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Vitamin B and pain

As a chiropractor I can’t prescribe medication to my patients but I can recommend alternatives that may assist with pain relief. I had learned awhile back that low levels of B vitamins, specifically B12, could be the result of pain in patients.  So is this true? Could simply increasing your B vitamin levels help with your pain? I decided to do some research.  Here is what I learned

  1. Adding B vitamins to diclofenac (a non steroidal anti-inflammatory, NSAID) is more effective than diclofenac alone
  2. Less diclofenac is needed when B-vitamins are added
  3. The injection of B12 Vitamin into those with lower back pain resulted in less need for pain medication.
  4. Reduced treatment time for those with lower back pain when B vitamins added to diclofenac
  5. Low levels of B12 associated with myofascial pain.  note: Low levels of  zinc are significantly decreased in those with myofascial pain.

Does this mean that if we consume higher levels of B  vitamins we will have less pain? I am not 100% sure but there seems to be a connection.  It might be worthwhile to add a multivitamin or B vitamin complex to aid in pain.  I’d like to find more research on the subject

Dr Notley

Effect of diclofenac with B vitamins on the treatment of acute pain originated by lower-limb fracture and surgery.

Source

Área Académica de Medicina del Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, 42090 Pachuca, HGO, Mexico.

Abstract

The aim of this study was to compare the efficacy of diclofenac, for the treatment of acute pain originated by lower-limb fracture and surgery, with that of diclofenac plus B vitamins. This was a single-center, prospective, randomized, and double-blinded clinical trial. Patients with lower-limb closed fractures rated their pain on a 10 cm visual analog scale (VAS). Patients were then randomized to receive diclofenac or diclofenac plus B vitamins (thiamine, pyridoxine, and cyanocobalamin) intramuscularly twice daily. Patient evaluations of pain intensity were recorded throughout two periods: twenty-four hours presurgery and twenty-four hours postsurgical. One hundred twenty-two patients completed the study. The subjects’ assessments of limb pain on the VAS showed a significant reduction from baseline values regardless of the treatment group. Diclofenac plus B vitamins combination was more effective to reduce the pain than diclofenac alone. The results showed that the addition of B vitamins to diclofenac increased its analgesic effect. The novelty of this paper consists in that diclofenac and diclofenac plus B vitamins were useful for treatment of acute pain originated by lower-limb fracture and surgery.

Eur Rev Med Pharmacol Sci. 2000 May-Jun;4(3):53-8.

Vitamin B12 in low back pain: a randomised, double-blind, placebo-controlled study.

Source

Clinica Ortopedica e Traumatologica con Fisioterapia e Medicina dello Sport, Università degli Studi di Palermo, Italy.

Abstract

OBJECTIVES:

The objective of this double-blind randomised, placebo-controlled study was to examine the efficacy and safety intramuscular vitaminB12 (Tricortin 1000) in the treatment of low back pain in patients with mechanical or irritative lumbago.

METHODS:

60 patients aged between 18 and 65 years with lumbago or sciatic neuritis of mechanical origin without need for surgical procedures were enrolled. Patients had to present with a proven medical history for back pain (lasting from 6 months to 5 years) and a pain intensity [as evaluated with a Visual Analogic Scale (VAS)] equal or greater than 60 mm. Efficacy primary end-point was evaluated by means of a visual analogic scale (VAS) and a Disability Questionnaire (DQ). Consumption of paracetamol during the study period was the secondary efficacy end-point.

RESULTS:

Both treatment groups experienced a sharp decrease in pain and disability. However, comparison between groups at the end of the treatment period showed a statistically significant difference in favour of the active treatment both for VAS and DQ (p < 0.0001 and p < 0.0002, respectively). Consumption of paracetamol proved significantly higher in the placebo group than in the active treatment (p < 0.0001).

CONCLUSIONS:

The efficacy and safety of parenteral Vitamin B12 in alleviating low back pain and related disability and in decreasing the consumption of paracetamol was confirmed in patients with no signs of nutritional deficiency.

Curr Med Res Opin. 2009 Nov;25(11):2589-99. doi: 10.3111/13696990903246911.

Diclofenac plus B vitamins versus diclofenac monotherapy in lumbago: the DOLOR study.

Source

Centro Universitário Serra dos Orgãos (UNIFESO), Rio de Janeiro, Brazil.

Abstract

OBJECTIVES:

To assess the influence of vitamins B1, B6 and B12 on the analgesia success achieved by diclofenac in subjects with acute lumbago.

RESEARCH DESIGN AND METHODS:

A randomised, double blind controlled clinical study in parallel groups, in which subjects received twice-daily oral administration of either the combination therapy, Group DB (50 mg diclofenac plus 50 mg thiamine, 50 mg pyridoxine and 1 mg cyanocobalamin) or diclofenac monotherapy, Group D (50mg diclofenac). The study period lasted a maximum of 7 days. If sufficient pain reduction was achieved (defined as Visual Analogue Scale <20 mm and patient’s satisfaction), subjects could withdraw from the treatment after 3 or 5 days. All subjects gave written informed consent to participate in the study. Main outcome measures: The primary confirmatory study objective was to determine the number of patients with sufficient pain reduction after 3 days of treatment.

