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Vitamin B12 for nerve health and chronic pain

Vitamin B12 for nerve health and chronic pain

Vitamin B12, also known as cobalamin,  is a vital but often overlooked nutrient for nerve health and chronic pain syndromes.

Symptoms of B12 deficiency

  • Persistent pain
  • Pins and needles / numbness
  • Fatigue
  • Depression/ anxiety
  • Ulcers/ mouth sores
  • PMS
  • Allergy-like symptoms

Am I deficient?

B12 deficiency has been found to be reasonable common affecting between 1.5% and 15% of the general population.

Certain populations such as vegetarians and vegans are even more likely to have inadequate B vitamin levels as B12 is found almost exclusively in animal products. In one study 70% of all vegetarians and over 90% of all vegans have evidence in their bloodwork of early B12 deficiency.

Causes of deficiency

A common cause of low B12 is poor absorption from the digestive tract. This is often the case with people with disorders such as IBS or inflammatory bowel diseases (Crohn’s / ulcerative colitis) or those who have undergone weight loss surgery. Nutrient absorption also tends to reduce as we age leaving people over 60 years of age at higher risk of deficiency.  

Certain medications can also reduce B12 absorption. Proton pump inhibitors (PPIs) such as omeprazole or Lansoprazole are commonly prescribed to reduce stomach acid. However, stomach acid is needed to break B12 from food so that it can be absorbed and so these medications can lead to reduced absorption and ultimately deficiency. In one study “ Nearly 50% of the patients on prolonged acid suppression therapy were either “deficient” or “insufficient” in blood  vitamin B12 levels” Damodharan, 2020]

Metformin has also been shown to reduce vitamin B12 absorption.  

Vitamin B12 and Pain

Vitamin B12 is thought to alleviate pain by a number of mechanisms including promoting myelination (nerve insulation), increasing nerve regeneration and decreasing nerve “mis-firing”.

Vitamin B12 and low back pain

Vitamin B12 can help in the treatment of back pain

In a study of patients with chronic low back pain, Vitamin B12 given for 2 weeks reduced pain by 32% compared to placebo [Chiu, 2011]

Vitamin B12 and painful neuropathy 

In a 2020 systematic review looking at the use of B12 for nerve-related pain it was found that there is moderate evidence for the therapeutic effect of B12 in the treatment painful peripheral neuropathy [Julian, 2020].

Vitamin B12 for pain relief and injury recovery

If you suffer with more than one of signs of B12 deficiency (and particularly if you are in an “at-risk group i.e., vegan/ vegetarian, >60 yoa, or taking PPIs or metformin), try a 1-month trial of increased B12-rich food intake (see below) along with a good quality B12 supplement and review your symptoms.

You can download the ‘Modified Multiple Symptoms Questionnaire’ and complete it before and after your trial to help you do this.

Best food sources of Vitamin B12

  • Liver*
  • Clams and oysters*
  • Meat and fish
  • Milk and cheese
  • Some mushrooms (black trumpet, chanterelle, or shiitake)
  • If you don’t eat liver, oysters, or clams, you must eat at least 350 grams of meat, poultry, fish, or dairy reach your RDA

B12 supplementation

Sublingual B12 tablets are particularly useful as they are absorbed in the mouth which bypasses any absorption issues in the bowel (i.e. patients >60 yoa, those with IBS or inflammatory bowel diseases, or those taking PPI’s or metformin)


Take 1000-5000mcg daily of the active forms of B12 (methyl-cobalamin and adenysl-cobalamin) for 1 month and then re-assess symptoms.

Vitamin B9 (folate) and vitamin B6 work together with B12, supplementing these at the same time often gives better results.

We recommend:

Combined with

Available from the Dynamic Health Clinic or online at The Natural Dispensary (use practitioner ‘Steffen Toates’ to register)

Who shouldn’t take B12

Vitamin B12 is non-toxic and thus 100% safe however the ‘active’ forms of B12 (methyl-cobalamin and adenysl-cobalamin) should NOT be taken by patients with a history of severe anxiety.

Instead use 500mcg of ‘inactive’ B12 (hydroxycobalamin) ONLY, without any other B vitamins to start.

