vitamin-b-12 and Neuralgia

Pain is a complex sensory and emotional experience with nociceptive, nociplastic, and neuropathic components. An involvement of neurotropic B vitamins (B1 - thiamine, B6 - pyridoxine, and B12 - cyanocobalamin) as modulators of inflammation and pain has been long discussed. New evidence suggests their therapeutic potential in different pain conditions. In this review, we discuss the main role of neurotropic B vitamins on different nociceptive pathways in the nervous system and to describe their analgesic action mechanisms. The performed literature review showed that, through different mechanisms, these vitamins regulate several inflammatory and neural mediators in nociceptive and neuropathic pain. Some of these processes include aiming the activation of the descending pain modulatory system and in specific intracellular pathways, anti-inflammatory, antioxidative and nerve regenerative effects. Moreover, recent data shows the antinociceptive, antiallodynic, and anti-hyperalgesic effects of the combination of these vitamins, as well as their synergistic effects with known analgesics. Understanding how vitamins B1, B6, and B12 affect several nociceptive mechanisms can therefore be of significance in the treatment of various pain conditions.

Topics: Analgesics; Humans; Neuralgia; Pyridoxine; Thiamine; Vitamin B 12; Vitamin B Complex

Peripheral neuropathy (PN) is an insidious disease that is often asymptomatic during the early stages but which can have a significant impact on quality of life at later stages when nerve damage occurs. There is currently no guidance on the use of neurotropic B vitamins (B1, B6, and B12) for the management of asymptomatic and symptomatic PN.. To provide guidance to primary care physicians on an integrated approach to managing PN with neurotropic B vitamins (B1, B6, and B12).. A multidisciplinary panel of eight experts participated in an iterative quasi-anonymous Delphi survey consisting of two rounds of questions and a virtual meeting. A literature review formed the basis of the survey questions. The first round included multiple select, qualitative, and Likert Scale questions; the subsequent round consisted of 2-point scale (agree or disagree) questions that sought to develop consensus-based statements refined from the first round and recommendations derived from discussions during the virtual expert panel meeting.. Clinical recommendations for the use of neurotropic B vitamins (B1, B6, and B12) have been developed for the prevention of PN progression or to delay onset in patients at high risk of developing PN. Recommendations have also been provided for the assessment of PN etiology and considerations for the use of loading dose (high dose) and maintenance dose (lower dose) of these neurotropic B vitamins (B1, B6, and B12).. These clinical recommendations provide an initial step towards formulating comprehensive guidelines for the early and long-term management of PN with neurotropic B vitamins (B1, B6, and B12) and move beyond addressing only neuropathic pain associated with the late stages of PN.

Topics: Consensus; Humans; Neuralgia; Quality of Life; Vitamin A; Vitamin B 12; Vitamin B Complex

Neuropathic pain describes a range of unpleasant sensations caused by a lesion or disease of the somatosensory nervous system. The sensations caused by neuropathic pain are debilitating and improved treatment regimens are sought in order to improve the quality of life of patients. One proposed treatment for neuropathic pain is vitamin B12, which is thought to alleviate pain by a number of mechanisms including promoting myelination, increasing nerve regeneration and decreasing ectopic nerve firing. In this paper, the evidence for B12 as a drug treatment for neuropathic pain is reviewed. Twenty four published articles were eligible for inclusion in this systematic review in which a range of treatment regimens were evaluated including both B12 monotherapy and B12 in combination with other vitamins or conventional treatments, such as gabapentinoids. Overall, this systematic review demonstrates that there is currently some evidence for the therapeutic effect of B12 in the treatment of post-herpetic neuralgia (level II evidence) and the treatment of painful peripheral neuropathy (level III evidence).

Topics: Clinical Trials as Topic; Humans; Neuralgia; Observational Studies as Topic; Peripheral Nervous System Diseases; Treatment Outcome; Vitamin B 12

Complementary and alternative treatment modalities are commonly utilized by patients for neuropathy and neuropathic pain due to perceived lack of benefit from conventional medical treatment. As the association between metabolic syndrome and neuropathy is increasingly recognized, diet and lifestyle interventions are becoming important components in the management of neuropathy. Progress in the understanding of the gut-immune interaction highlights the role the gut microbiome and inflammation plays in the modulation of neuropathy and neuropathic pain. Evidence for nutritional interventions, exercise, supplements, acupuncture, and mindfulness-based practices in the treatment of neuropathic pain is encouraging. This article reviews the available evidence to support the safe use of complementary and alternative treatments for commonly encountered conditions associated with neuropathy and neuropathic pain. Muscle Nerve 60: 124-136, 2019.

