vitamin-b-12 and Pain

Based on current scientific reports, vitamin B12 (cobalamin), used in the treatment of pernicious anemia, may be used as a pain reliever. It has been shown to be effective in the treatment of different sorts of pain, including diabetic neuropathic, musculoskeletal, abdominal, back and spine ones, but also pain in Alzheimer's disease and pain ailments resulting from the development of neoplasms. In addition, it helps regeneration of the sensory nerves and relieves pain in eye diseases, for example in dry eye syndrome. This review summarizes recent research reports on pain-relieving properties of vitamin B12.

Topics: Anemia, Pernicious; Dietary Supplements; Humans; Pain; Vitamin B 12; Vitamin B 12 Deficiency

Metformin is a hypoglycemic drug widely used in the treatment of type 2 diabetes. It has been proven to have analgesic and neuroprotective effects. Metformin can reverse pain in rodents, such as diabetic neuropathic pain, neuropathic pain caused by chemotherapy drugs, inflammatory pain and pain caused by surgical incision. In clinical use, however, metformin is associated with reduced plasma vitamin B12 levels, which can further neuropathy. In rodent diabetes models, metformin plays a neuroprotective and analgesic role by activating adenosine monophosphate-activated protein kinase, clearing methylgloxal, reducing insulin resistance, and neuroinflammation. This paper also summarized the neurological adverse reactions of metformin in diabetic patients. In addition, whether metformin has sexual dimorphism needs further study.. 二甲双胍是一种广泛用于治疗2型糖尿病的降糖药物。它已被证明具有镇痛和神经保护作用。二甲双胍可以逆转啮齿类动物的疼痛，如糖尿病性神经痛、化疗药物引起的神经性疼痛、炎症性疼痛、手术切口引起的疼痛。然而，在临床使用中，二甲双胍与血浆维生素B12水平降低有关，这可能会进一步加剧神经病变。在啮齿动物糖尿病模型中，二甲双胍通过激活AMPK、清除MGO、降低胰岛素抵抗和神经炎症发挥神经保护和镇痛作用。本文还总结了二甲双胍对糖尿病患者的神经系统不良反应。此外，二甲双胍是否有两性区别还有待进一步研究。.

Topics: Adenosine Monophosphate; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Humans; Hypoglycemic Agents; Metformin; Neuroprotective Agents; Pain; Protein Kinases; Vitamin B 12

Topics: Humans; Ointments; Pain; Stomatitis, Aphthous; Vitamin B 12; Vitamins; Water

First isolated as cyanocobalamin in 1948, vitamin B12 has been explored for pain treatment almost since its discovery. With the advent of the opioid epidemic, safer treatments for pain are needed.. Our objective was to compile the latest information on potential mechanisms from animal studies and clinical trial data on vitamin B12 for the treatment of pain conditions.. We conducted a narrative review.. PubMed was searched using the terms "methylcobalamin pain", "hydroxycobalamin pain", "cyanocobalamin pain", and "vitamin B12 pain." Animal studies that identified mechanisms of action for the effects of pain were collected. Clinical trials utilizing larger, pharmaceutical doses of vitamin B12 (> 100 µg/dose) in pain treatment were identified and reviewed.. Animal studies support multiple beneficial effects of vitamin B12 including the regeneration of nerves and the inhibition of cyclooxygenase enzymes and other pain-signaling pathways. In addition, animal studies have demonstrated synergistic benefits of vitamin B12 combined with other pain medications, including nonsteroidal anti-inflammatory drugs and opiates. Clinical trials provide evidence for the effectiveness of vitamin B12 for the treatment of low back pain and neuralgia, although data is still fairly limited and optimal treatment regimens have not been identified.. More large, double-blind placebo-controlled trials are needed to fully establish efficacy and best dosing parameters.. Vitamin B12 may prove to be an adjunctive or integrative treatment for pain conditions. While more research is needed, considering the low incidence of side effects and overall safety, B12 may be an additional tool to consider for pain treatment.. Vitamin B12, cyanocobalamin, methylcobalamin, hydroxycobalamin, pain, chronic pain, neuropathy, low back pain.

Topics: Animals; Humans; Pain; Pain Management; 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

Amlexanox appears to be most effective overall. Amlexanox 5% paste reduces ulcer size, pain duration, and healing time.

Topics: Administration, Topical; Aminopyridines; Anti-Allergic Agents; Anti-Infective Agents, Local; Anti-Inflammatory Agents; Beclomethasone; Cautery; Clobetasol; Eupatorium; Humans; Mouthwashes; Pain; Phytotherapy; Plant Preparations; Secondary Prevention; Stomatitis, Aphthous; Vitamin B 12

The purpose of this brief narrative review is to summarize the evidence derived from randomized controlled trials pertaining to the nonsurgical treatment of lumbar spinal stenosis (LSS).. The MEDLINE (January 1950 to the fourth week of January 2010) and EMBASE (January 1980 to 2009, week 53) databases, the MESH term "spinal stenosis", and the key words, "vertebral canal stenosis" and "neurogenic claudication", were searched. Results were limited to randomized controlled trials (RCTs) conducted on human subjects, written in English, and published in peer-reviewed journals. Only RCTs pertaining to nonsurgical treatment were considered. Studies comparing conservative and surgical management or different surgical techniques were not included in the review.. The search criteria yielded 13 RCTs. The average enrolment was 54 subjects per study. Blinded assessment and sample size justification were provided in 85% and 39% of RCTs, respectively. The available evidence suggests that parenteral calcitonin, but not intranasal calcitonin, can transiently decrease pain in patients with LSS. In the setting of epidural blocks, local anesthetics can improve pain and function, but the benefits seem short-lived. The available evidence does not support the addition of steroids to local anesthetic agents. Based on the limited evidence, passive physical therapy seems to provide minimal benefits in LSS. The optimal regimen for active physiotherapy remains unknown. Although benefits have been reported with gabapentin, limaprost, methylcobalamin, and epidural adhesiolysis, further trials are required to validate these findings.. Because of their variable quality, published RCTs can provide only limited evidence to formulate recommendations pertaining to the nonsurgical treatment of LSS. In this narrative review, no study was excluded based on factors such as sample size justification, statistical power, blinding, definition of intervention allocation, or clinical outcomes. This aspect may represent a limitation as it may serve to overemphasize evidence derived from "weaker" trials. Further well-designed RCTs are warranted.

