Vitamin B12 Injections For Chronic Pain

Below is a study poster presented to the Canadian Pain Society showing benefits of frequent B12 Injections. Unfortunately, a study found men with smoking history have a 3 times lung cancer rate so I have now restricted B12 injection use to women.

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Office Ketamine For Chronic Pain Poster

here is poster in pdf format:

Poster CPS 2017 ketaminefinal (2)

in word format:
Pilot Study


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Welcome to Painmuse


visit me there!

I have a program that tracks where users are from – pain is worldwide:

Thanks admin

Hit     CTRL  +   to make things larger

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Reaching “Critical Mass” to Achieving Pain Control – Procedure Pearls

I have recently achieved (previously unattainable) control in some of my chronic pain subjects using recent innovations – but to acheive this required use of multiple modalities at once.

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Posted in arm, Back Pain, Botox, complex regional pain, Drugs, Fibromyalgia, Headaches, Injection, IV therapy, Leg Pains, Manual Med, myofascial pain, Neck, neuropathic, Pain Dystrophy, piriformis, post herpetic neuralgia, radiculitis, shoulder, Uncategorized | 9 Comments

Commonly Missed Problems in Chronic Pain

Back in 2006, Janice Montbriand  and I wrote a poster about “Often Missed Treatable Co-Morbidities in Patients with Treatment Resistant Chronic Pain”. They included Bipolar disease, B12 and Vitamin D deficiencies, and sleep disorders.  Each one of these is still an important issue today.

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Finger pressure can relieve many migraine headaches

Over three minute pressure to occipital arteries can greatly relieve migraine pain in over 1/2 of cases; almost sounds too good to be true. Continue reading

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Helps to Diagnose Hypermobility / Ehlers–Danlos syndrome

German journal article has good templates for diagnosing Ehlers–Danlos syndrome and I thought the world should share this…

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6 Month High Dose Methotrexate For Early OA Hands

6 months of 20 mg Methotrexate can improve significant early hand OA by 25%.

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Pregabalin and Gabapentin Can Worsen COPD Flares

Patients on gabapeninoids (gabapentin and pregabalin) for pain or epilepsy that have COPD are up to 1.5 times more likely to have a severe exacerbation. This scares me.

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Clavulin Might have helped Chronic Low Back pain by Affecting Glutamate in the Brain

Amoxicillin-clavulanic acid 100 day treatment was shown to have significant effect on chronic low back pain yet straight penicillin did not. Recent works on clavulanic drugs has demonstrated it can lower brain glutamate levels (pain transmitter) and help with withdrawal and addiction.

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What Does One Use For Worst Topical Pains – Lidocaine2.5% /Prilocaine 2.5%

I remember lidocaine/prilocaine mix as Emla – used to put on sites for those terrified of needle pokes. It didn’t have “poison prevention packaging” and was removed from market though generics are available or compounding pharmacy can make up. Was found to be the only agent successful at treating Monkeypox painful skin lesions in two cases.

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Irritable Bowel (IBS) Treatment -Amitriptyline Maybe

Drug treatment for IBS has been fraught with problems of efficacy and wrought with issues of excessive expense. Amitriptyline, an old serotonin simulator, is cheap, helps one sleep, and recently found sort of efficacious.

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Gene Therapy Coming of Age – Sickle Cell With a Catch

Eradicating your bone marrow stem cells, and replacing with gene edited cells can cure the disease but leaves one sterile.  Preemptive egg and tissue freezing and sperm banking  saves the day but can cost up to $20,000 US dollars ( less for sperm) and In vitro fertilization (IVF) for women (not for sperm) comes with similar price tags. Concerns are, that one might carry the gene to baby, so outside donor IVF might be more sensible and carries similar price-tags. However, the cure is a miracle. Read more about it here:

New gene therapies confront many sickle cell patients with an impossible choice: a cure or fertility

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Anxiety – Mouthwatering Relief with Stellate Blocks

Anxiety /GAD levels reduced to HALF with stellate ganglion blocks- better results with bilateral,

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Stellate Block for Long COVID 19

In 41 case, right sided stellate block gave rapid relief of brain fog and  fatigue often within 15 minutes of injection. Magical.

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Cannabinoids Not So Great For Pain

In my younger days, there was a group of pain experts that used opioids as their linchpin. Then studies came our showing only 1/2 can tolerate them and only 1/4 will stay on them. Opioid abuse reared its head. Pain reduction was not great except among a subgroup of responders.