Topics: Acetylcarnitine; Anti-Inflammatory Agents, Non-Steroidal; Curcumin; Diet; Diet Therapy; Dietary Supplements; Dysbiosis; Exercise; Exercise Therapy; Fatty Acids, Omega-3; Folic Acid; Gastrointestinal Microbiome; Humans; Integrative Medicine; Life Style; Metabolic Syndrome; Neuralgia; Peripheral Nervous System Diseases; Pyridoxal Phosphate; Thioctic Acid; Vitamin B 12; Vitamin B Complex; Vitamin B Deficiency; Vitamin D

Diabetic peripheral neuropathy (DPN) is a common and severe complication that affects 50% of people with diabetes. Painful DPN is reported to occur in 16% to 24% of people with diabetes. A complete and comprehensive management strategy for the prevention and treatment of DPN, whether painful or not, has not yet been defined.Research into treatment for DPN has been characterised by a series of failed clinical trials, with few noteworthy advances. Strategies that support peripheral nerve regeneration and restore neurological function in people with painful or painless DPN are needed. The amino acid acetyl-L-carnitine (ALC) plays a role in the transfer of long-chain fatty acids into mitochondria for β-oxidation. ALC supplementation also induces neuroprotective and neurotrophic effects in the peripheral nervous system. Therefore, ALC supplementation targets several mechanisms relevant to potential nerve repair and regeneration, and could have clinical therapeutic potential. There is a need for a systematic review of the evidence from clinical trials.. To assess the effects of ALC for the treatment of DPN.. On 2 July 2018, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, LILACS, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. We checked references, searched citations, and contacted study authors to identify additional studies.. We included randomised controlled trials (RCTs) and quasi-RCTs of ALC compared with placebo, other therapy, or no intervention in the treatment of DPN. Participants could be of any sex and age, and have type 1 or type 2 diabetes mellitus, of any severity, with painful or painless DPN. We accepted any definition of minimum criteria for DPN, in accordance with the Toronto Consensus. We imposed no language restriction.Pain was the primary outcome, measured as the proportion of participants with at least 30% (moderate) or 50% (substantial) decrease in pain over baseline, or as the score on a visual analogue scale (VAS) or Likert scale for pain.. We followed standard Cochrane methods.. We included four studies with 907 participants, which were reported in three publications. Three trials studied ALC versus placebo (675 participants); in one trial the dose of ALC was 2000 mg/day, and in the other two trials, it was 1500 mg/day or 3000 mg/day. The fourth trial studied ALC 1500 mg/day versus methylcobalamin 1.5 mg/day (232 participants). The risk of bias was high in both trials of different ALC doses and low in the other two trials.No included trial measured the proportion of participants with at least moderate (30%) or substantial (50%) pain relief. ALC reduced pain more than placebo, measured on a 0- to 100-mm VAS (MD -9.16, 95% CI -16.76 to -1.57; three studies; 540 participants; P = 0.02; I² = 56%; random-effects; very low-certainty evidence; a higher score indicating more pain). At doses of 1500 mg/day or less, the VAS score after ALC treatment was little different from placebo (MD -0.05, 95% CI -10.00 to 9.89; two studies; 159 participants; P = 0.99; I² = 0%), but at doses greater than 1500 mg/day, ALC reduced pain more than placebo (MD -14.93, 95% CI -19.16 to -10.70; three studies; 381 participants; P < 0.00001; I² = 0%). This subgroup analysis should be viewed with caution as the evidence was even less certain than the overall analysis, which was already of very low certainty.Two placebo-controlled studies reported that vibration perception improved after 12 months. We graded this evidence as very low certainty, due to inconsistency and a high risk of bias, as the trial authors did not provide any numerical data. The placebo-controlled studies did not measure functional impairment and disability scores. No study used validated symptom scales. One study performed sensory testing, but the evidence was very uncertain.The fourth included study compared ALC with methylcobalamin, but did not report effects on pain. There was a reduction from baseline to 24 weeks in functional impairment and disability, based on the change in mean Neuropathy Disability Score (NDS; scale from zero to 10), but there was no important difference between the ALC group (mean score 1.66 ± 1.90) and the methylcobalamin group (mean score 1.35 ± 1.65) groups (P = 0.23; low-certainty evidence).One placebo-controlled study reported that six of 147 participants in the ALC > 1500 mg/day group (4.1%) and two of 147 participants in the placebo group (1.4%) discontinued treatment because of adverse events (headache, facial paraesthesia, and gastrointestinal disorders) (P. We are very uncertain whether ALC causes a reduction in pain after 6 to 12 months' treatment in people with DPN, when compared with placebo, as the evidence is sparse and of low certainty. Data on functional and sensory impairment and symptoms are lacking, or of very low certainty. The evidence on adverse events is too uncertain to make any judgements on safety.

Topics: Acetylcarnitine; Adult; Aged; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Female; Humans; Male; Middle Aged; Neuralgia; Pain Measurement; Placebos; Randomized Controlled Trials as Topic; Sensation; Vibration; Vitamin B 12

