Vitamin B12 and Pain – What You Need to Know

By Dr Amod Manocha, Pain Specialist, International Pain Centre

What is Vitamin B12?

Vitamin B12 is a vital nutrient that plays an important role in our overall health. It is essential for:

• Producing red blood cells (important for carrying oxygen in the body)
• Maintaining healthy nerves and brain function
• DNA production
• Helping convert food into energy

The human body cannot make Vitamin B12 on its own. We must get it from food or supplements.

Why is Vitamin B12 Important for Pain?

Vitamin B12 supports the health of nerves, which means it can play a key role in pain conditions—especially nerve-related pain.

Research shows that Vitamin B12 can be helpful in treating:

• Diabetic neuropathy
• Postherpetic neuralgia
• Chronic low back pain
• Peripheral neuropathy
• Chemotherapy-related nerve pain
• Aphthous mouth ulcers
• Morton’s neuroma

How Does B12 Help with Pain?

• Nerve Healing: It helps repair damaged nerves and supports nerve regrowth.
• Reduces Inflammation: It reduces inflammation linked to chronic pain.
• Improves Nerve Signals: It boosts nerve conduction and the ability of nerves to send signals properly.
• Supports Brain Chemicals: It helps balance neurotransmitters like serotonin and noradrenaline, which can reduce pain.
• Works with Painkillers: It may reduce tolerance and dependence on opioids when used together.

Signs and Symptoms of Vitamin B12 Deficiency

Early symptoms:

• Weakness and fatigue
• Pale skin
• Headaches
• Mild mood changes

Intermediate symptoms:

• Tingling or numbness in hands and feet
• Breathlessness
• Heart palpitations
• Mouth ulcers or a red, swollen tongue (early to intermediate signs)

Advanced symptoms:

• Memory problems
• Depression, anxiety, mood swings
• Poor balance or coordination
• Weight loss, poor appetite
• Constipation or loose motions
• Visual disturbances

In some cases, long-term deficiency can cause permanent nerve damage, so early detection is key.

Who Is at Risk of Vitamin B12 Deficiency?

You may be at risk if you:

• Are in the elderly age group
• Follow a vegetarian or vegan diet
• Have had stomach or intestinal surgery
• Suffer from digestive issues like celiac disease or Crohn’s disease
• Take acid-lowering medications like PPIs or H2 blockers
• Take metformin for diabetes
• Are pregnant or breastfeeding

Sources of Vitamin B12

B12 is mainly found in animal-based foods:

• Meat, poultry, fish (especially liver)
• Eggs and dairy (milk, cheese, curd, paneer)
• Fortified cereals and plant-based milk (almond or soy milk)

Note: B12 is not naturally found in plant foods, so vegetarians need to ensure they get it from dairy or fortified foods.

How is Vitamin B12 Deficiency Diagnosed?

Doctors may recommend tests such as:

• Blood test for B12 levels (normal range: 200–950 pg/mL)
• Homocysteine or methylmalonic acid tests (for unclear cases)
• Blood count to check for anaemia

How is Vitamin B12 Treated?

Depending on severity, your doctor may suggest:

1. Oral Supplements/ nasal sprays- Ideal for mild deficiencies.

2. Injections

• Used in moderate to severe cases or if absorption is poor and in those with neurological signs. Injections are often needed—daily/ alternate days at first, then weekly or monthly.
• For those with chronic absorption problems, lifelong treatment may be necessary.

Most people feel better within days to weeks of starting treatment, especially with fatigue and mood symptoms. Nerve symptoms can take longer and neurological damage is difficult to reverse.”

Can B12 Cause Side Effects?

Vitamin B12 is usually very safe. Side effects are rare but may include:

• Mild allergic reactions
• Acne-like skin rash
• Nausea or upset stomach

Always consult your doctor before starting B12 supplements, especially if you are on other medications.

Important Tips

• Avoid alcohol, processed foods, excessive coffee, and sugary snacks, which can worsen B12 absorption.
• If you are vegetarian or elderly, consider regular B12 testing.
• Do not ignore symptoms like tingling or weakness—early treatment can prevent permanent nerve damage.

Final Word from Dr Amod Manocha

Vitamin B12 plays a powerful role in nerve health and pain management. Many people are unaware they may be deficient, and this deficiency can worsen or even cause chronic pain.

If you have nerve-related pain or any of the symptoms listed above, talk to your doctor about checking your Vitamin B12 levels.

Simple blood test can help
Early treatment is effective and safe
Don’t wait for serious symptoms to show up