Sadly, they fared better then many of the other agents (gapapentinoids, antidepressants fare poorly in back pains/scaiticas which account for over 1/2 pain patients).

Cannabinoids came under fire early in an issue of PAIN years ago (need to treat 25 to get one good case) and was ignored. Now a recent metanalysis found benefits were:
“Cannabinoids reduced chronic pain and improved quality of sleep, but the effect sizes are of questionable importance. Cannabinoids had no effects on acute pain or cancer pain and increased the risks of non-serious adverse events. The harmful effects of cannabinoids for pain seem to outweigh the potential benefits.

My experience with cannabinoids showed that titration took so long that patients really didn’t notice much benefit and were often unwilling to buy a second batch as a result. Now it looks like it really doesn’t do much significant difference.

I live by the philosophy of threes: – You need to do three things at once to obtain any meaningful results. – meds, exercise, massage/Tai chi and so forth. Maybe not abandon but couple with two other treatments to expect anything.

I’ve had to deal with some chronic pain and found botulinum injection, massage and regular gym use is making a difference.  Any one, by itself, would have done little.

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Multiple Sclerosis / MS helped by Probiotics

Saccharomyces boulardii supplement for four months reduced pain by 31% versus 12.5% by placebo. Fatigue reduced by 19% versus 8% by placebo.

Asghari, K.M., Dolatkhah, N., Ayromlou, H. et al.
The effect of probiotic supplementation on the clinical and para-clinical findings of multiple sclerosis: a randomized clinical trial.
Sci Rep 13, 18577 (2023).

  • repeated evidence that “gut microbiota can influence the inflammatory responses of individuals and animals with MS”
  • BioDigest® is a commercial dietary supplement containing 250 mg of SB (1010 CFU), a lactose filler, and a magnesium acetate oil. – one/day ? 1010 colony forming units = 10 x10 to tenth power so maybe 10 biliion.
  • That strength you can get off Amazon
  • multiple studies confirming improvement with inflammatory markers with probiotics

Comment – probiotics would be an easy option

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Acute Nerve Injury – Fasting and No NSAID’s

Fasting promotes growth of Clostridium sporogenes which elevates levels of indole-3-propionic acid (IPA).  In mouse model, improves “promotes neutrophil infiltration into the dorsal root ganglia (DRG), which enhances the regeneration of sciatic nerve fibers”.

Nerve growth is contingent on a type of neurophils (and also a type of macrophages). Arthritis Pills/NSAIDs would interfere with that.

I sustained injury to the back skin nerves (cluneal) and I stayed off NSAID for  6 weeks to allow nerves to regrow. Tramadol would be a good option in meantime.

I tried some fasting but can’t say if helped.

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New Hope For PTSD – Bilateral Stellate Blocks/Botulinum/Radiofrequency +/- Ketamine

For years now, stellate ganglion blocks have been found to help anxiety and PTSD. Some are spectacular and some not. Most have been right sided stellate blocks only. Now a case with BILATERAL stellate blocks has been done with initial significant (>75%) results, and repeated 2 month later with bilateral (botulinum 50 u one side two weeks apart) of each other lead to immense improvement. Swallowing issues for 6 weeks is annoying. Radiofrequency to ganglions prolonged effect and Ketamine addition improved results.

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Pain Mechanisms and Patients in Acute Pain are Screwed

It has been widely shown that neuropathic pain to include significant changes in spinal support cells called Microglia. Now it’s been shown that “newly identified CD11c-positive microglia as a subset that increases during the remission phase of neuropathic pain”.

Jeff Mogil’s group in McGill has shown that although inflammation is involved in development of pain, there are inflammatory neutrophil leukocytes that  protect against development of chronic pain.

Blanket treatments against Microglia or White Blood Cell inflammation might be coounterproductive

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Ehlers-Danlos / Hypermobility Syndrome is oft a Small Fiber Neuropathy Pain Syndrome and Dysautonomia/POTS

61% of Ehlers-Danlos (EH) syndromes cases have small fiber neuropathy

Fibromyalgia(FM) is now, in the worser forms, considered a small fiber neuropathy and in the milder forms with evidence of skin nerve immune attack. Hence EH could be said to have a version of FM with all the pain this entails. POTS like symptoms can occur in up to 3/4 cases.