Neuropathic pain may be caused by nerve damage, and is often followed by changes to the central nervous system. Uncertainty remains regarding the effectiveness and safety of acupuncture treatments for neuropathic pain, despite a number of clinical trials being undertaken.. To assess the analgesic efficacy and adverse events of acupuncture treatments for chronic neuropathic pain in adults.. We searched CENTRAL, MEDLINE, Embase, four Chinese databases, ClinicalTrials.gov and World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) on 14 February 2017. We also cross checked the reference lists of included studies.. Randomised controlled trials (RCTs) with treatment duration of eight weeks or longer comparing acupuncture (either given alone or in combination with other therapies) with sham acupuncture, other active therapies, or treatment as usual, for neuropathic pain in adults. We searched for studies of acupuncture based on needle insertion and stimulation of somatic tissues for therapeutic purposes, and we excluded other methods of stimulating acupuncture points without needle insertion. We searched for studies of manual acupuncture, electroacupuncture or other acupuncture techniques used in clinical practice (such as warm needling, fire needling, etc).. We used the standard methodological procedures expected by Cochrane. The primary outcomes were pain intensity and pain relief. The secondary outcomes were any pain-related outcome indicating some improvement, withdrawals, participants experiencing any adverse event, serious adverse events and quality of life. For dichotomous outcomes, we calculated risk ratio (RR) with 95% confidence intervals (CI), and for continuous outcomes we calculated the mean difference (MD) with 95% CI. We also calculated number needed to treat for an additional beneficial outcome (NNTB) where possible. We combined all data using a random-effects model and assessed the quality of evidence using GRADE to generate 'Summary of findings' tables.. We included six studies involving 462 participants with chronic peripheral neuropathic pain (442 completers (251 male), mean ages 52 to 63 years). The included studies recruited 403 participants from China and 59 from the UK. Most studies included a small sample size (fewer than 50 participants per treatment arm) and all studies were at high risk of bias for blinding of participants and personnel. Most studies had unclear risk of bias for sequence generation (four out of six studies), allocation concealment (five out of six) and selective reporting (all included studies). All studies investigated manual acupuncture, and we did not identify any study comparing acupuncture with treatment as usual, nor any study investigating other acupuncture techniques (such as electroacupuncture, warm needling, fire needling).One study compared acupuncture with sham acupuncture. We are uncertain if there is any difference between the two interventions on reducing pain intensity (n = 45; MD -0.4, 95% CI -1.83 to 1.03, very low-quality evidence), and neither group achieved 'no worse than mild pain' (visual analogue scale (VAS, 0-10) average score was 5.8 and 6.2 respectively in the acupuncture and sham acupuncture groups, where 0 = no pain). There was limited data on quality of life, which showed no clear difference between groups. Evidence was not available on pain relief, adverse events or other pre-defined secondary outcomes for this comparison.Three studies compared acupuncture alone versus other therapies (mecobalamin combined with nimodipine, and inositol). Acupuncture may reduce the risk of 'no clinical response' to pain than other therapies (n = 209; RR 0.25, 95% CI 0.12 to 0.51), however, evidence was not available for pain intensity, pain relief, adverse events or any of the other secondary outcomes.Two studies compared acupuncture combined with other active therapies (mecobalamin, and Xiaoke bitong capsule) versus other active therapies used alone. We found that the acupuncture combination group had a lower VAS score for pain intensity (n = 104; MD -1.02, 95% CI -1.09 to -0.95) and improved quality of life (n = 104; MD -2.19, 95% CI -2.39 to -1.99), than those receiving other therapy alone. However, the average VAS score of the acupuncture and control groups was 3.23 and 4.25 respectively, indicating neither group achieved 'no worse than mild pain'. Furthermore, this evidence was from a single study with high risk of bias and a very small sample size. There was n. Due to the limited data available, there is insufficient evidence to support or refute the use of acupuncture for neuropathic pain in general, or for any specific neuropathic pain condition when compared with sham acupuncture or other active therapies. Five studies are still ongoing and seven studies are awaiting classification due to the unclear treatment duration, and the results of these studies may influence the current findings.

Topics: Acupuncture Therapy; Adult; Analgesics; Chronic Pain; Drugs, Chinese Herbal; Humans; Inositol; Middle Aged; Neuralgia; Nimodipine; Pain Measurement; Quality of Life; Randomized Controlled Trials as Topic; Vitamin B 12

Methylcobalamin (MeCbl), the activated form of vitamin B12, has been used to treat some nutritional diseases and other diseases in clinic, such as Alzheimer's disease and rheumatoid arthritis. As an auxiliary agent, it exerts neuronal protection by promoting regeneration of injured nerves and antagonizing glutamate-induced neurotoxicity. Recently several lines of evidence demonstrated that MeCbl may have potential analgesic effects in experimental and clinical studies. For example, MeCbl alleviated pain behaviors in diabetic neuropathy, low back pain and neuralgia. MeCbl improved nerve conduction, promoted the regeneration of injured nerves, and inhibited ectopic spontaneous discharges of injured primary sensory neurons. This review aims to summarize the analgesic effect and mechanisms of MeCbl at the present.

Topics: Analgesics, Non-Narcotic; Animals; Humans; Nerve Regeneration; Neural Conduction; Neuralgia; Pain; Vitamin B 12; Vitamins

Topics: Herpes Zoster; Humans; Injections, Intramuscular; Neuralgia; Pain Measurement; Pilot Projects; Prospective Studies; Treatment Outcome; Vitamin B 12