Topics: Administration, Intranasal; Alprostadil; Amines; Analgesics, Non-Narcotic; Anesthetics, Local; Anti-Inflammatory Agents; Calcitonin; Cyclohexanecarboxylic Acids; Epidural Space; Gabapentin; gamma-Aminobutyric Acid; Humans; Injections, Spinal; Pain; Randomized Controlled Trials as Topic; Research Design; Spinal Stenosis; Vitamin B 12

Topics: Adrenal Cortex Hormones; Age Factors; Antidepressive Agents; Drug Therapy, Combination; Female; Humans; Middle Aged; Mouth Diseases; Pain; Postmenopause; Prognosis; Risk Assessment; Risk Factors; Vitamin B 12

Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Deglutition Disorders; Female; Ganglioneuroma; Horner Syndrome; Humans; Hypertension; Infant; Infant, Newborn; Lung Diseases; Lung Neoplasms; Male; Mediastinal Neoplasms; Mediastinum; Meningocele; Middle Aged; Neoplasm Regression, Spontaneous; Neoplasms, Nerve Tissue; Neurilemmoma; Neuroblastoma; Neurofibroma; Neurofibromatosis 1; Neurologic Manifestations; Osteoarthropathy, Secondary Hypertrophic; Pain; Paraganglioma, Extra-Adrenal; Pheochromocytoma; Sex Factors; Vitamin B 12

Breast cancer patients receiving endocrine therapy with aromatase Inhibitors (AIs) often experience musculoskeletal and joint-related side effects. The purpose of this study was to evaluate the effect of Vitamin B12 supplements on musculoskeletal symptoms such as pain and arthralgias induced by AIs and to correlate response with serum and inflammatory biomarkers. Upon receiving approval by the Institutional Review Board (IRB), the majority of the patients consented into the study were treated at the Texas Tech Breast Care Center. Included were patients who had a diagnosis of invasive breast cancer (Stages I-III), and were experiencing significant musculoskeletal symptoms associated to AIs. Only patients with an average pain score ≥ 4, as assessed by the Brief Pain Inventory-Short Form (BPI-SF) questionnaire, were included in the study. Participants received 2500 mcg of sublingual vitamin B12 daily for 90 days. Assessments at baseline and at 3 months included: BPI-SF pain scores, the impact on quality of life determined by Functional Assessment of Cancer Therapy-Endocrine Symptoms (FACT-ES), and correlative serum markers relative to baseline (a pre-post study). A total of forty-one patients were enrolled. Average pain scores were improved by 34% (P < .0001) at 3 months compared to baseline. In addition, a 23% improvement in worst pain was noted (P = .0003). Analysis of the results for the FACT-ES scoring showed improvement on all scales. No significant adverse events were observed. Decrease in pain score was correlated with increased serum B12 levels. This study suggests that Vitamin B12 reduces pain and improves quality of life for patients taking AIs who experienced AI-related musculoskeletal symptoms. If confirmed in large randomized prospective trials, Vitamin B12 would be a safe and cost-effective option for the treatment of AI-related musculoskeletal symptoms.

Topics: Administration, Oral; Aged; Aromatase Inhibitors; Biomarkers; Breast Neoplasms; Female; Humans; Middle Aged; Musculoskeletal Diseases; Pain; Quality of Life; Treatment Outcome; Vitamin B 12

Painful diabetic neuropathy (PDN) is a prevalent and impairing disorder. The objective of this study was to show the efficacy and safety of gabapentin (GBP) plus complex B vitamins: thiamine (B1) and cyanocobalamine (B12) compared to pregabalin in patients with moderate to severe intensity PDN.. Multicenter, randomized, blind study. Two hundred and seventy patients were evaluated, 147 with GBP/B1/B12 and 123 with PGB, with a 7/10 pain intensity on the Visual Analog Scale (VAS). Five visits (12 weeks) were scheduled. The GBP/B1 (100 mg)/B12 (20 mg) group started with 300 mg at visit 1 to 3600 mg at visit 5. The PGB group started with 75 mg/d at visit 1 to 600 mg/d at visit 5. Different safety and efficacy scales were applied, as well as adverse event assessment.. Both drugs showed reduction of pain intensity, without significant statistical difference (P = 0.900). In the GBP/B1/B12 group, an improvement of at least 30% on VAS correlated to a 900 mg/d dose, compared with PGB 300 mg/d. Likewise, occurrence of vertigo was lower in the GBP/B1-B12 group, with a significant statistical difference, P = 0.014.. Our study shows that GPB/B1-B12 combination is as effective as PGB. Nonetheless, pain intensity reduction is achieved with 50% of the minimum required gabapentin dose alone (800 to 1600 mg/d) in classic NDD trials. Less vertigo and dizziness occurrence was also observed in the GBP/B1/B12 group. This trial is registered with ClinicalTrials.gov NCT01364298.

Topics: Adolescent; Adult; Aged; Amines; Cyclohexanecarboxylic Acids; Diabetic Neuropathies; Drug Combinations; Female; Gabapentin; gamma-Aminobutyric Acid; Humans; Male; Middle Aged; Pain; Pain Measurement; Pregabalin; Thiamine; Visual Analog Scale; Vitamin B 12

Aphthous ulcers, the most common oral mucosal lesions seen in primary care, occur in up to ∼2%-50% of the general population. Our objective was to confirm the analgesic benefit of treatment of mouth ulcers with vitamin B12 as adjunctive therapy. A randomized, double-blind, placebo-controlled trial was performed with primary care patients. The intervention group received vitamin B12 ointment for 2 days. In total, 42 patients suffering from aphthous ulcers participated in the study: 22 were included in the intervention group and 20 in the control group. All parameters of aphthous ulcers of patients in the intervention group were recorded and compared with those in the control group. We assessed the patients' pain levels before and after treatment using a visual analog scale. The statistical analyses were performed using a nonparametric Mann-Whitney test. Statistically significant differences in pain levels were found between the intervention group and the control group after 2 days of treatment (mean visual analog scale, 0.36 [95% CI, 0.01-0.71] vs. 1.80 [1.16-2.44]; p < .001). In conclusion, the results of this research study provide evidence that vitamin B12 is an effective analgesic treatment for aphthous ulcers. This study indicates that healthcare providers could use vitamin B12 as an adjunctive therapy for mouth ulcers, providing more effective pain management and improving the quality of life for patients with mouth ulcers.