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Celine Dion Should Not Have to be Disabled

Diffuse idiopathic skeletal hyperostosis (DISH) disability should be ameliorated, by use of IV pamidronate, Vitamin D 3 4000 u/day and  methyl f0rm B12 3000 mg/day.  HCG shots are helpful. Mood could be relieved with Transcranial magnetic stimulation and hyperbaric oxygen treatments. Muscle knots might be helped with Intramuscular stiimulation (IMS devised by Dr. Chan Gunn from Vancouver and many physios now do).  Facet botulinum or stem cell injections might help. All expensive but she didn’t work all these years for nothing.

Pamidronate IV Biphosphonate  Treatments

There are bone building inflammatory disorders – the most common is SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis).

Nguyen, Minhchau Thi, et al. “The SAPHO syndrome.” Seminars in arthritis and rheumatism. Vol. 42. No. 3. WB Saunders, 2012.

It is oft treated with IV bone building meds called biphosphonates – widely used in any bone inflammatory condition of spine and out of control CRPS newer pains.

(multiple article on site – use search function)


Pamidronate is an Iv given in this case monthly – takes few hours to run IV in. Have to have decent teeth as can get tooth infection or loose teeth otherwise.

One article mentioned its use in DISH:

Slobodin, Gleb, et al. “Pamidronate treatment in rheumatology practice: a comprehensive review.” Clinical rheumatology 28 (2009): 1359-1364.

“we recently used six monthly 60-mg intravenous pamidronate infusions in three patients
with painful diffuse idiopathic skeletal hyperostosis (unpublished data), with resulting significant pain relief in all patients”

given there are multiple articles using it in all sort of back pain issues not surprising it works. (search pamidronate on my site)

Vitamin B12:

B12 has been found useful in back pain:

Chronic Back Pain Help – Forgotten B12 Injections and What Else Good For…

I did a study on injectable B12 (given like a insulin shot) for chronic pain and found a 20% drop in pains with use. It also helped fatigue and mood.

Vitamin B12 Injections For Chronic Pain

I uses injectable but you can try oral methyl based B12 at 3000 mg though response would be slower.

Vitamin D3

Vitamin D at 4000 u/day has pain relieving effect by about 1/3

Vitamin D – Could High Doses Help Pains?

several studies found vitamin D helpful it helpful in chronic back pain particularly if their levels are lowish:

Low Vitamin D and Chronic Pain – What is the Evidence?


HCG Injections

Human Chorionic Gonadotrophin pregnancy hormone shots are used by weightlifters and people trying to lose weight but can remarkably reduce pain:

Human Chorionic Gonadotrophin (HCG) Touted as Only Curative Agent For Pain That Has Centralized


intramuscular needling stimulation to tender muscle triggers could give significant pain relief:

wealth of information at their web site:


as well as info on practitioners near you.

Warning though – there are three ways to do IMS

-temporary needle maybe with some twisting of needle

– needle with electrical stimulation

I was one of the first few people taught IMS by Dr. Gunn and he was using a pointer plus at time. It has a DC settling and you can add pulses every few seconds by depressing a switch. If done 120 – 180 times you can get profound relaxation of muscle you are needling. I had one lady with neck instability that needling this way gave profound relief while other straight IMS did not. She ask for the pointer plus with added pulses 180 times for each stop. Could take 30 min+ to do all spot

self manipulation:

You can “thump” your own tender facet joints with an activator chiropractic manipulator:

This is best done initially under supervision with a physiotherapist.  I thump joints from the front, side and back. You can buy them off ebay. If you don’t have muscle strength in hands, then maybe get an electrical


Injections of facets

I found injecting cervical facets with 5-10 u botulinum could cause remarkable improvement in facet pains using a technique described in South Korea

Orthopedics. 2009 Aug;32(8), 557-567
Injection in the cervical facet joint for shoulder pain with myofascial trigger points in the upper trapezius muscle.
Tsai CT(1), Hsieh LF, Kuan TS, Kao MJ, Hong CZ.

I presented this technique a twice to the Canadian Association of Orthopaedic Medicine (CAOM)
perhaps contacting them can find out if anyone is using it near you.

Last year someone at CAOM discussed use of stem cell injections to facet joints but I can’t find reference.


Depression and Pain – TMS and Hyperbaric oxygen

Weekly Transcranial magnetic stimulation is effective for mood and avoids medications:

Leung, Albert, et al. “Transcranial magnetic stimulation for pain, headache, and comorbid depression: INS-NANS expert consensus panel review and recommendation.” Neuromodulation: Technology at the Neural Interface 23.3 (2020): 267-290.

