Herpes zoster (HZ) is an acute inflammatory neurocutaneous disease caused by the reactivation of varicella-zoster virus. It is estimated that the incidence of postherpetic neuralgia following HZ is 10–20%.
Epidemiological evidence and clinical studies have indicated an association between pain and suboptimal vitamin C status. At present, vitamin C has been used as an additional option in the treatment of HZ-associated pain.
Despite the current controversy, case reports and randomized controlled studies have indicated that both acute and postherpetic neuralgia can be dramatically alleviated following intravenous vitamin C infusions.
[I]ntravenous infusion of vitamin C was applied and resulted in an immediate remission of the breakthrough pain in the male patient and cutaneous lesions in the female patient.
Herpes zoster (HZ) is an acute inflammatory neuroutaneous disease caused by the reactivation of varicella-zoster virus (VZV)…
Postherpetic neuralgia (PHN), which is the most frequent chronic complication of HZ and the most common peripheral neuropathic pain resulting from infection, is defined as pain persisting more than 30 days after the onset of the rash…
Treatment for HZ is focused on inhibiting viral replication, alleviating pain, and preventing PHN.
Despite several therapeutic modalities for herpes zoster and its complications, the treatment remains a challenge.
It has been confirmed that aging and suppressed cellular immunity are the strongest risk factors for both HZ and PHN.
Therefore, enhancing the immune function of patients is an important therapeutic strategy, especially in the elderly frail patients.
Vitamin C is an essential micronutrient in many metabolic pathways, acting as a water-soluble antioxidant, and plays a key role in enhancing white blood cell function and promoting protein metabolism and neurotransmitter production.
Epidemiological evidence has indicated an association between several models of pain (musculoskeletal, virus-associated, cancer-related, and postsurgical pain) and suboptimal vitamin C status.
A community-based case-control study has revealed that lower vitamin C intake significantly increases HZ risk…
Another study has shown that the concentration of vitamin C in the plasma of PHN patients is lower, and the high sensitivity of PHN patients to vitamin C deficiency may be a permanent factor in the formation of chronic neuropathic pain.
[Patient 2] has prescribed 75mg pregabalin along with paracetamol/tramadol (37.5 mg/325 mg) three times per day. There was no pain relief on the second day. Therefore, paracetamol/tramadol was replaced by 100 mg tramadol hydrochloride every 12 hours. Two days later, the VAS dropped to 6, but her duration of sleep at night still lasted for no more than 3 hours…
4g vitamin C was administered intravenously on the fourth day of hospitalization. However, it did not alleviate the pain, and therefore, vitamin C dose was added up to 8 g the next day.
After 5 days of treatment, the patient claimed that the pain was unperceivable, and there was a significant improvement in her eyelid edema. At 3-month follow-up, she continued to be pain-free without any complications.
Studies have shown that the decline of cell-mediated immune function plays a critical role in the reactivation of VZV infection and the development of PHN; therefore, investigating the role of immune-relevant micronutrition from the therapeutic point of view is worth- while.
In summary, low plasma levels of vitamin C detected in PHN patients may be due to the excessive oxygen-free radicals caused by a varicella-zoster infection in the early stage.