Topics: Adult; Aged; Aged, 80 and over; Analgesics; Double-Blind Method; Female; Humans; Male; Middle Aged; Pain; Stomatitis, Aphthous; Treatment Outcome; Vitamin B 12; Vitamin B Complex; Young Adult

In a randomized, placebo-controlled double-blind trial a combination of lofepramine, phenylalanine and vitamin B(12) was found to be effective in relieving the symptoms of multiple sclerosis (MS). The effect occurred within 2-4 weeks, and improved all types of symptoms in all types of MS. The combination was also effective in relieving symptoms in patients with chronic pain and chronic fatigue. We hypothesize that the action of this combined therapy may relate to activation of the noradrenergic locus coeruleus/lateral tegmentum (LC/LT) system which has the potential to influence the functioning of large areas of the brain and spinal cord.

Topics: Adrenergic Fibers; Adrenergic Uptake Inhibitors; Antidepressive Agents; Chronic Disease; Double-Blind Method; Drug Therapy, Combination; Fatigue Syndrome, Chronic; Humans; Locus Coeruleus; Lofepramine; Methylation; Multiple Sclerosis; Norepinephrine; Pain; Phenylalanine; Severity of Illness Index; Stroke; Stroke Rehabilitation; Tegmentum Mesencephali; Treatment Outcome; Vitamin B 12

The relationship between vitamin B12 levels and survival was studied in a group of 161 terminally ill cancer patients who were recruited consecutively between 1988 and 1989. Their average age was 74.7 years. The length of survival decreased with the increase in serum vitamin B12 levels (P = 0.0015, Cox model). In multivariate analyses, C-reactive protein (CRP) was the most important prognostic factor in this population, and vitamin B12 provided information independent of CRP in predicting survival. These data indicate that an elevated serum vitamin B12 level is a predictive factor for mortality in patients with cancer, independent of CRP or other factors. Multiplying it by the CRP makes it possible to create a new, easy-to-use prognostic index, which can distinguish different levels of mortality risk at three months.

Topics: Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Neoplasms; Pain; Palliative Care; Prognosis; Prospective Studies; Vitamin B 12

To find out the clinical effects of methylcobalamin on the conservative treatment of degenerative lumbar spinal stenosis, the study was carried out as a control single blind trial with 2 year follow-up in 152 patients, 68 males and 84 females, whose ages ranged from 55 to 85 years, average 67 +/- 18.1 years. They were randomly allocated into 2 groups, the control group, 82 patients, and the methylcobalamin group, 70 patients. All had classical history, and physical and radiographic findings which confirmed the diagnosis of spinal stenosis. Conventional management, including patient education, physical therapy and medication, were carried out in every patient and in addition methylcobalamin 0.5 mg was given orally three times a day in the methylcobalamin group for 6 months. All patients were followed up periodically for 2 years. Most of the patients in both groups showed improvement but there was no significant difference between the 2 groups in terms of pain improvement and neurological signs, except neurogenic claudication distance which was better in the M-group.

Topics: Aged; Aged, 80 and over; Chemotherapy, Adjuvant; Female; Follow-Up Studies; Humans; Intermittent Claudication; Male; Middle Aged; Pain; Patient Education as Topic; Physical Therapy Modalities; Radiography; Single-Blind Method; Spinal Stenosis; Treatment Outcome; Vitamin B 12

Forty-five diabetes patients with painful peripheral polyneuropathy were enrolled in a 3-month observational study comparing the therapeutic efficacy of Milgamma tablets (50 mg benfothiamine and 0.25 mg cyancobalamine) with parallel randomized treatment assignment with the conventional vitamin B complex treatment regimen Neurobex. Thirty patients in group one were randomized to receive two Milgamma tablets qid for three weeks followed by 1 Milgamma tablet tid for 9 weeks. In group two 15 patients received two Neurobex tablets tid for the entire 3-month study period. Therapeutic efficacy was assessed on the basis of within-patient differences in pain severity between Milgamma and Neurobex-treated patients and in vibration perception thresholds using the Rydel-Seiffer biothesiometer at baseline and at the end of the study. Statistically significant relief of both background and peak neuropathic pain was achieved in all of the Milgamma-treated patients and vibration perception thresholds dramatically improved with a median of 1.56 measured on the biothesiometer scale (t = 3.24, P < 0.01). The sensory symptoms improvement was insignificant in the Neurobex-treated patient group and the changes in the vibration perception thresholds failed to reach statistical significance. The therapeutic efficacy of Milgamma was greater in patients with early-stage diabetes as compared with those with advanced diabetic neuropathy. No adverse reactions were observed following the administration of the medication. Our results underscore the importance of Milgamma tablets as an indispensable element in the therapeutic regimen of patients with painful diabetic polyneuropathy.