Hyperbaric oxygen  is helpful for pain and depression as well.  Could she get her own equipment?

Krzystanek, Marek, et al. “Whole Body Cryotherapy and Hyperbaric Oxygen Treatment: New Biological Treatment of Depression? A Systematic Review.” Pharmaceuticals 14.6 (2021): 595.

I hope this gives her some  ideas. There would be one dangerous thing to worry about if you have DISH syndrome: – Don’t get in any car accidents as it can snap your neck and potentially damage spinal cord:

Spine (Phila Pa 1976). 2010 May 15;35(11):E458-64.
Spine fractures in patients with ankylosing spinal disorders.
Caron T et al

I had one of my patients with DISH like Xray stiffness driving people from car dealership while their car was being repaired.  Showed him article and don’t think he’s putting himself in that much risk anymore.



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Plantar stretching for Plantar fasciitis

Despite some thinking there is nothing that could be done for plantar fasciitis, combination of fascia exercises (prior post) and plantar stretches combined with high dose arthritis pills (often combined with an ulcer pill) can lead to satisfactory relief.  Regular plantar stretches by self can lead to over 50% improvement.

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Fascial based Exercises For Plantar Fasciitis

Put foot on stairs (or a block of wood would do) and drop heel down – NOT really a stretch but strengthening and revising the plantar fascia has good effect on plantar fasciitis

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Plantar Fasciitis Statistically Shockwave Treatments Beat Botulinum but…

Botulinum injections in Plantar fasciitis had an appeal because of the lack of atrophy you can get with steroid inject.  Shockwave therapy is an option, and works in more people but pain relief looks same or better in Botulinum group?

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Plantar Fasciitis Steroid Injections – Good and Bad News

Good news is a recent meta- analysis concluded that steroid injections did not result in plantar fascia thinning. Bad news is that though it is effective, it wears off in 4-12 weeks. Rare plantar fascia ruptures can occur just like can happen with shoulder tendon injections. Continue reading

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Dysfunction of Hydroxymethylglutaryl-CoA (HMG-CoA) Reductase behind some Limb Girdle Muscular Dystrophy and Statin Muscle Problems and Treatable

Exciting discovery! Hydroxymethylglutaryl-CoA (HMG-CoA) Reductase is involved in cholesterol metabolism and cholesterol pills block that enzyme. People with a less functioning version of that enzyme ended up with statin induce myopathy according to one study. Another study found it implicated in some limb-girdle muscular dystrophy and treatable with a compound that helps this enzyme – called oral mevalonolactone.

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B6 / Pyridoxine 100 mg for Nerve Pain

I’m a big advocate of B12 for nerve damage pain but have added B6 to my regimen as came across article using it for drug induced neuropathy. Been previously shown to help carpal tunnel symptoms. B6 is touchy as 400 mg can cause nerve damage so best stick to 100 mg/day.

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Vitamin D in Dogs – are we missing the boat? – Arthritis and Itching

Dogs cannot make vitamin D – not even from sun and hence are totally dependent on diet. Osteoarthrtis in humans is only  protected in humans with HIGH vitamin D levels. Might this apply to my dog as well?

Below article discusses the potential need for Vitamin D. Deficiencies were common:

Thirty-three dogs (71·7 %) had 25(OH)D values below the previously reported minimum concentration indicating sufficient vitamin D status of 100 ng/ml”

Young, Lauren R., and Robert C. Backus. “Oral vitamin D supplementation at five times the recommended allowance marginally affects serum 25-hydroxyvitamin D concentrations in dogs.” Journal of nutritional science 5 (2016).

Importance of Vitamin D in dogs so far:

In veterinary medicine, many investigators have reported associations between low serum 25(OH)D concentrations and canine mast cell tumour(16) , chronic kidney disease (17), congestive heart failure(18) , inflammatory bowel disease (19) and cancer (10)

16 Wakshlag JJ, Rassnick KM, Malone EK, et al. (2011)
Cross-sectional study to investigate the association between vitamin D status and cutaneous mast cell tumours in Labrador retrievers. Br J Nutr 106, S60–S63

17 Gerber B, Hassig M & Reusch CE (2003) Serum concentrations of 1,25-dihydroxycholecalciferol and 25-hydroxycholecalciferol in clinically normal dogs and dogs with acute and chronic renal failure. Am J Vet Res 64, 1161–1166

18 Kraus MS, Rassnick KM, Wakshlag JJ, et al. (2014) Relation of vitamin D status to congestive heart failure and cardiovascular events in dogs. J Vet Intern Med 28, 109–115

19 Gow AG, Else R, Evans H, et al. (2011) Hypovitaminosis D in dogs with inflammatory bowel disease and hypoalbuminaemia. J Small Anim Pract 52, 411–418.