RESULTS:

Three hundred and seventy-two subjects were allocated at random to either treatment group: Group DB – 187 subjects and Group D – 185 subjects. After 3 days of treatment, a statistically significant higher proportion of subjects in Group DB (n = 87; 46.5%) than in Group D (n = 55; 29%) terminated the study due to treatment success (chi(2): 12.06; p = 0.0005). Furthermore, the combination therapy yielded superior results in pain reduction, improvement of mobility and functionality. Drug safety monitoring profile throughout the trial was within the expected safety profile of diclofenac.

CONCLUSIONS:

The combination of diclofenac with B vitamins was superior to diclofenac monotherapy in lumbago relief after 3 days of treatment. As a study drawback, daily VAS measurements were only recorded until subject withdrawal from treatment, whether after 3, 5, or 7 days. There were no differences in safety profile between the two study groups.

Klin Wochenschr. 1990 Jan 19;68(2):107-15.

[Reduced diclofenac administration by B vitamins: results of a randomized double-blind study with reduced daily doses of diclofenac (75 mg diclofenac versus 75 mg diclofenac plus B vitamins) in acute lumbar vertebral syndromes].

[Article in German]

Source

Deutsches Krebsforschungszentrum Heidelberg.

Abstract

Pain syndromes of the lumbar spine are one of the main problems in orthopedic practice. The therapeutic effect of NSAIDs is not subject to doubt in this connection. But considering that the application of NSAIDs is frequently associated with side effects, a reduction of dosage would be to the patient’s benefit. Clinical studies have shown that concomitant treatment with vitamins B1, B6, B12 and diclofenac leads to a more efficient pain relief than treatment using diclofenac alone and thus provides the possibility of saving NSAIDs. This clinical trial was carried out in order to determine whether these results can also be achieved when a reduced dosage of diclofenac (75 mg daily) is used. 123 patients with acute pain syndromes of the lumbar spine were treated with either B-vitamins and diclofenac or diclofenac alone for a maximum of 7 days. There was the option to terminate therapy in the trial after 3-4 days in the case of total pain relief. 45 patients could stop the treatment due to remission of symptoms. 30 patients belonged to the combination therapy group, the other 15 took diclofenac alone; this difference is statistically significant (p less than 0.05). All parameters concerning pain relief and movement of the vertebral column showed statistically significant differences in favour of the B-vitamin-diclofenac-combination, too. The results document the positive influence of B-vitamins on painful vertebral syndromes and indicate that B-vitamins contribute to saving of NSAIDs by shortening the treatment time and reducing daily NSAID-dosage.
Z Rheumatol. 1988 Sep-Oct;47(5):351-62.

[Shortening diclofenac therapy by B vitamins. Results of a randomized double-blind study, diclofenac 50 mg versus diclofenac 50 mg plus B vitamins, in painful spinal diseases with degenerative changes].

[Article in German]

Source

Klinik Auerbach, Bensheim.

Abstract

The use of nonsteroidal anti-inflammatory drugs (NSAID) such as diclofenac for treatment of degenerative rheumatic disorders of the lumbar spine is of great significance in orthopedic practice. Clinical studies have shown that concomitant treatment with vitamins B1, B6, B12 and diclofenac provides more efficient pain relief than treatment using diclofenac alone. This study was undertaken in order to determine whether the duration of treatment with diclofenac for lower back pain can be shortened by adding B-vitamins to the therapeutic regimen. From September through December of 1986, 256 patients participated in a multicenter, controlled, randomized double-blind trial which compared the clinical efficacy of diclofenac (50 mg) with a combined therapy of diclofenac (50 mg) and vitamins B1, B6, and B12 (thiamine nitrate, pyridoxine hydrochloride, and cyanocobalamine, resp.; in dosages of 50 mg, 50 mg, and 0.25 mg, resp.). Patients were treated with 3 X 1 capsule daily for a maximum of two weeks, having the option to terminate participation in the trial after 1 week in the event of total pain relief. The data of 238 patients were able to be included in the evaluation. 29 patients opted to discontinue therapy due to remission on symptoms. Nineteen (65.6%) of these patients belonged to the combined therapy group, the other 10 (34.4%) having taken diclofenac alone; this difference is statistically significant (p less than 0.05). An important aspect in the evaluation of therapy was the patient response regarding the improvement of painful symptoms which, in addition to their subjective feedback, was reflected in the test results of the “Hoppe Pain Questionnaire (HPQ).” All parameters used as a measure of pain relief indicated superior results with the B-vitamin supplemented therapy when compared with results obtained with diclofenac alone. Moreover, after 3 days of therapy the “sensory”pain factor “sharpness” improved significantly. Undesirable side-effects were documented with 39 patients, 14 of them having discontinued therapy for this reason. No statistically significant difference could be determined within this group with regard to therapy. The study results document the positive influence of B-vitamins on painful symptoms and indicate that less NSAID is needed for pain relief when combined with B-vitamins.
Klin Wochenschr. 1990 Jan 19;68(2):116-20.

