Cyanocobalamin (Vitmain B12) and Neuropathic Pain Syndrome

[Dr MD]

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It is well known that cyanocobalamin (Vitamin B12) can be injected subcutaneously. My question is:

Can cyanocobalamin be injected subcutaneously as a mixture with local anesthetic like bupivacaine at the ankle as a nerve ankle block cocktail to target all five nerves that innervate the foot as a way to relieve neuropathic pain in the foot, in cases of polyneuropathy in the feet? Thank you

 

[Taus]

What field are you an Attending in and why would you want to do this?

 

[Dr MD]

Internal Medicine is my specialty.

Bupivacaine would be used to block aberrant pain signals in neuropathic nerves of the foot. Vitamin B12 as a nutrient for the neuropathic nerves (neuropathic peripheral nerve axons have been known to be deficient in Vitamin Bs). Peripheral nerves need vitamin B12 for proper function.

Bupivacaine by itself has been used for many years in subcut. nerve blocks to relieve neuropathic pain.

My question though is how about injecting Vitamin B12 cyanocobalamin to these neuropathic nerves as a mixture with bupivacaine in the ankle nerve block???

 

[Ducttape]

I don't think it would work, for the reason that neuropathic pain from, say, diabetes probably is multifactorisl with central sensitization along with peripheral sensitization and pain transmission through a-d and C fibers. The cause of the damage is multifactorial and not solely related to vitamin b deficiency...

Metanx has been advertised as effective for diabetic neuropathy but clinically I have seen no benefit at all.

 

[Dr MD]

I don't think it would work, for the reason that neuropathic pain from, say, diabetes probably is multifactorisl with central sensitization along with peripheral sensitization and pain transmission through a-d and C fibers. The cause of the damage is multifactorial and not solely related to vitamin b deficiency...

Metanx has been advertised as effective for diabetic neuropathy but clinically I have seen no benefit at all.

Would it be safe to inject subcutaneously cyanocobalamin in the ankle???

 

[lobelsteve]

Would it be safe to inject subcutaneously cyanocobalamin in the ankle???

Review B12 role, MOA, absorption.

http://www.wikipathways.org/index.php/Pathway:WP1533


There cannot be a role for local injection of this substance based on human physiology and its pathophysiological correlates.

 

[Dr MD]

Review B12 role, MOA, absorption.

http://www.wikipathways.org/index.php/Pathway:WP1533


There cannot be a role for local injection of this substance based on human physiology and its pathophysiological correlates.

Ok. Alot of biochemistry pathways here. Does not really answer the question well.

Could you enlighten me in your own words (your professional medical opinion) on the route of cyanocobalamin inside the body once injected subcutaneously in the ankles to five nerves innervating the foot suffering from polyneuropathy? (i.e. deep peroneal nerve, superficial peroneal nerve, posterior tibial nerve, sural nerve, and saphenous nerve)?

Thanks doc.

 

[lobelsteve]

Ok. Alot of biochemistry pathways here. Does not really answer the question well.

Could you enlighten me in your own words (your professional medical opinion) on the route of cyanocobalamin inside the body once injected subcutaneously in the ankles to five nerves innervating the foot suffering from polyneuropathy? (i.e. deep peroneal nerve, superficial peroneal nerve, posterior tibial nerve, sural nerve, and saphenous nerve)?

Thanks doc.

The medication will be deposited into muscle where it would be absorbed systemically and processed exactly the same as any IM injection. There is no role for focal or local injections of B12.

 

[Dr MD]

The medication will be deposited into muscle where it would be absorbed systemically and processed exactly the same as any IM injection. There is no role for focal or local injections of B12.

MMMM??? Interesting....So, local eventually becomes systemic via absorption by the skeletal muscles near the ankle (but not the peripheral nerves traversing the ankle), and hence less optimized benefit for the neuropathic nerves innervating the feet. And it seems that PASSIVE absorption seems to be involved. If so, only 1% of cyanocobalamin gets absorbed this way into the skeletal muscles and then to the liver to be processed into methylcobalamin and then into the systemic circulation of the body for soft tissues like nerves. Does not seem very optimal to me as a therapeutic symptomatic regimen.

Thanks doc for this info. I will just stick with bupivacaine nerve blocks then for my neuropathy patients. At least there is a plethora of peer reviewed published medical journals on use of local anesthetic nerve blocks for symptomatic treatment of neuropathic pain syndromes in the distal lower extremities.

My dilemma was I could not find any peer reviewed published medical journals showing the use of cyanocobalamin in subcut. injections to nerves suffering from neuropathy. Which is why I addressed this question on this forum for any anecdotal information.

 

[Ligament]

No known role, however would not hurt to try.

 

[bedrock]

MMMM??? Interesting....So, local eventually becomes systemic via absorption by the skeletal muscles near the ankle (but not the peripheral nerves traversing the ankle), and hence less optimized benefit for the neuropathic nerves innervating the feet. And it seems that PASSIVE absorption seems to be involved. If so, only 1% of cyanocobalamin gets absorbed this way into the skeletal muscles and then to the liver to be processed into methylcobalamin and then into the systemic circulation of the body for soft tissues like nerves. Does not seem very optimal to me as a therapeutic symptomatic regimen.

Thanks doc for this info. I will just stick with bupivacaine nerve blocks then for my neuropathy patients. At least there is a plethora of peer reviewed published medical journals on use of local anesthetic nerve blocks for symptomatic treatment of neuropathic pain syndromes in the distal lower extremities.

My dilemma was I could not find any peer reviewed published medical journals showing the use of cyanocobalamin in subcut. injections to nerves suffering from neuropathy. Which is why I addressed this question on this forum for any anecdotal information.

Speaking of evidence, I've never seen any controlled studies that demonstrated local blocks of the feet provided LONG-TERM relief of neuropathy.

 

[lobelsteve]

We are all thinking this is a troll, right?

IM doing peripheral blocks with Marcaine and asking about B12?

Not bloody likely.

 

[bedrock]

We are all thinking this is a troll, right?

IM doing peripheral blocks with Marcaine and asking about B12?

Not bloody likely.

uh yah, I was thinking that all along. No way is that person an MD. They should be banned for trolling.

More likely to be an NP trying to set up a pain clinic with bogus procedures like ankle blocks for peripheral neuropathy