10 Selting KA, Sharp CR, Ringold R, et al. (2014) Serum 25-hydroxyvitamin D concentrations in dogs – correlation with health and cancer risk. Vet Comp Oncol (epublication ahead of print version 8 July 2014).



What is little known in human studies is only high levels fully protect people

only HIGH levels fully protect mono sufferers from getting MS:
Munger, Kassandra L., et al. “Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis.” Jama 296.23 (2006): 2832-2838.

“HIGH circulating levels of vitamin D are associated with a lower risk of multiple sclerosis.”

HIGH levels fully help protect subjects from heart disease:

J Prev Med Public Health. 2017 Jul; 50(4): 278–281.
The Big Vitamin D Mistake
Dimitrios T. Papadimitriou

HIGH  levels are helpful in lupus:

Pakchotanon, Rattapol, et al. “Randomized Double-Blind Controlled Trial To Evaluate Efficacy Of Vitamin D Supplementation Among Patients With Systemic Lupus Erythematosus.” Journal of Southeast Asian Medical Research 4.1 (2020): 24-32.


AND Most importantly, only HIGH levels gave best protection against Osteoarthritis.

In a Framingham study of osteoarthritis only subjects in the Upper 1/3 blood levels of vitamin D were protected from osteoarthritis progression: Relation of Dietary Intake and Serum Levels of Vitamin D to Progression of Osteoarthritis of the Knee among Participants in the Framingham Study Timothy E. McAlindon et al Ann Intern Med. 1996;125(5):353-359.

“Risk for progression increased threefold in participants in the middle and lower tertiles for both vitamin D intake (odds ratio for the lower compared with the upper tertile, 4.0 [95% CI, 1.4 to 11.6]) and serum levels of vitamin D (odds ratio for the lower compared with the upper tertile, 2.9 [CI, 1.0 to 8.2]).”

This is huge with “normal” and low levels getting THREE times the osteoarthritis rates. However, where I live vitamin D deficiency is rampant and there seems to be no understanding that knee replacement might be in part related to low vitamin D levels.

 Suspect same seems to go with canines.

Dogs carry huge risk of osteoarthritis yet there is little research into need for vitamin d.

Initial article used:

2·3 μg vitamin D 3 /kg BW exp 0·75

Exponenting the weight comes from studies:
Sidhu KS. Basis for body weight exponent (0.75) as a scaling factor in energy metabolism and risk assessment. J Appl Toxicol. 1992 Oct;12(5):309-10

1 mcg vitamin D is equal to 40 IU

10 kg exp 0.75 comes to 5.6 kg

Results work out to 560 u/day for a 10 kg dog (400 u = one drop pediatric – so one drop for 3 days and 2 drops on forth day)


Gave my 10 k cocker spaniel his first drop today….  More heavy set dogs are going to need it more…

addendum – vit d supplementation might help itch in dogs:

Klinger, Christoph J., et al.
Vitamin D shows in vivo efficacy in a placebo‐controlled, double‐blinded, randomised clinical trial on canine atopic dermatitis.
Veterinary Record 182.14 (2018): 406-406.

“After eight weeks of treatment, patients who received cholecalciferol showed significantly less pruritus than patients from the placebo group (P<0.0001)” – actually cut it in half! I’m hoping my dog will scratch less…


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Emotional and Physical Pain Might Be a Memory Engram and How to Prevent It

Dr. AV Apkarian has pioneered the idea that brain changes occur following pain injury that leaves a pain memory.

Mansour, A. R., M. A. Farmer, M. N. Baliki, and A. Vania Apkarian. “Chronic pain: the role of learning and brain plasticity.” Restorative neurology and neuroscience 32, no. 1 (2014): 129-139.

“We argue that the definition of chronic pain can be recast, within the associative learning and valuation concept, as an inability to extinguish the associated memory trace”

Perhaps early use of steroids can prevent this pain memory as seen in whiplash and more recently, in a PTSD like situation.

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Vitamin B12 in Chronic Pain

Since it was found that high dose B12 shots can almost double life expectancy of victims with ALS, the use of B12 shots has taken a new life

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