Comparative Effectiveness of B and E Vitamins with Diclofenac in Reducing Pain Due to Osteoarthritis of the Knee

Abstract

Background:Knee osteoarthritis is one of the most prevalent chronic disorders. Several pharmacological and non pharmacological approaches are used to treat this disease. Today, the effect of B and E vitamins on rheumatology diseases is being discussed. In this study, the efficacy of B and E vitamins accompanied with diclofenac on pain relief in patients with knee osteoarthritis was investigated and compared.Methods:In this double-blinded clinical trial, 120 patients with knee osteoarthritis referring training Rheumatology and Orthopedics Clinic of Shahrekord University of Medical sciences were investigated. Of these patients, 12 were excluded throughout the study. The patients underwent treatment in three groups (oral diclofenac + oral B vitamin, oral diclofenac + oral vitamin E, and oral diclofenac + placebo). Pain relief was assessed by visual analogue scale (VAS) questionnaire and morning stiffness and physical function were assessed by WOMAC standard questionnaire at three times; the first examination, two weeks, and three weeks after referring.Results:The mean score of WOMAC questionnaire at VASs of knee pain, total pain severity, knee joint stiffness, and function of the last 48 hours decreased significantly in all three groups (diclofenac, E and B vitamins) from the first to third examination (P<0.001). Decrease in VAS of knee pain and function of the last 48 hours was higher in B vitamin group than the diclofenac and E vitamin group (P=0.008) and decrease in total pain severity was reported higher in B vitamin group than E vitamin and diclofenac group (P=0.019). Decrease in knee joint stiffness underwent a similar trend in the three groups.Conclusion:In view similar analgesic and anti-inflammatory properties, as well as very few, non prevalent complications of B and E vitamins, use of two or more drugs with a different mechanism of effect seems necessary to enhance their effect on osteoarthritis treatment.

Alteration of Metabolic Pathways in Osteoarthritis

“…The study suggests that vitamins K, B, and C may have a protective role against knee OA and might lead to disease-modifying treatments, in part via the Krebs cycle. A clinical trial showed that vitamin B complex including thiamine, niacin, and cobalamin significantly reduced knee pain in knee OA patients and the decrease in knee pain was significantly higher in the patients taking vitamin B complex than those in the vitamin E and diclofenac (COX-2 inhibitor) groups [31]. While B vitamins, such as thiamine, riboflavin, and niacin, are important for the Krebs cycle for energy production, their pain reduction effect observed in this clinical trial might be also via other pathways, such as anti-inflammatory pathways or an enhanced effect and/or availability of norepinephrine, as proposed by the authors [31].…”

Nutmeg oil alleviates chronic inflammatory pain through inhibition of COX-2 expression and substance P release in vivo

“…Diclofenac, which belongs to the nonsteroidal anti-inflammatory drugs, is probably the most commonly used pain reliever ( 32 ). As an anti-inflammatory and analgesic drug, it is probably the most efficient inhibitor of prostaglandins, which are used for treatment of rheumatic diseases ( 33 ) and post-operational pain relievers ( 34 ).…”

Therapeutic Agents for the Treatment of Temporomandibular Joint Disorders: Progress and Perspective

“…An intramuscular injection of diclofenac + B vitamin mixture showed a superior analgesic effect compared with the injection of diclofenac alone (Magaña- Villa et al, 2013). A human experiment of patients with knee OA indicated stronger analgesic property of vitamin B than vitamin E and diclofenac; the study highlighted the potential effects of vitamin B on TMD (Dehghan, 2015). Mechanically, the anti-inflammatory and analgesic effect may relate to the cyclooxygenase pathway and opioid receptors (Tamaddonfard et al, 2018).…”