Topics: Adult; Aged; Diabetic Neuropathies; Female; Humans; Male; Middle Aged; Pain; Thiamine; Vitamin B 12; Vitamin B Complex

Topics: Clinical Trials as Topic; Dose-Response Relationship, Drug; Humans; Pain; Pyridoxine; Thiamine; Vitamin B 12

Topics: Analgesics; Clinical Trials as Topic; Cobamides; Coenzymes; Drug Tolerance; Female; Humans; Male; Neoplasms; Nerve Degeneration; Pain; Peripheral Nervous System Diseases; Vitamin B 12

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

Type 1 diabetes mellitus (T1DM) is a lifelong diagnosis that involves immune-mediated damage of pancreatic beta cells and subsequent hyperglycemia, manifesting as: polyuria, polydipsia, polyphagia, and weight loss. Treatment of type 1 diabetes centers on insulin administration to replace or supplement the body's own insulin with the goal of achieving euglycemia and preventing or minimizing complications. Patients with T1DM are at risk for developing other autoimmune conditions, most commonly thyroid or celiac disease.. A 20-year-old African American female with T1DM was referred by her endocrinologist to pediatric gastroenterology for 2 months of nocturnal, non-bloody diarrhea, left lower quadrant pain, and nausea; she was also being followed by neurology for complaints of lower extremity paresthesias and pain. The patient's initial lab-workup was remarkable for a low total Immunoglobulin A (IgA) level of < 6.7 mg/dL. As IgA deficiency is associated with an increased risk of celiac disease, the patient underwent upper and lower endoscopy, which was grossly unremarkable; however, histology revealed a pattern consistent with autoimmune gastritis. Subsequent serum evaluation was remarkable for an elevated fasting gastrin level and an elevated parietal cell antibody level without macrocytic anemia, iron deficiency, or vitamin B12 depletion. The patient was diagnosed with autoimmune gastritis (AIG) and subsequently initiated on parenteral B12 supplementation therapy with improvement in her neurologic and gastrointestinal symptoms.. This case illustrates the importance of recognition of red flag findings in a patient with known autoimmune disease. Following well-established health maintenance recommendations for individuals with T1DM ensures that common comorbidities will be detected. Autoimmune gastritis, while a rarer pathology in the pediatric population, deserves consideration in patients with pre-existing autoimmune conditions and new gastrointestinal or neurologic symptoms, as AIG can be associated with poor outcomes and risk of malignancy. Initial lab findings associated with an eventual diagnosis of AIG typically include anemia, iron deficiency, or Vitamin B12 deficiency. However, as demonstrated in this case, symptoms of AIG can rarely present before anemia or Vitamin B12 deficiency develops. To prevent permanent neurological damage, parenteral Vitamin B12 therapy must be considered even in the absence of Vitamin B12 deficiency, especially in those patients already experiencing neurological symptoms.

Topics: Adult; Anemia, Iron-Deficiency; Autoimmune Diseases; Celiac Disease; Child; Diabetes Mellitus, Type 1; Diarrhea; Female; Gastritis; Humans; Insulins; Pain; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Recurrent oral ulcer is one of the most prevalent inflammatory ulcerative disorders of the oral mucosa. Due to the indeterminant cause and unpredictable course of the disease, clinical treatment of patients with recurrent oral ulcer is focused on relieving the pain, shortening the course of the disease, and prolonging the intermission period. Numerous chemical and biologic agents have been characterized as beneficial in the treatment of patients with recurrent oral ulcer, but there is currently no definitive therapy available. This study aimed to investigate the clinical effects and tolerability of combined mecobalamin tablets and vitamin E capsules in the treatment of recurrent oral ulcer.. A total of 58 patients with recurrent oral ulcer admitted to our hospital were allocated to receive mecobalamin tablets + vitamin E soft capsules (test group) or Fe complex enzyme gargle only (control group) (n = 29 per group). Changes in parameters such as pain level, as measured on a 10-point visual analog scale (VAS); ulcer status and number of ulcers; proinflammatory cytokine levels; and quality of life, as measured using SF-36, from before to after treatment were measured. Mean intermission time and mean ulcer healing time were calculated. Total effectiveness rate was also calculated. The occurrences of adverse reactions in the two groups were quantified.. The total intermission time interval was significantly longer, the mean ulcer healing time was considerably shorter, the total number of ulcers was appreciably less, and the total effectiveness rate was significantly greater in the test group compared to the control group (all, P < 0.05). The VAS scores were significantly greater after treatment than before treatment in both the test and control groups (mecobalamin + vitamin E, 2.16 [1.09] vs 7.87 [0.51]; control, 3.72 [1.15] vs 7.94 [0.56]; both, P < 0.05). Interleukin (IL)-8, tumor necrosis factor α, and C-reactive protein levels were appreciably down-regulated in both groups when compared to before treatment. In addition, IL-2 concentration and SF-36 scores were much greater after treatment in the test group with respect to the control group. Levels of IL-8, TNF-α, and CRP were significantly lesser in the test group than in the control group (all, P < 0.05).. The combination of mecobalamin tablets and vitamin E soft capsules was effective in the treatment of recurrent oral ulcer. This combination can be used as an adjunctive therapy, offering effective pain control and improving quality of life in patients with oral ulcers.

Topics: Capsules; Humans; Oral Ulcer; Pain; Quality of Life; Ulcer; Vitamin B 12; Vitamin E

To investigate whether a cocktail therapy of dexamethasone, ropivacaine, dexmedetomidine, and vitamin B12 can achieve satisfactory pain relief and promote early functional recovery after PPECD.. Eighty single-level patients with CDH who received PPECD were retrospectively divided into two groups: the cocktail and control groups. Clinical data were recorded and evaluated by a dedicated physician who was not involved in the patient's treatment. The primary clinical outcomes included visual analog scores (VASs) for upper limber pain and neck disability index (NDI) scores. The follow-up time points were preoperatively and postoperative 1 week, 1 month, 3 months, 6 months, and 12 months. The modified MacNab criteria was used to evaluate the surgical effect of the last follow-up.. The follow-up data of 74 cases were complete, except 6 cases lost to follow-up. There was no significant difference between the two groups in demographics, duration of symptoms, operation stage (p > 0.05), and operation time (80.5 ± 5.5 vs. 81.5 ± 3.5 min). The VAS in the upper limbs pain was significantly higher postoperatively than preoperatively in both groups (p < 0.05). The cocktail group had a lower VAS than the control group 1 week postoperatively (p < 0.05); however, VAS not different between groups at the remaining time points. The NDI scores were significantly better postoperatively than preoperatively, and no significant differences were seen when comparing nodes at postoperative follow-up (p > 0.05). In the control group, two cases with foraminal stenosis were found to have unrelieved pain in the early postoperative period, but the pain was relieved at the final follow-up and did not convert to open decompression surgery.. Cocktail treatment, in which a drug sustained-release material made of gelatin sponge was impregnated with dexamethasone, ropivacaine, dexmedetomidine and vitamin B12, facilitates pain relief and early postoperative recovery after PPECD.

