What if it is just vitamin C deficiency? The role of vitamin C deficiency in musculoskeletal pain. Mechanisms, clinical implications, and therapeutic approaches

Subclinical vitamin C deficiency, while less apparent than scurvy, is increasingly recognized as a contributing factor to idiopathic musculoskeletal pain, yet it remains underdiagnosed in clinical settings. This review consolidates mechanistic and clinical evidence that links vitamin C insufficiency to dysfunction in joints, bones, and muscles, advocating for its integration into pain management protocols. A comprehensive literature analysis of peer-reviewed studies was conducted, focusing on the roles of vitamin C in collagen biosynthesis, antioxidant defense, and immunomodulation. Clinical trials, observational studies, and mechanistic research were evaluated to clarify associations with musculoskeletal symptoms and therapeutic outcomes. Vitamin C deficiency disrupts collagen stability, increases oxidative stress, and triggers pro-inflammatory cytokine cascades, leading to nonspecific myalgia, arthralgia, and delayed recovery. High-risk populations, including smokers, the elderly, bariatric surgery patients, and socioeconomically disadvantaged groups, are disproportionately affected. Repletion trials indicate that vitamin C supplementation can reduce pain and improve functional outcomes, supporting its therapeutic use. Clinicians should routinely screen for vitamin C deficiency in patients presenting with unexplained musculoskeletal pain, particularly among at-risk groups. Evidence-based supplementation, dietary modifications, and interdisciplinary collaboration are essential to address this reversible contributor to chronic pain. The prevalence of vitamin C deficiency remains a significant public health concern, with estimates suggesting that approximately 7% of the U.S. population is affected, based on NHANES data from 2003 to 2006 and 2017–2018. In India, the prevalence is notably higher, with 74% of adults in North India and 46% in South India exhibiting deficiency, with men showing a higher prevalence than women. Further research is necessary to establish causality and optimize dosing regimens to mitigate the burden of vitamin C deficiency on musculoskeletal health.