4/10, can complete follow-up in English or French, and do not meet exclusion criteria are ideal candidates.

Not a fit: Patients who are hospitalized after ED evaluation, treated for chronic pain, recently used opioids or vitamin C, or who have contraindications such as hemochromatosis, oxalate nephropathy, liver cirrhosis, or are on warfarin/cyclosporine are unlikely to benefit or be eligible.

Why it matters

Potential benefit: If effective, vitamin C could offer a low-cost, widely available, and opioid-sparing way to reduce short-term pain after acute musculoskeletal injuries.

How similar studies have performed: Previous postoperative and surgical trials and meta-analyses have reported reduced pain and opioid use with vitamin C, but this is the first randomized trial targeting acute traumatic musculoskeletal pain in the ED setting.

Eligibility criteria

Inclusion Criteria:

1. Age ≥ 18 years old
2. Presenting to the ED with acute MSK pain of ≤ 48 hours duration at triage
3. Verbal numerical rating scale pain intensity at triage of ≥ 4 on a 0-10 scale
4. Triaged to the ambulatory section of the ED
5. Able to communicate in French or English

Exclusion Criteria:

1. Usage of Vit C supplements in the last week
2. Active cancer
3. Treated with opioids for any pain within 24 hours prior to recruitment
4. Treatment for chronic pain
5. Unable to fill out a pain intensity diary or unavailable for follow-up
6. Allergy to milk (lactose in the placebo) or Vit C
7. Treated with cyclosporine or warfarin
8. Pre-existing oxalate nephropathy, liver cirrhosis or hemochromatosis
9. Hospitalized after clinician evaluation

Where this trial is running

Ottawa, Ontario and 3 other locations

• The Ottawa Hospital - General and Civic Campus — Ottawa, Ontario, Canada (Not_yet_recruiting)
• Hôtel-Dieu de Lévis — Lévis, Quebec, Canada (Not_yet_recruiting)
• Hopital du Sacre-Coeur de Montreal — Montreal, Quebec, Canada (Recruiting)
• CHU de Québec - Université Laval — Québec, Quebec, Canada (Not_yet_recruiting)

Study contacts

• Principal investigator: Raoul Daoust, MD MSc — Université de Montréal
• Study coordinator: Martin Marquis, MSc

Conditions Pain, Acute; Vitamin C; NSAID; Emergency department; Pain; RCT