Topics: Anti-Inflammatory Agents; Cervical Vertebrae; Dexamethasone; Dexmedetomidine; Diskectomy; Feasibility Studies; Gelatin; Humans; Pain; Retrospective Studies; Ropivacaine; Treatment Outcome; Vitamin B 12

It is believed that vitamin B12 deficiency and hyperhomocysteinemia cause endothelial cell damage by increasing the levels of free oxygen radicals, which may, in turn, be related to the onset of migraine episodes.. The objective of our study was to ascertain a correlation between vitamin B12 levels and migraine attack frequency and pain severity.. 127 patients with migraine and 45 healthy controls who presented to Okmeydanı Training and Research Hospital were included in the study. The migraine attack frequency and the duration and severity of pain in migraineurs were recorded. Pain severity was evaluated using a visual analogue scale (VAS). Vitamin B12 levels below 300 ng/L were considered low.. The vitamin B12 levels in migraineurs were found to be significantly lower than those in the control group (227.30 ± 104.72 ng/L vs 278.44 ± 149.83 ng/L; p = 0.047). The vitamin B12 levels of patients with chronic migraine (CM) were found to be lower than those in patients with less frequent migraine attacks (197.50 ± 69.16 ng/L vs 278.56 ± 147.91 ng/L; p = 0.019). The ratio of vitamin B12 levels of 300 ng/L and above in patients with CM was lower than that of patients with episodic migraine (p < 0.05).. Along with attack frequency and pain severity assessment, it is important that migraine follow-ups should include regular measurement of vitamin B12 levels. We found lower vitamin B12 values in the CM group.

Topics: Humans; Hyperhomocysteinemia; Migraine Disorders; Pain; Vitamin B 12; Vitamin B 12 Deficiency

To observe the effectiveness of digital subtraction angiography (DSA) assisted musculoskeletal flap transplantation in the treatment of osteonecrosis of the femoral head (ONFH).. The clinical data of 15 patients with 15 hips of ONFH admitted between January 2016 and December 2019 were retrospectively analyzed. All patients were male, aged 20-45 years, with an average age of 31.6 years. There were hormone type in 9 cases and alcohol type in 6 cases. The disease duration ranged from 15 days to 3 years, with an average of 8 months. The Association Research Circulation Osseous (ARCO) staging: 4 hips in stage Ⅱ, 11 hips in stage Ⅲ. The preoperative visual analogue scale (VAS) score was 6.2±0.2, and the Harris score of the hip joint was 57.3±1.3. Preoperative DSA examination of the femoral head was performed to determine the location of vascular lesions of the femoral head. According to the results of the angiography, the surgical selection of the musculoskeletal flap was guided. For the patients with both superior and inferior retinaculum vessels developed, simple core decompression was performed. For the patients with superior retinaculum vessels developed but inferior retinaculum vessels not developed, anterolateral tensor fasciae flap was used. For the patients whose superior retinaculum did not develop and the inferior retinaculum developed, posterolateral quadratus femoris flap was used. The fibular flap with anastomotic vessels was used in the patients whose superior and inferior retinaculum vessels were not developed.. For patients with ONFH who need musculoskeletal flap transplantation, preoperative DSA of femoral head can determine the location of vascular lesions of femoral head, so as to guide the selection of musculoskeletal flap transplantation, which is of great significance for hip-conserving surgery.. 观察数字减影血管造影（digital subtraction angiography，DSA）技术辅助肌骨瓣移植治疗股骨头坏死（osteonecrosis of the femoral head，ONFH）的临床疗效。.. 回顾分析 2016 年 1 月—2019 年 12 月收治的 15 例 15 髋 ONFH 患者临床资料。患者均为男性，年龄 20～45 岁，平均 31.6 岁。病因：激素型 9 例，酒精型 6 例。病程 15 d～3 年，平均 8 个月。国际骨循环协会（ARCO）分期：Ⅱ期 4 髋，Ⅲ期 11 髋。术前疼痛视觉模拟评分（VAS）为（6.2±0.2）分，髋关节 Harris 评分为（57.3±1.3）分。术前行股骨头 DSA 检查确定股骨头血管病变部位，根据造影结果指导肌骨瓣移植术式的选择。对于股骨头上、下支持带血管均显影者行单纯髓芯减压术，对上支持带血管显影而下支持带血管未显影者采用前外侧入路的阔筋膜张肌骨瓣移植，对上支持带血管不显影而下支持带血管显影者采用经后外侧入路的股方肌骨瓣移植，对上、下支持带血管均未显影者行吻合血管的腓骨瓣移植。.. 对于需行肌骨瓣移植的 ONFH 患者，术前行股骨头 DSA 可明确股骨头血管病变部位，以此指导肌骨瓣移植术式的选择，对保髋手术具有重要意义。.

Topics: Adolescent; Adult; Aged; Angiography, Digital Subtraction; Bone Transplantation; Case-Control Studies; Fatigue; Female; Femur Head; Femur Head Necrosis; Ferritins; Fibromyalgia; Follow-Up Studies; Humans; Iron Deficiencies; Male; Middle Aged; Pain; Retrospective Studies; Sleep Quality; Surveys and Questionnaires; Treatment Outcome; Vitamin B 12; Vitamin D; Vitamins

Hansen disease is an infectious chronic disease with various clinical manifestations. Its joint performance may easily mimic rheumatoid arthritis.. We report a case of a 57-year-old woman diagnosed with Hansen disease 10 years ago, who suffered from joints swelling, pain and joints deformities of both hands for 19 years. The skin on the hands showed rashes, thickening, desquamation and chapping, with both thenar muscles atrophy. She also had severe hypoalgesia of the whole body, and morning stiffness for one hour.. The final diagnosis was joint damage and peripheral neuropathy due to Hansen disease.. The patient received neurotrophic treatment instead of anti-rheumatic treatment.. At 1-year follow up, no further aggravation of joint swelling and pain was detected.. The correct diagnosis of Hansen disease involving joints depends on the combination of medical history, careful physical examination, and laboratory examination.