The present study was designed to explore the efficacy of locally injected thiamine or cobalamin in relieving itch or pain and improving the daily living activities among patients with herpetic itching.. Eighty eligible patients with herpetic itching with a worst itching score of ≥ 4 were randomized to receive locally injected thiamine (B1 group), cobalamin (B12 group), lidocaine (LD group), or combination of thiamine and cobalamin (COB group) for 4 weeks. The treatment efficacy was assessed based on the patients' pruritus and pain severity, global impression of change, and activities of daily living and quality of life.. After 7 days, thiamine yielded a significant itch relief, cobalamin yielded a significant pain relief, and their combination significantly relieved both pain and itch; which all continued till the endpoint (all Ps<0.001). However, lidocaine did not provide significant itch or pain relief than the other groups. Sixteen patients in the thiamine group achieved ≥ 30% itch reduction; 18 patients in the cobalamin group obtained ≥ 30% pain reduction; and 18 patients achieved ≥ 30% itch reduction and 19 patients obtained ≥ 30% pain reduction in the combination group. The activities of daily living and quality of life data at the endpoint were consistent with a significant benefit in the thiamine (P<0.05), cobalamin, and combination groups (both Ps<0.001).. Locally injected thiamine had a significant antipruritic effect, cobalamin had an analgesic effect, and their combination had the dual effect with no obvious synergies. This intervention was efficacious, tolerable, and safe for herpetic itching.

Topics: Activities of Daily Living; Anesthetics, Local; Anti-Inflammatory Agents, Non-Steroidal; Female; Herpes Zoster; Humans; Lidocaine; Male; Middle Aged; Neuralgia; Pain Measurement; Pruritus; Quality of Life; Severity of Illness Index; Thiamine; Time Factors; Treatment Outcome; Vitamin B 12

Despite many therapeutic options, painful diabetic neuropathy is still a common and challenging complication of diabetes mellitus and is often resistant to treatment with current modalities.. In this randomized, single-blind clinical trial we compared the efficacy of parenteral vitamin B(12) and nortriptyline, for symptomatic improvement of pain, paresthesia, burning, freezing, stabbing and electrical sensation. Changes in nerve conduction parameters of amplitude, duration and latency were also compared.. One hundred patients (50 in each group) completed the study. After treatment, the pain score based on a visual analogue scale decreased 3.66 units in the vitamin B(12) group and 0.84 units in the nortriptyline group (P <0.001). Similarly, the paresthesia score decreased 2.98 units versus 1.06 units (P <0.001). The decrements of tingling sensation were 3.48 units versus 1.02 units (P <0.001). Changes in vibration, position, pinprick and nerve conduction parameters were not significant in two groups.. In conclusion, vitamin B(12) is more effective than nortriptyline for the treatment of symptomatic painful diabetic neuropathy.

Topics: Adolescent; Adult; Analgesics, Non-Narcotic; Anticonvulsants; Antidepressive Agents, Tricyclic; Blood Glucose; Diabetic Neuropathies; Female; Glycated Hemoglobin; Humans; Injections, Intramuscular; Lipids; Male; Middle Aged; Neural Conduction; Neuralgia; Neurons; Nortriptyline; Pain Measurement; Paresthesia; Surveys and Questionnaires; Time Factors; Vitamin B 12; Young Adult

To assess the safety of duloxetine at a fixed-dose of 60 mg twice daily (BID) for up to 52 weeks, and compare duloxetine with routine care in the management of patients with diabetic peripheral neuropathic pain (DPNP).. Patients who completed a 13-week, randomized, double-blind, placebo-controlled acute therapy period were randomly reassigned in a 2:1 ratio to therapy with duloxetine 60 mg BID (N = 197) or routine care (N = 96) for an additional 52 weeks.. The trial included outpatients > or =18 years of age diagnosed with moderate to severe DPNP caused by type 1 or type 2 diabetes.. Fourteen patients discontinued due to adverse events or death (11 [5.6%] duloxetine- and 3 [3.1%] routine care-treated patients). There were no significant therapy-group differences observed for patients with >/=1 serious adverse event. In total, 110 (55.8%) duloxetine- and 47 (49%) routine care-treated patients had > or =1 treatment-emergent adverse event (TEAE). The TEAE with a significant therapy-group difference, with patients in the duloxetine therapy group experiencing a higher percentage of events, was asthenia (11 [5.6%] duloxetine- vs no routine care-treated patients). Duloxetine did not appear to adversely affect lipid profiles, or nerve or eye function. There were no significant therapy-group differences observed in mean change in systolic blood pressure, weight, or electrocardiogram parameters. Significant therapy-group differences were observed in favor of duloxetine in the SF-36 physical component summary score, and subscale scores of physical functioning, bodily pain, mental health, and vitality.. The results of this study provide support for the use of duloxetine in the long-term management of DPNP.

Topics: Acetaminophen; Amitriptyline; Analgesics; Carbamazepine; Diabetes Complications; Diabetic Neuropathies; Diclofenac; Double-Blind Method; Duloxetine Hydrochloride; Female; Humans; Lipids; Male; Meloxicam; Middle Aged; Neuralgia; Pentoxifylline; Selective Serotonin Reuptake Inhibitors; Thiamine; Thiazines; Thiazoles; Thioctic Acid; Thiophenes; Time; Vitamin B 12

In an open, multicentric observational study involving 234 doctors in private practice, the evolution of symptoms and the tolerability of a vitamin B preparation (Neurotrat forte) used as treatment in 1,149 patients with polyneuropathy, neuralgia, radiculopathy and neuritis associated with pain and paresthesias, were observed. The form of administration (ampoules, dragées), dosage and duration of treatment were left to the individual care-providing physician. The target symptoms evaluated were intensity of pain, muscle weakness affecting the legs, and paresthesia.. Under treatment, there was a clear improvement in these symptoms. At a second examination approximately three weeks after initiation of treatment, a positive effect on pain in particular was observed in 69% of the cases. Similar observations were also made for paresthesias and muscular weakness in the legs.

