Musculoskeletal (MSK) injuries such as sprains, strains, bruises, and fractures are among the most common reasons people visit the emergency department. These injuries often cause significant pain in the first few days, making it difficult to move, work, or sleep. Usual pain medications like ibuprofen or acetaminophen can help, but they are not safe or effective for everyone. Some people cannot take them because of heart, kidney, stomach, or liver problems. Others still experience strong pain despite treatment. Because of these limits, some patients receive opioids, which can cause side effects and carry a risk of dependence. Safer and more accessible options are needed.
Vitamin C is widely known for supporting the immune system, but research suggests it may also help reduce pain and inflammation. Studies in surgical patients have shown that vitamin C can lower pain levels, reduce the need for opioids, and support healing. These effects may be linked to its antioxidant properties and its role in tissue repair. However, no study has tested whether vitamin C can help people with recent MSK injuries treated in the emergency department.
The VICAMED study aims to answer this question. Adults arriving with an MSK injury that occurred within the past 48 hours can participate if they have at least moderate pain. Participants are randomly assigned to receive either vitamin C or a placebo. The first dose is given in the emergency department, followed by twice daily capsules for three days. Pain is measured using a simple 0-100 scale, recorded in an electronic or paper diary. A follow-up on day six helps the research team understand each participant's recovery, medication use, and overall experience.
Vitamin C is inexpensive, widely available, and very safe at the doses used in this study. If it proves effective, it could offer a simple, low risk option to help patients manage pain after an MSK injury and reduce the need for opioids in emergency care.
Age ≥ 18 years old
Presenting to the ED with acute MSK pain of ≤ 48 hours duration at triage
Verbal numerical rating scale pain intensity at triage of ≥ 4 on a 0-10 scale
Triaged to the ambulatory section of the ED
Usage of Vit C supplements in the last week
Active cancer
Treated with opioids for any pain within 24 hours prior to recruitment
Treatment for chronic pain
Parallel
Vitamin C
Dietary supplement900 mg vitamin C taken orally twice a day (one in the morning and one in the evening) for a 3-day period after ED discharge for the treatment arm.
Placebo
Other interventionPlacebo taken orally twice a day (one in the morning and one in the evening) for a 3-day period after ED discharge for the treatment arm.
Time-weighted sum of the pain-intensity difference (SPID)
The primary outcome is the time-weighted sum of the pain-intensity difference (SPID) over the three-day treatment period on a 0-100 visual analog scale (VAS), where 0 is no pain and 100 the worst pain imaginable. The SPID accounts for both the magnitude of the pain change and its duration, producing a single value that reflects the patient's overall experience.
Difference in pain intensity
The main secondary outcome is the difference in pain intensity, also measured on a 0-100 visual analog scale (VAS), where 0 is no pain and 100 the worst pain imaginable, between groups one hour after taking the first study drug in the ED.
Consumption of as-needed pain medication
Participants will be asked the name and the total amount of pain medication taken during the three-day follow-up.
Time for significant pain relief
Time for significant pain relief, reported in hours, is define in a 50% reduction in pain intensity.
Time to pain-free
Time, reported in hours, when pain reach 0 on a 0-100 visual analog scale (VAS), where 0 is no pain and 100 the worst pain imaginable
Click on the lead sponsor to view all of their trials.
Centre Integre Universitaire de Sante et Services Sociaux du Nord de l'ile de Montreal
Lead sponsor
Hopital de l'Enfant-Jesus
Collaborator
The Ottawa Hospital
Collaborator