[Results of a double-blind study of diclofenac + vitamin B1, B6, B12 versus diclofenac in patients with acute pain of the lumbar vertebrae. A multicenter study].

[Article in German]

Source

Weserberglandklinik, Höxter.

Abstract

Several clinical trials have shown that the duration of treatment of painful vertebral syndromes can be shortened by using a combination of vitamins B1, B6, B12 and diclofenac instead of diclofenac. In addition, a more efficient pain relief could be achieved by the combination therapy. In order to confirm these results, we compared the clinical efficacy of diclofenac (25 mg) and a combination preparation with diclofenac (25 mg) plus vitamins B1 (thiamine nitrate 50 mg), B6 (pyridoxine hydrochloride 50 mg) and B12 (cyanocobalamin 0.25 mg) in a multicentric randomized double-blind study including 418 patients. All patients received 3 x 2 capsules daily for a maximum of 2 weeks. In case of total pain relief, therapy should be discontinued after one week. Data of 376 patients could be evaluated. 53 out of 184 patients receiving the combination and 48 out of 192 patients treated with diclofenac alone could stop therapy due to sufficient pain relief after one week. The evaluation of the “Hoppe Pain Questionnaire” and the data concerning pain intensity also revealed better results for the combination preparation. The differences in favour of the B-vitamin-diclofenac-combination were statistically significant in patients with severe pain at the beginning of therapy. Considering undesirable side-effects (symptoms in 70 out of 418 patients) there were no significant differences between the two medications. This clinical trial provides further evidence that the combination therapy with diclofenac plus B-vitamins is more effective than diclofenac alone for the treatment of painful vertebral syndromes.

Singapore Med J. 2011 Dec;52(12):868-73.

The efficacy and safety of intramuscular injections of methylcobalamin in patients with chronic nonspecific low back pain: a randomised controlled trial.

Source

Department of Orthopaedic Surgery, International Medical University, Clinical School, Seremban 70300, Malaysia. cheekidd_chiu@imu.edu.my

Abstract

INTRODUCTION:

Chronic, nonspecific low back pain is a difficult ailment to treat and poses an economic burden in terms of medical expenses and productivity loss. The aim of this study was to determine the efficacy and safety of intramuscular metylcobalamin in the treatment of chronic nonspecific low back pain.

METHODS:

This was a double-blinded, randomised, controlled experimental study. 60 patients were assigned to either the methylcobalamin group or the placebo group. The former received intramuscular injections of 500 mcg parenteral methylcobalamin in 1 ml solution three times a week for two weeks, and the placebo group received 1 ml normal saline. Patients were assessed with Oswestry Disability Index questionnaire Version 2.0 and Visual Analogue Scale pain score. They were scored before commencement of the injections and at two months interval.

RESULTS:

Of the 60 patients, 27 received the placebo injections and 33 were given methylcobalamin injections. A total of 58 patients were available for review at two months (placebo: n is 26; methylcobalamin: n is 32). There was a significant improvement in the Oswestry Disability Index and Visual Analogue Scale pain scores in the methylcobalamin group as compared with the placebo group (p-value less than 0.05). Only minor adverse reactions such as pain and haematoma at the injection sites were reported by some patients.

CONCLUSION:

Intramuscular methylcobalamin is both an effective and safe method of treatment for patients with nonspecific low back pain, both singly or in combination with other forms of treatment.

The relationship between serum trace elements, vitamin B12, folic acid and clinical parameters in patients with myofascial pain syndrome.

Source

Department of First Physical Medicine and Rehabilitation, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey.drmuyesser@hotmail.com

Abstract

BACKGROUND:

Myofascial pain syndrome (MPS) is characterized by myofascial trigger points in a palpable taut band of skeletal muscle.

OBJECTIVE:

We aimed to investigate serum trace elements, vitamin B12, folic acid levels and their correlations with clinical findings and functional status in patients with MPS.

METHODS:

Thirty eight patients with at least one trigger point located on shoulder muscles, and at least 6 months duration, were included in this study. The demographic data, disease duration of patients were noted. Serum copper, zinc, magnesium and iron levels, vitamin B12 and folic acid levels were measured. Visual analogue scale (VAS) was implemented to estimate daily severity of pain. Pain pressure threshold of subjects and control groups were assessed by using Fischer’s tissue compliancemeter. The Turkish version of the Beck Depression Inventory (BDI) was administered for the presence of any depressive disorder.

RESULTS:

The mean age of patients in MPS group and control group were 33.1 and 37.8 years respectively. Serum levels of zinc (p< 0.006) were significantly decreased in patients with MPS. VAS, total myalgic and BDI scores of patients were significantly higher than the control group (Respectively p< 0.000, p< 0.012, p< 0.000). Association between TMS and magnesium, vitamin B12 levels was found statistically significant. BDI score correlated significantly with the serum zinc level (r:-0.548, p< 0.001) and VAS in patients with MPS (r:0.641, p< 0.000).

CONCLUSION:

According to the results of this study, it was asserted that trace elements, vitamins may play an important role in the pathophysiology of MPS and psychological factors may also have additional effect.

Originally posted 2013-08-28 18:35:41.