Topics: Diabetic Neuropathies; Drug Combinations; Female; Humans; Male; Middle Aged; Neuralgia; Neurologic Examination; Peripheral Nervous System Diseases; Pyridoxine; Thiamine; Vitamin B 12

Topics: Adult; Aged; Aminopyrine; Cinchona; Clinical Trials as Topic; Drug Combinations; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Neuralgia; Neuritis; Phenylbutazone; Phytotherapy; Plants, Medicinal; Prednisolone; Rheumatic Diseases; Thrombophlebitis; Vitamin B 12

Topics: Brachial Plexus Neuritis; Clinical Trials as Topic; Humans; Hydroxocobalamin; Joint Diseases; Neuralgia; Pain; Vitamin B 12

Recent studies have shown a relatively higher prevalence of peripheral neuropathy in idiopathic Parkinson's disease (IPD). The hypothesis is that prolonged levodopa exposure causes vitamin B12 deficiency, which leads to peripheral neuropathy. The aim of our study was to find the relationship between vitamin B12 and its precursor methylmalonic acid (MMA) in IPD patients with neuropathic pain. We performed a cross-sectional study by enrolling consecutive 43 patients who were clinically tested positive for F-18 FP-CIT PET and 15 patients were diagnosed with peripheral neuropathy according to the Toronto clinical scoring system (TCSS). The severity of neuropathic pain was evaluated using total neuropathy scale, revised (TNSr), and Korean Neuropathic Pain Questionnaire (KNPQ). The correlations between age, IPD duration, levodopa equivalent dose (LED), UPDRS III, vitamin B12, MMA, and homocysteine levels were assessed. The prevalence rate of peripheral neuropathy in IPD patients was 35%. Among the serums assessed, MMA levels showed a positive correlation to TNSr and KNPQ in the IPD patients with peripheral neuropathy (TNSr r = 0.882, p < 0.001, KNPQ r = 0.710, p = 0.004), while Vitamin B12 and homocysteine showed no statistically significant correlation. Our study showed a prevalence of peripheral neuropathy in 35% of Korean IPD patients. The serum MMA positively correlated with the severity of neuropathic pain and this can be used as a useful marker in assessment of peripheral neuropathy in Parkinson's disease.

Topics: Aged; Antiparkinson Agents; Biomarkers; Cross-Sectional Studies; Female; Homocysteine; Humans; Levodopa; Male; Methylmalonic Acid; Middle Aged; Neural Conduction; Neuralgia; Pain Measurement; Parkinson Disease; Prevalence; Severity of Illness Index; Vitamin B 12

Treatment of neuropathic pain and chemotherapy-induced peripheral neuropathy (CIPN) in patients with malignancy is often unsuccessful. Functional vitamin B12 deficiency, defined by elevated levels of the B12-dependent metabolites, methylmalonic acid (MMA), and/or homocysteine, despite normal B12 values, may cause neuropathy and is associated with disorders linked to increased oxidative stress. Since both cancer and neurotoxic antineoplastic agents increase oxidative stress, a role for functional B12 deficiency in CIPN was considered.. A retrospective record review of 241 cancer subjects evaluated by the adult palliative care service for B12 deficiency in a university-based cancer center between October 2008 and September 2012 with measurement of B12, MMA, and/or homocysteine levels was performed.. B12 values were elevated (>900 pg/ml) in 30 % and low (≤300 pg/ml) in 17 % of subjects tested. Elevated MMA (>250 nmol/l) and homocysteine (>12.1 μmol/l) levels occurred in 38 and 23 % of subjects respectively and at least one metabolite was increased in 54 % of evaluable subjects. Even when B12 values were ≥1500 pg/ml (n = 36), increased MMA and homocysteine values occurred in 31 and 23 % of subjects, respectively. B12 therapy decreased MMA values in all four subjects studied and improved neurologic findings in the three subjects tested.. Functional vitamin B12 deficiency is common in subjects with advanced malignancy. Further studies are needed to determine if this disorder is a risk factor for CIPN and if B12 therapy has a role in the management and/or prevention of neuropathy and neuropathic pain in this population.