Topics: Arthritis, Rheumatoid; Diagnosis, Differential; Female; Humans; Joints; Leprosy; Middle Aged; Pain; Peripheral Nervous System Diseases; Skin; Thiamine; Vitamin B 12

Current therapies for diabetic peripheral neuropathy with pain mask the painful symptoms while the underlying pathology continues to progress. This study assessed changes in symptoms and quality of life in patients taking a novel prescription medical food, L-methylfolate-methylcobalamin-pyridoxal-5-phosphate (LMF-MC-PP, Metanx ), intended to address the underlying metabolic needs of patients with diabetic peripheral neuropathy.. Between November 2010 and April 2012, patients rated their experiences before and after using LMF-MC-PP through an automated telephone system that included symptomatic items from the Neuropathy Total Symptom Score-6 (NTSS-6) questionnaire and questions related to quality of life and medication satisfaction.. A total of 544 patients participated in the study. Patients reported a mean reduction of 35% in NTSS-6 scores from after 12 weeks on LMF-MC-PP. Mean (standard deviation) score was reduced by 1.5 (1.8) at 12 weeks from a baseline of 4.3 (1.5) (p < 0.05). Patients achieved significant reductions in self-reported disruptions in work/school activities, social life, and family life, respectively. Overall pain rating decreased by 32% (p < 0.05). Patients previously treated with medications reported a 52% improvement in medication satisfaction (p < 0.05).. In a real-world clinical setting, patients with diabetic peripheral neuropathy treated with LMF-MC-PP achieved significant improvements in total symptom score (NTSS-6) and in quality of life and functioning, together with greater medication satisfaction. A limitation of this study was the use of a survey instrument to collect data on patient outcomes.

Topics: Adult; Aged; Diabetic Neuropathies; Female; Humans; Male; Middle Aged; Pain; Pyridoxal Phosphate; Quality of Life; Surveys and Questionnaires; Tetrahydrofolates; Vitamin B 12

Carpal tunnel syndrome is the most common type of peripheral entrapment neuropathy.. We performed an exploratory, open-label, multicenter, observational study of 48 patients with peripheral entrapment neuropathy. Patients received a daily capsule of uridine monophosphate, folic acid + vitamin B12 for 2 months and were evaluated using the Pain DETECT questionnaire.. The global score for pain decreased from 17.3 ± 5.9 at baseline to 10.3 ± 6.1 at the final evaluation (p < 0.001). Concomitant analgesic and anti-inflammatory treatment was stopped or the dose reduced in 77.4% of patients.. Uridine monophosphate + folic acid + vitamin B12 reduced total pain score, intensity and characterization of pain and associated symptoms. These results should be tested in a well-designed, adequately powered randomized controlled trial.

Topics: Administration, Oral; Adult; Aged; Analgesics; Anti-Inflammatory Agents; Carpal Tunnel Syndrome; Female; Folic Acid; Humans; Male; Middle Aged; Nerve Compression Syndromes; Pain; Pain Measurement; Tarsal Tunnel Syndrome; Treatment Outcome; Uridine Monophosphate; Vitamin B 12

The antinociceptive effect of cyanocobalamin (Vit B12) has been reported in animal models and human studies. Our previous study showed the effect of Vit B12 on morphine tolerance. The dependence and tolerance were induced in male mice using subcutaneous morphine injections, 3 times a day (50, 50 and 75 mg/kg/day) for 3 days. Mice also received Vit B12 (100, 250 and 500 µg/kg), clonidine, memantine and saline intraperitoneally before morphine administration. On fourth day mice received only 7 mg /kg morphine just before tail-flick test. To determine the expression of morphine dependence and tolerance, all compounds were injected once intraperitoneally on the day of experiment. The tolerance was evaluated by the tail-flick test. The effect of Vit B12 and other agents on dependence were evaluated by counting the number of jumps (induced by naloxone 5 mg/kg). Co-administration of Vit B12 (100-500 µg/kg) and morphine in 3 days reduced the development of tolerance to morphine analgesic effect (8.2±0.5 and 7.83±0.5 s. vs. normal saline, 3.57±0.3 s). Repeated administration of Vit B12, also, diminished the reduced naloxane withdrawal signs of naloxone withdrawal test (100-500 µg/kg: 5±1.9 and 1.2±0.8 jumps vs. normal saline 72.6±12.2). However, Vit B12 had no effect on the expression of morphine tolerance and physical dependence. It is concluded that co-administration of Vit B12 and morphine could reduce tolerance to analgesic effect of morphine chronic administration and also reduce its withdrawal symptoms.

Topics: Analgesics, Opioid; Animals; Clonidine; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Tolerance; Male; Memantine; Mice; Morphine; Morphine Dependence; Naloxone; Pain; Vitamin B 12

Dietary supplementation with methyl donors can influence the programming of epigenetic patterns resulting in persistent alterations in disease susceptibility and behavior. However, the dietary effects of methyl donors on pain have not been explored. In this study, we evaluated the effects of dietary methyl donor content on pain responses in mice.. Male and female C57BL/6J mice were treated with high or low methyl donor diets either in the perinatal period or after weaning. Mechanical and thermal nociceptive sensitivity were measured before and after incision.. Mice fed high or low methyl donor diets displayed equal weight gain over the course of the experiments. When exposed to these dietary manipulations in the perinatal period, only male offspring of dams fed a high methyl donor diet displayed increased mechanical allodynia. Hindpaw incision in these animals caused enhanced nociceptive sensitization, but dietary history did not affect the duration of sensitization. For mice exposed to high or low methyl donor diets after weaning, no significant differences were observed in mechanical or thermal nociceptive sensitivity either at baseline or in response to hindpaw incision.. Perinatal dietary factors such as methyl donor content may impact pain experiences in later life. These effects, however, may be specific to sex and pain modality.

