Back pain brings about one of the heaviest burden of disease. Despite much research, this condition remains poorly understood, and effective treatments are frustratingly elusive. Thus, researchers in the field need to consider new hypotheses. Vitamin C (ascorbic acid) is an essential cofactor for collagen crosslinks, a key determinant of ligament, tendon, and bone quality. Recent studies have reported high frequency of hypovitaminosis C in the general population. We hypothesized that lack of vitamin C contributes to poor collagen properties and back pain. We conducted this study to examine the associations between serum concentration of vitamin C and the prevalence of spinal pain and related functional limitations in the adult general population. This study used nationwide cross-sectional data from the U.S. National Health and Nutrition Examination Survey (NHANES) 2003–2004. Data were available for 4742 individuals aged ≥20 years. Suboptimal serum vitamin C concentrations were associated with the prevalence of neck pain (adjusted odds ratio [aOR]: 1.5; 95% confidence interval [CI]: 1.2-2.0), low back pain (aOR: 1.3; 95% CI: 1.0-1.6), and low back pain with pain below knee (aOR: 1.3; 95% CI: 1.0-1.9) in the past 3 months, self-reported diagnosis of arthritis/rheumatism (aOR: 1.4; 95% CI: 1.2-1.7), and related functional limitations' score (adjusted difference of means [aB]: 0.03; 95% CI: 0.00-0.05). The prevalence of hypovitaminosis C in the general population is high. Our study shows associations between vitamin C and spinal pain that warrant further investigation to determine the possible importance of vitamin C in the treatment of back pain patients.
Supplemental Digital Content is Available in the Text.In a large sample representative of the US general adult population, lower serum concentrations of vitamin C were inversely statistically associated with most spinal outcomes, suggesting that hypovitaminosis C might be a contributing factor to back pain.
aCentre de recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada
bQuebec Centre of Excellence on Aging (CEVQ), Centre de recherche du CHU de Québec-Université Laval, Quebec City, QC, Canada
cDepartment of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
dFaculty of Pharmacy, Université Laval, Quebec City, QC, Canada
eSchool of Nutrition, Université Laval, Quebec City, QC, Canada
fDepartment of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
gEmergency Department, CHU de Québec-Université Laval, Quebec City, QC, Canada
hDepartment of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
Corresponding author. Address: Centre de recherche du CHU de Québec-Université Laval, Hôpital du Saint-Sacrement, 1050, Chemin Ste-Foy, Québec, QC, Canada, G1S 4L8. Tel.: (418) 682-7511, ext. 84675; fax: (418) 682-7949. E-mail address: firstname.lastname@example.org (C. E. Dionne).
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Received January 21, 2016
Received in revised form July 08, 2016
Accepted July 12, 2016