Topics: Aged; Female; Humans; Male; Methylmalonic Acid; Middle Aged; Neoplasms; Neuralgia; Peripheral Nervous System Diseases; Retrospective Studies; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Vincristine, a widely used chemotherapeutic agent, often induces painful peripheral neuropathy and there are currently no effective drugs to prevent or treat this side effect. Previous studies have shown that methylcobalamin has potential analgesic effect in diabetic and chronic compression of dorsal root ganglion model; however, whether methylcobalamin has effect on vincristine-induced painful peripheral neuropathy is still unknown.. We found that vincristine-induced mechanical allodynia and thermal hyperalgesia, accompanied by a significant loss of intraepidermal nerve fibers in the plantar hind paw skin and an increase in the incidence of atypical mitochondria in the sciatic nerve. Moreover, in the spinal dorsal horn, the activity of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase and the protein expression of p-p65 as well as tumor necrosis factor a was increased, whereas the protein expression of IL-10 was decreased following vincristine treatment. Furthermore, intraperitoneal injection of methylcobalamin could dose dependently attenuate vincristine-induced mechanical allodynia and thermal hyperalgesia, which was associated with intraepidermal nerve fibers rescue, and atypical mitochondria prevalence decrease in the sciatic nerve. Moreover, methylcobalamin inhibited the activation of NADPH oxidase and the downstream NF-kB pathway. Production of tumor necrosis factor a was also decreased and production of IL-10 was increased in the spinal dorsal horn following methylcobalamin treatment. Intrathecal injection of Phorbol-12-Myristate-13-Acetate, a NADPH oxidase activator, could completely block the analgesic effect of methylcobalamin.. Methylcobalamin attenuated vincrinstine-induced neuropathic pain, which was accompanied by inhibition of intraepidermal nerve fibers loss and mitochondria impairment. Inhibiting the activation of NADPH oxidase and the downstream NF-kB pathway, resulting in the rebalancing of proinflammatory and anti-inflammatory cytokines in the spinal dorsal horn might also be involved. These findings might provide potential target for preventing vincristine-induced neuropathic pain.

Topics: Animals; Axons; Cytokines; Enzyme Activation; Hyperalgesia; Interleukin-10; Male; Mitochondria; NADPH Oxidases; Nerve Fibers; Neuralgia; NF-kappa B; Phorbol Esters; Rats, Sprague-Dawley; Sciatic Nerve; Spinal Cord Dorsal Horn; Tumor Necrosis Factor-alpha; Vincristine; Vitamin B 12

To report the case of a 28-year-old patient with persistent bilateral burning pain and foreign body sensation in both eyes for the past 1 year. The patient showed a poor response to 0.05% cyclosporine eye drops and frequent instillations of artificial tears. Ocular examination showed few superficial punctate epithelial defects, well-positioned laser in situ keratomileusis (performed 5 years ago with symptomless recovery) flaps, and clear interfaces bilaterally, with a tear film breakup time of 7 and 8 seconds in the right and left eyes, respectively. The results of Schirmer tests, confocal microscopy, corneal esthesiometry, and meibography were normal for both eyes. The patient was incidentally diagnosed with vitamin B12 deficiency, with a serum vitamin B12 value of 90 pg/mL (reference range, 236-911 pg/mL), during routine laboratory tests. In view of weak correlation between signs and symptoms, a putative diagnosis of ocular neuropathic pain secondary to vitamin B12 deficiency was made.. Case report.. The patient was treated with parenteral vitamin B12, and topical therapy was continued without any changes. The patient experienced dramatic improvement with a decrease in symptoms within 3 weeks of administering vitamin B12 supplements and was symptom-free in the absence of any topical medication 6 months after treatment.. Vitamin B12 deficiency, although common in India, has not been reported to be associated with ocular symptoms, including pain and mimicking those seen in severe dry eye. Vitamin B12 deficiency should be considered in the differential diagnosis of ocular neuropathic pain and dry eye in patients presenting with recalcitrant ocular neuropathic pain.

Topics: Adult; Eye Pain; Humans; Infusions, Parenteral; Keratomileusis, Laser In Situ; Male; Myopia; Neuralgia; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

The number of ex-leprosy patients has reduced rapidly who were forced to be admitted under leprosy prevention/segregation law and are staying at national sanatoriums with different disabilities due to different physical and social reasons for long time in Japan. Most of them have been of clinically cured status for decades after effective chemotherapy. Some have still been suffering from acute or chronic neuralgic pains which are supposed to be long standing consequences of nerve damage of leprosy and getting medications for long period. Pharmacy department of National Suruga Sanatorium has studied the amount of prescriptions of some medicines for last 11 years, which were thought to be prescribed for pain including neuralgic pain. There seem to be some tendencies of medications during last decade. VitaminB12 (Mecobalamine) is one of the commonest drugs for neuralgic pain at this sanatorium and the amount of prescription had almost been unchanged through the years. Prescription of non-steroid anti-inflammatory drugs (NSAIDs) increased year by year, which may reflect the increasing age of ex-patients who need more pain killers for their painful joints or back. Loxoprofen is the most popular pain killer here and increased by ten times for last decade. The number of prescription for Pentazocine and Hydroxyzine Hydrochloride injection increased for last several years, which reflects a few patients who were still suffering from severe chronic neuralgia for years. It is desirable that a standard regimen for chronic neuralgic pain as a consequence of nerve impairment in leprosy will be developed as soon as possible.