Topics: Animals; Choline; Dietary Supplements; Female; Folic Acid; Hindlimb; Hyperalgesia; Male; Methionine; Mice; Mice, Inbred C57BL; Pain; Vitamin B 12; Weaning

Vitamin B(12) deficiency is a common but underrecognized problem in older adults. Historically, B(12) deficiency was diagnosed once a severe pernicious anemia developed. Scientific developments have led to a new understanding of a broader spectrum of B(12) deficiency and identification of a milder form of deficiency associated with food/vitamin B(12) malabsorption. Using an individual example, this article describes the functional impact of vitamin B(12) deficiency and highlights modern approaches to diagnosis and treatment.

Topics: Activities of Daily Living; Aged, 80 and over; Anorexia; Fatigue; Female; Geriatric Assessment; Geriatric Nursing; Humans; Nurse Practitioners; Nursing Assessment; Pain; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

The effect of some B vitamins in chemical and thermal models of nociception in mice was investigated. The association thiamine/pyridoxine/cyanocobalamin (TPC, 20-200 mg/kg, i.p. or per os), thiamine, pyridoxine (50-200 mg/kg, i.p.) or riboflavin (3-100 mg/kg, i.p) induced an antinociceptive effect, not changed by naloxone (10 mg/kg, i.p.), in the acetic acid writhing model. Treatment for 7 days with thiamine/pyridoxine/cyanocobalamin (100 or 200 mg/kg, i.p.), thiamine (50 or 100 mg/kg) or pyridoxine (50 or 100 mg/kg) or acute treatment with riboflavin (6 or 12 mg/kg, i.p) inhibited the nociceptive response induced by formaldehyde. The B vitamins did not inhibit the nociceptive response in the hot-plate model. Both 7-day thiamine/pyridoxine/cyanocobalamin (100 mg/kg, i.p.) or acute riboflavin (25 or 50 mg/kg, i.p.) treatment partially reduced formaldehyde-induced hindpaw oedema. The B vitamins antinociceptive effect may involve inhibition of the synthesis and/or action of inflammatory mediators since it was not observed in the hot-plate model, was not reversed by naloxone, only the second phase of the formaldehyde-induced nociceptive response was inhibited, and formaldehyde-induced hindpaw oedema was reduced.

Topics: Acetic Acid; Animals; Constriction; Disease Models, Animal; Dose-Response Relationship, Drug; Edema; Formaldehyde; Hindlimb; Injections, Intraperitoneal; Injections, Subcutaneous; Male; Mice; Motor Activity; Naloxone; Nociceptors; Pain; Pain Measurement; Pyridoxine; Riboflavin; Thiamine; Vitamin B 12; Vitamin B Complex

Topics: Alprostadil; Anticonvulsants; Antidepressive Agents, Tricyclic; Child; Diabetic Neuropathies; Female; Humans; Hyperglycemia; Male; Mexiletine; Pain; Pain Management; Polymers; Sensation; Sodium-Potassium-Exchanging ATPase; Vitamin B 12

Topics: Animals; Humans; Pain; Pyridoxine; Thiamine; Vitamin B 12

To establish the diagnostic safety and the prognosis in outpatients with non-organic upper abdominal pain, 37 patients were followed up 5-7 years after the index investigation. In only one case had the diagnosis been changed during the follow-up period. This was in a man who erroneously had not been examined sufficiently before entry. He turned out to have gallstones. Eighty-one per cent still had abdominal pain, but 51% had improved (P less than 0.005). At the index investigation back pain was reported by 76% and headache by 60%. At the follow-up study back pain was unchanged in severity, but headache was significantly improved. The course of abdominal pain was significantly correlated with the course of back pain and headache. At the index investigation a psychic symptom score indicating vulnerability was significantly higher than in a matched patient group with well-defined pain. It was unchanged high at the follow-up study and unrelated to the course of the abdominal pain. Fifty-four per cent of the patients had symptoms of irritable bowel syndrome, but the course of the abdominal pain was unrelated to this.

Topics: Adult; Amylases; Calcium; Chronic Disease; Female; Folic Acid; Follow-Up Studies; Hemoglobins; Humans; Liver; Male; Middle Aged; Pain; Prognosis; Radiography, Abdominal; Vitamin B 12

27 patients with pernicious anaemia, followed for a long period, were consecutively treated with 3 different vitamin B12 preparations while, during intervening periods, no therapy was given until signs of B12 deficiency developed. The mean of the vitamin B12-free period lasted 400 d. Some patients were 'short-reactors' whereas others were 'long-reactors'. Some patients repeatedly revealed deficiency signs at cobalamin values greater than 200 pmol/l and others at values less than 50 pmol/l, pointing to individually different cut-off points for appearance of signs of deficiency. Hypersegmentation was the first sign in about 2/3, neuropathy in 1/3 and mucosal changes in about 1/10 of the patients. The same type of deficiency was repeatedly noted in the same patient. The daily decline of plasma cobalamin values decreased during the vitamin B12-free period. In perorally treated patients the unsaturated transcobalamin values showed an inverse relationship to the cobalamin values. Marked increases in unsaturated transcobalamin I values were noted in 4 of 16 patients treated with B12 injections, resulting in prolonged high cobalamin values and prolongation of the vitamin B12-free periods.