We recommend  

Available from the Dynamic Health Clinic or online at The Natural Dispensary (use practitioner ‘Steffen Toates’ to register)

Related articles


  • Chiu, C. K., Low, T. H., Tey, Y. S., Singh, V. A., & Shong, H. K. (2011). The efficacy and safety of intramuscular injections of methylcobalamin in patients with chronic nonspecific low back pain: a randomised controlled trial. Singapore medical journal, 52(12), 868-873.
  • Damodharan, S., Raj, G. M., Sakthibalan, M., Dakshinamoorthy, K., & Muraliswaran, P. (2020). Effect of long-term acid suppression therapy with proton pump inhibitors or H 2 receptor blockers on serum vitamin B 12 levels in elderly population. Irish Journal of Medical Science (1971-), 1-5.
  • Julian, T., Syeed, R., Glascow, N., Angelopoulou, E., & Zis, P. (2020). B12 as a Treatment for peripheral neuropathic pain: a systematic review. Nutrients, 12(8), 2221.

This post was written by Steffen Toates. Steffen is a chiropractor at Dynamic Health Chiropractic in Jersey CI. For more information about Steffen click here.

11 Responses to Vitamin B12 for nerve health and chronic pain

  1. How long should a person be on these high doses of b 6-12?
    I have sciatic pain I’ve done a lot of physical therapy and doing my exercises but still my sciatic if I lift anything or up on my legs too long it starts to ache. Let me know what I need to take to heal.

    • Everybody is different but typically patients can reduce to maintenance dose once symtpoms have resolved or symptom improvement has plateued. Magnesium is also very important for nerve health. If your improvement has plateued you may also want a second opinion with regards to further assessment or change in treatment/ exercise approach.

  2. I found this article very interesting. Thank you for addressing these issues. I suffer from lower back pain(3 back surgeries) and a lot of nerve pain in my back and else where. A recent hip replacement has thrown everything out of whack. I have been taking many of the vitamins you have mentioned for nerve pain, but not Curcumin. Likewise, I will add that just to see if it helps. I was told by a doctor that the B vitamins cause you to gain weight. He even pointed to an article in the medical research books for Drs online. Have you heard anything about this? Why would Vit Bs do this if true. He told me to stop taking them. Thank you again.

    • Hi Faye, No I haven’t seen any research indicating B vitamin supplementation causing weight gain. I cannot think of a mechanism as to how that would be the case, if anything the reverse but I will look into it. Thank you

  3. Thank you Doctor for having this site. I to suffer with sciatica nerve damage an 2 buldging discs. My one doctor said from the mri there not that bulging to cause this much pain. He put me on gabapentin. By time I eased up to the full dosage, I found I was light headed. So I lessened the dosage then researched vitamins. I took myself off the gabapentin a put myself on potassium an my multivitamin. I’ve been seeing a doctor for my knee an told him what I had been doing for my sciatica. He suggested the same as you. Magnesium 400 mg for nerves. Yes I have my good days not much pain with the sciatica ( when I remember to take them) a bad days when I don’t. I get forgetful due to I had a nurse tell me take them every other day because the doctor has me on levothyroxine sodi 25 mg. She said to much of something in my body isn’t good either.
    Thank you Sincerely Elaine

  4. I suffer from peripheral neuropathy. I have 3 bulging discs in my lower back. I am on a lot of medication for various ailments including lansoprazole. ( ppi )) and blood thinners.

    Should I be taking sublingual vit b12. daily and magnesium, at what dose and magnesium. I also take folic acid

    I would love to see you face to face but I live in the UK. My own GP is not too knowledgable on treatments for my condition and I am finding it very hard to do my own research.

    I am 77 years old with numerous health conditions but these are pretty much under control. The neuropathy however is getting me down. Is there any advice you could give John

    • Hi John, If you you contact the clinic via email I’ll see whether we can arrange a telephone consult. All the best

  5. Not sure how I found this site. Very interesting. Have sciatica and al.ost constant back pain..take turmeric twice a day.too much acetaminophen lidocaine patches..creme..Voltaren gel..all only a minor relief. Will start magnesium. 70 yrs old fairly active when able. Walk lots daily even when struggling. If this is my golden years…a major disappointment!

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