Topics: Aged; Analgesics; Anti-Inflammatory Agents; Chronic Disease; Drug Utilization; Female; Humans; Japan; Leper Colonies; Leprostatic Agents; Leprosy; Male; Neuralgia; Pentazocine; Phenylpropionates; Prescriptions; Time; Vitamin B 12

Treatment of neuropathic pain is an area of largely unmet medical need. Therefore, this pain may require the development of novel drug entities. In the search for alternatives, B vitamins have been found to be a clinically useful pharmacological tool for patients with neuropathic pain. However, preclinical studies supporting this use are lacking. In this study, we assessed the possible antiallodynic effects of thiamine, pyridoxine, and cyanocobalamin as well as dexamethasone and their combination on spinal nerve ligation induced allodynia. Sub cutaneous administration of thiamine (75-600 mg/kg), pyridoxine (75-600 mg/kg), cyanocobalamin(0.75-6 mg/kg), and dexamethasone (4-32 mg/kg) significantly reduced tactile allodynia in rats. Maximal antiallodynic effects were reached with 600 mg/kg of thiamine (approximately 58%), 600 mg/kg of pyridoxine (approximately 22%), 6 mg/kg of cyanocobalamin (approximately 73%), and 32 mg/kg of dexamethasone (approximately 68%). Since a small antiallodynic effect was observed with pyridoxine, this drug was not further analyzed in the combinations. Coadministration of thiamine or cyanocobalamin and dexamethasone remarkably reduced spinal nerve ligation induced allodynia (approximately 90%), showing a synergistic interaction between either thiamine or cyanocobalamin and dexamethasone. Our data indicate that thiamine and pyridoxine as well as the combination of B vitamins and dexamethasone are able to reduce tactile allodynia in rats and suggest the possible clinical use of these drugs in the treatment of neuropathic pain in human beings.

Topics: Animals; Anti-Inflammatory Agents; Dexamethasone; Drug Synergism; Drug Therapy, Combination; Female; Neuralgia; Pyridoxine; Rats; Rats, Wistar; Spinal Nerves; Thiamine; Vitamin B 12

Topics: Acyclovir; Analgesics; Antiviral Agents; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Vitamin B 12

Topics: Adult; Aged; Anus Diseases; Female; Humans; Hydroxocobalamin; Male; Middle Aged; Neuralgia; Rectal Diseases; Vitamin B 12

Topics: Adenine Nucleotides; Adult; Aged; Back Pain; Cyclic AMP; Drug Combinations; Drug Tolerance; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Neuralgia; Neuritis; Sciatica; Thiamine; Thymine Nucleotides; Vitamin B 12

Topics: Adult; Aged; Analgesics; Female; Humans; Male; Middle Aged; Neuralgia; Otorhinolaryngologic Diseases; Pain; Pyridoxine; Reflex Sympathetic Dystrophy; Spinal Diseases; Thiamine; Trigeminal Neuralgia; Vitamin B 12

Topics: Adult; Aged; Aminopyrine; Antipyrine; Drug Combinations; Female; Humans; Male; Middle Aged; Neuralgia; Niacinamide; Thiamine; Vitamin B 12

Topics: Adult; Aged; Alcoholism; Humans; Male; Middle Aged; Neuralgia; Paralysis; Paresthesia; Polyneuropathies; Polyradiculopathy; Vitamin B 12

Topics: Adult; Aged; Anti-Inflammatory Agents; Coenzymes; Female; Humans; Male; Middle Aged; Neuralgia; Osteoarthritis; Pyridoxine; Rheumatic Diseases; Spinal Nerve Roots; Spinal Nerves; Thiamine; Vitamin B 12

Topics: Adenine Nucleotides; Adult; Aged; Aminopyrine; Back Pain; Brachial Plexus Neuritis; Female; Glycerides; Humans; Male; Middle Aged; Neuralgia; Neuritis; Periarthritis; Sciatica; Suppositories; Thiamine; Vitamin B 12

Topics: Adenine Nucleotides; Adult; Aged; Aminopyrine; Back Pain; Brachial Plexus Neuritis; Female; Humans; Joint Diseases; Male; Middle Aged; Neuralgia; Sciatica; Thiamine; Vitamin B 12

Topics: Gingivitis; Neuralgia; Stomatitis; Vitamin B 12

Topics: Acetates; Adult; Aged; Arthritis, Rheumatoid; Female; Humans; Male; Middle Aged; Neuralgia; Periarthritis; Propylamines; Pyridoxine; Rheumatic Diseases; Thiamine; Vitamin B 12

Topics: Adult; Dexamethasone; Female; Flavonoids; Humans; Lidocaine; Male; Middle Aged; Neuralgia; Phenylbutazone; Phytotherapy; Plants, Medicinal; Rheumatic Diseases; Salicylamides; Spinal Osteophytosis; Thiamine; Vitamin B 12

Topics: Adult; Aged; Female; Humans; Iodides; Middle Aged; Neuralgia; Rheumatic Diseases; Sodium; Thiamine; Vitamin B 12

Topics: Adolescent; Adult; Aged; Analgesics; Anti-Inflammatory Agents; Humans; Joint Diseases; Lidocaine; Middle Aged; Neuralgia; Osteoporosis; Pyridoxine; Quinolines; Vitamin B 12

Topics: Betamethasone; Brachial Plexus Neuritis; Humans; Intervertebral Disc Displacement; Joint Diseases; Neuralgia; Polyneuropathies; Polyradiculopathy; Sciatica; Spinal Diseases; Vitamin B 12

Topics: Adult; Aged; Female; Galantamine; Humans; Male; Middle Aged; Neuralgia; Neuritis; Pyridoxal Phosphate; Pyridoxine; Thiamine; Vitamin B 12