Topics: Adult; Aged; Anemia, Pernicious; Diarrhea; Erythrocytes; Female; Humans; Male; Middle Aged; Mucous Membrane; Nervous System Diseases; Pain; Time Factors; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aminopyrine; Anesthetics, Local; Anti-Inflammatory Agents; Back Pain; Cauda Equina; Dexamethasone; Drug Combinations; Female; Humans; Injections; Lumbosacral Region; Male; Middle Aged; Pain; Paralysis; Pelvis; Phenylbutazone; Spinal Cord; Thiamine; Vitamin B 12

Topics: Analgesics; Animals; Anti-Inflammatory Agents; Ascorbic Acid; Dose-Response Relationship, Drug; Humans; Male; Pain; Pyridoxine; Rats; Thiamine; Vitamin B 12; Vitamin K 1; Vitamins

The effects of vitamin B12 are compared to those of aspirin and 0.9% saline in three different experimental pain models in rats and mice; an electric shock test, the hot-plate test, and the phenylbenzoquinone writhing test. Neither cyanocobalamin nor hydroxocobalamin showed any antinociceptive activity in any of the three tests at any of the doses used, whether the drug was administered as a single injection or as a series of daily injections lasting 7 days. These results run counter to those of clinical trials in man, though close scrutiny of the experimental procedures used in these trials often reveals a lack of rigor which casts doubts on their validity. This consideration, together with the negative findings reported here, suggests that the clinical use of vitamin B12 as an analgesic may be inappropriate.

Topics: Analgesics; Animals; Aspirin; Benzoquinones; Electroshock; Female; Male; Mice; Pain; Quinones; Rats; Rats, Inbred Strains; Reaction Time; Vitamin B 12

Topics: Acute Disease; Aminopyrine; Arthritis, Rheumatoid; Dexamethasone; Drug Combinations; Female; Humans; Lidocaine; Male; Pain; Phenylbutazone; Prednisolone; Riboflavin; Thiamine; Vitamin B 12

Topics: Adult; Aged; Body Weight; Disability Evaluation; Duodenal Ulcer; Dyspepsia; Female; Follow-Up Studies; Humans; Male; Mental Disorders; Middle Aged; Neurologic Examination; Neurologic Manifestations; Pain; Peptic Ulcer; Postgastrectomy Syndromes; Postural Balance; Sensation; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aminopyrine; Anti-Inflammatory Agents; Drug Combinations; Drug Evaluation; Esculin; Female; Humans; Joint Diseases; Male; Middle Aged; Osteoarthritis; Pain; Phenylbutazone; Pyridoxine; Rheumatic Diseases; Spinal Diseases; Vitamin B 12

Topics: Abdomen, Acute; Adult; Biopsy; Blood Pressure; Body Temperature; Diet Therapy; Female; Folic Acid; Hematocrit; Hemoglobins; Humans; Intestinal Mucosa; Intestinal Obstruction; Iron; Leukocyte Count; Pain; Strongyloides; Strongyloidiasis; Thiabendazole; Transferrin; United Kingdom; Vitamin B 12

Topics: Accidents, Traffic; Adolescent; Adult; Ascorbic Acid Deficiency; Calcium; Cheilitis; Diet; Dietary Fats; Gangrene; Hemoglobins; Humans; Intestinal Absorption; Intestine, Small; Iron; Leukocyte Count; Magnesium; Magnesium Deficiency; Male; Oligosaccharides; Pain; Prothrombin Time; Tetany; Vitamin A Deficiency; Vitamin B 12; Vitamin D

Topics: Adolescent; Adult; Aluminum; Dexamethasone; Drug Combinations; Female; Genital Diseases, Female; Glycine; Humans; Middle Aged; Pain; Pelvic Inflammatory Disease; Phenylbutazone; Thiamine; Tissue Adhesions; Uterine Diseases; Vitamin B 12; Vitamin B Complex

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; Analgesics; Bone Diseases; Coenzymes; Fractures, Bone; Humans; Injections, Intramuscular; Joint Dislocations; Middle Aged; Pain; Vitamin B 12

Topics: Adult; Aged; Analgesics; Arthritis, Rheumatoid; Dexamethasone; Female; Humans; Male; Middle Aged; Pain; Phenylbutazone; Pyrazoles; Rheumatic Diseases; Rheumatic Fever; Time Factors; Vitamin B 12

Topics: Amino Alcohols; Analgesics; Anti-Inflammatory Agents; Humans; Neuritis; Pain; Pyridoxine; Pyruvates; Rheumatic Diseases; Thiamine; Vitamin B 12

Topics: Analgesics; Antipyrine; Humans; Methylamines; Nervous System Diseases; Pain; Pyridoxine; Sulfonic Acids; Thiamine; Vitamin B 12

Topics: Adolescent; Adult; Aged; Child; Depression; Facial Paralysis; Herpes Zoster; Humans; Middle Aged; Pain; Perphenazine; Prednisolone; 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; Aged; Analgesics; Female; Humans; Middle Aged; Pain; Pelvic Neoplasms; Pregnancy; Vitamin B 12

Topics: Folic Acid; Humans; Nervous System Diseases; Pain; Quaternary Ammonium Compounds; Thiamine; Vitamin B 12; Vitamin B Complex

Topics: Aminopyrine; Analgesics; Analgesics, Non-Narcotic; Antipyretics; Muscle Relaxants, Central; Pain; Pain, Postoperative; Postoperative Complications; Vitamin B 12

Topics: Anemia; Anemia, Macrocytic; Anemia, Megaloblastic; Celiac Disease; Diverticulum; Drug Therapy; Geriatrics; Humans; Intestinal Diseases; Intestine, Small; Intestines; Pain; Steatorrhea; Tetracycline; Toxicology; 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; Hematinics; Humans; Lightning; Pain; Tabes Dorsalis; Vitamin B 12

Topics: Corrinoids; Humans; Leprosy; Pain; Vitamin B 12; Vitamin B Complex

Topics: Herpes Zoster; Humans; Nervous System Diseases; Neurology; Pain; Phantom Limb; Trigeminal Neuralgia; Vitamin B 12

Topics: Corrinoids; Hematinics; Humans; Pain; Pain, Postoperative; Surgical Procedures, Operative; Vitamin B 12; Vitamin B Complex

Topics: Humans; Neuritis; Pain; Vitamin B 12

Topics: Humans; Neuritis; Pain; Vitamin B 12