Topics: Adult; Aged; Aminopyrine; Analgesics; Female; Gout; Humans; Joint Diseases; Male; Middle Aged; Neuralgia; Neuritis; Pyridoxine; Quinolines; Spinal Diseases; Vitamin B 12

Topics: Adult; Aminopyrine; Analgesics; Female; Humans; Male; Middle Aged; Neuralgia; Pyridoxine; Quinolines; Sciatica; Spinal Diseases; Vitamin B 12

Topics: Adult; Aminopyrine; Analgesics; Arthritis, Rheumatoid; Female; Fever; Humans; Male; Middle Aged; Neuralgia; Pain; Pyridoxine; Quinolines; Rheumatic Fever; Urinary Tract Infections; Vitamin B 12

Topics: Adult; Aged; Aminopyrine; Analgesics; Fractures, Bone; Herpes Zoster; Humans; Joint Diseases; Middle Aged; Neuralgia; Pain; Pyridoxine; Quinolines; Rheumatic Diseases; Spinal Diseases; Vitamin B 12

Topics: Adult; Aged; Aminopyrine; Analgesics; Female; Humans; Male; Middle Aged; Neoplasms; Neuralgia; Neuritis; Pain; Pyridoxine; Quinolines; Rheumatic Diseases; Vitamin B 12

Topics: Adult; Cervical Vertebrae; Facial Paralysis; Female; Humans; Male; Middle Aged; Neck; Neuralgia; Osteochondritis; Prednisolone; Prednisone; Vitamin B 12

Topics: Acute Disease; Aged; Anti-Bacterial Agents; Diathermy; Electrophoresis; Encephalitis; gamma-Globulins; Ganglia; Herpes Zoster; Humans; Male; Massage; Meningism; Meningitis, Viral; Middle Aged; Neuralgia; Neuritis; Pantothenic Acid; Physical Therapy Modalities; Procaine; Radiography; Vitamin B 12; Vitamin B Complex

Topics: Bone Diseases; Fractures, Bone; Humans; Intervertebral Disc Displacement; Joint Diseases; Neuralgia; Peripheral Nerve Injuries; Phospholipids; Sciatica; Vitamin B 12

Topics: Arsenic; Cortisone; Cytopathogenic Effect, Viral; Dexamethasone; Drug Therapy; Epidemiology; Erythromycin; Fluorescent Antibody Technique; Geriatrics; Herpes Zoster; Herpesvirus 3, Human; Humans; Hyaluronoglucosaminidase; Methicillin; Neuralgia; Neutralization Tests; Oxytetracycline; Poisoning; Prednisolone; Spironolactone; Vitamin B 12

Topics: Autonomic Nervous System Diseases; Barbiturates; Biomedical Research; Blood Chemical Analysis; Carbon Monoxide Poisoning; Cerebrovascular Disorders; Chemical Phenomena; Chemistry; Humans; Hydroxocobalamin; Mental Disorders; Neuralgia; Neuritis; Neurology; Pharmacology; Poisoning; Vitamin B 12

Topics: Diabetes Mellitus; Diabetic Neuropathies; Geriatrics; Hepatitis; Hepatitis A; Humans; Hydroxocobalamin; Liver Cirrhosis; Neuralgia; Thiamine; Vitamin B 12

Topics: Herpes Zoster; Humans; Nervous System Diseases; Neuralgia; Neuritis; Pain; Phantom Limb; Pyridoxine; Thiamine; Vitamin B 12; Vitamin B Complex

Topics: Corrinoids; Herpes Zoster; Herpesvirus 3, Human; Humans; Neuralgia; Thiamine; Vitamin B 12; Vitamins

Topics: Adenine Nucleotides; Herpes Zoster; Humans; Multiple Sclerosis; Nervous System Diseases; Neuralgia; Neuritis; Pyridoxine; Thiamine; Vitamin B 12; Vitamins

Topics: Corrinoids; Hematinics; Humans; Neuralgia; Neuritis; Osteochondritis; Pyridoxine; Thiamine; Vitamin B 12

Topics: Corrinoids; Hematinics; Humans; Neuralgia; Neuritis; Vitamin B 12

Topics: Humans; Neuralgia; Orbit; Vitamin B 12

Topics: Corrinoids; Hematinics; Neuralgia; Neuritis; Paresthesia; Vitamin B 12

Topics: Adenine Nucleotides; Adenosine; Humans; Neuralgia; Neuritis; Niacin; Niacinamide; Nicotinic Acids; Polyphosphates; Thiamine Pyrophosphate; Vitamin B 12

Topics: Adenine Nucleotides; Adenosine; Neuralgia; Neuritis; Niacin; Niacinamide; Nicotinic Acids; Polyphosphates; Thiamine Pyrophosphate; Vitamin B 12

Topics: Corrinoids; Humans; Neuralgia; Neuritis; Niacin; Procaine; Vitamin B 12; Vitamin B Complex

Topics: Corrinoids; Hematinics; Herpes Zoster; Neuralgia; Vitamin B 12

Topics: Corrinoids; Hematinics; Humans; Neuralgia; Neuritis; Vitamin B 12