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Is B12 neuropathy painful?

B12 neuropathy can certainly be painful for those experiencing it. B12 deficiency can cause damage to nerves, leading to numbness, tingling, and pain symptoms. In this article, we’ll explore what B12 neuropathy is, what causes it, symptoms, diagnosis, and treatments for pain relief.

What is B12 Neuropathy?

Neuropathy refers to damage or dysfunction in the peripheral nervous system, which transmits information between the central nervous system (the brain and spinal cord) and the rest of the body. B12 deficiency can lead to a type of neuropathy known as B12 neuropathy or subacute combined degeneration. It gets its name from the B12 vitamin deficiency that causes it.

B12 plays an important role in the healthy function and development of nerves. It helps form the protective covering around nerve fibers known as the myelin sheath. When B12 levels are too low, the myelin sheath deteriorates. This leaves nerves exposed and vulnerable to damage. Over time, the cumulative damage can lead to widespread neuropathy symptoms.

What Causes B12 Neuropathy?

The leading cause of B12 deficiency is pernicious anemia. This autoimmune disorder prevents the body from properly absorbing vitamin B12 from food. B12 requires a protein made in the stomach called intrinsic factor to be absorbed by the digestive tract. When intrinsic factor is lacking or antibodies attack it, B12 absorption is hindered.

There are other causes of B12 deficiency as well, including:

  • Gastrointestinal disorders: Conditions affecting the GI tract like Crohn’s disease or celiac disease can impair B12 absorption.
  • Surgery: Procedures like gastric bypass or bowel resection surgery can lead to insufficient B12 levels.
  • Medications: Drugs that reduce stomach acid like proton pump inhibitors can decrease B12 absorption over time.
  • Inadequate intake: Strict vegan or vegetarian diets without sufficient supplementation can result in deficiency.
  • Pregnancy: Increased B12 needs during pregnancy raise deficiency risk.

When B12 levels get low enough, neurological symptoms like B12 neuropathy can develop. This typically occurs after B12 deficiency has been present for an extended period.

Symptoms of B12 Neuropathy

B12 neuropathy often starts gradually, with mild symptoms slowly progressing. Symptoms frequently begin in the feet and legs. Some early signs can include:

  • Numbness
  • Tingling
  • Prickling sensations

As neuropathy advances, more distinct symptoms emerge such as:

  • Sharp, shooting pains
  • Burning sensations
  • Loss of temperature sensitivity
  • Loss of coordination or balance
  • Muscle weakness
  • Cramping

Neurological symptoms typically start in the feet and move upwards as B12 deficiency continues. Most commonly, hands become affected after the feet. In severe cases, symptoms can spread to the arms and trunk. Autonomic nervous system dysfunction is also possible, causing issues like orthostatic hypotension and constipation.

Is B12 Neuropathy Painful?

Yes, B12 neuropathy frequently causes significant pain. While numbness and tingling may be initial mild symptoms, many people with B12 neuropathy experience discomfort ranging from uncomfortable to severe as neuropathy progresses. Common complaints include:

  • Burning: Neuropathy can cause burning pain in the feet, hands or other areas affected by nerve damage.
  • Sharp, stabbing pains: Also referred to as lightning pains, these brief but intense jolts of pain are common in B12 neuropathy.
  • Aching: Some people describe a persistent ache or soreness in affected limbs.
  • Hypersensitivity: Experiencing pain from stimuli that should not be painful, like light touch or clothing rubbing the skin.
  • Allodynia: Feeling pain from non-painful stimuli, such as a cool breeze across the skin.

This pain results from the nerve irritation and misfiring caused by neuropathy. Pain levels can fluctuate but often worsen at night. B12 neuropathy pain can severely impact quality of life and ability to sleep, walk or perform daily activities.

How is B12 Neuropathy Pain Treated?

While correcting the B12 deficiency is the ultimate treatment goal, additional strategies help relieve neuropathic pain in the short-term. Options include:

  • Pain medication: Over-the-counter nonsteroidal anti-inflammatory drugs or prescription medications like gabapentin can reduce pain.
  • Topical treatments: Capsaicin creams, lidocaine patches and nerve blocks can ease localized pain.
  • Alternative therapies: Methods like acupuncture, massage and transcutaneous electrical nerve stimulation may provide relief for some people.
  • Lifestyle approaches: Techniques like relaxation exercises, ice/heat therapy and elevating painful limbs can help manage pain.

A combination approach incorporating medication, topical treatments, lifestyle changes and alternative therapies often provides the greatest pain relief. Pain management strategies can be adjusted until an effective regimen is found.

Diagnosing B12 Neuropathy

B12 neuropathy is diagnosed through a combination of blood tests, neurological exams and possibly nerve conduction studies. Key diagnostic steps include:

  1. Test B12 levels: Blood work measuring B12 levels, along with other biomarkers like homocysteine and methylmalonic acid, help confirm B12 deficiency.
  2. Clinical exam: A neurological exam evaluates symptoms like numbness, pain, balance and muscle weakness.
  3. Nerve conduction study: This can help assess nerve damage and is sometimes performed.
  4. Rule out other causes: Testing is done to exclude neuropathy from diabetes, toxins, autoimmune disorders and other conditions.

Diagnosing B12 deficiency before neuropathy occurs is ideal. But for those already experiencing symptoms, addressing the deficiency is critical to stop progression and allow healing.

Treating B12 Neuropathy

Treatment aims first to correct the underlying B12 deficiency. This includes:

  • B12 injections: Intramuscular injection avoids absorption issues to rapidly increase B12 levels. Initial weekly injections are typical.
  • Oral B12: High dose oral supplements can also raise B12 levels, especially for mild deficiencies.
  • Diet changes: People with absorption issues may need to emphasize B12-rich foods like meat, eggs and dairy.

Neuropathy symptoms may start to stabilize once adequate B12 status is reestablished. But full recovery can take months or even years. Some regenerate nerves effectively and regain nearly full function. But a portion have permanent residual symptoms or disability.

Continuing B12 therapy is necessary to prevent recurrence of deficiency and worsening neuropathy.

Preventing B12 Neuropathy

For those with absorption disorders, problems are usually lifelong. Preventing neuropathy means proactively maintaining healthy B12 status through injections or high-dose supplements. This also limits progression of any existing damage.

Those without absorption issues should aim to meet the B12 RDA through diet and/or standard supplements. Good food sources include:

Food Serving B12 Amount
Beef liver 3 ounces 70 mcg
Mackerel 3 ounces 16 mcg
Sockeye salmon 3 ounces 9.8 mcg
Trout 3 ounces 5.4 mcg
Fat-free milk 1 cup 1.4 mcg
Yogurt 1 cup 1.5 mcg
Eggs 1 large 0.6 mcg

For those with low dietary intakes, like vegans and vegetarians, supplements are beneficial for meeting needs. The RDA is 2.4 mcg for adults. Screening bloodwork can also help identify issues before neuropathy develops.


When caught early, B12 neuropathy often responds well to treatment and the prognosis is good. Nerve damage and symptoms can be fully reversed if deficiency is addressed promptly. The key is starting B12 replacement before extensive neuropathy develops.

However, recovery becomes less likely and less complete the longer neuropathy progresses untreated. Permanent nerve injury and disability are risks if deficiency goes uncorrected for an extended period. Heightened awareness and early diagnosis are important.

With appropriate long-term B12 therapy, further deterioration can be prevented. But some residual neuropathy may persist as a result of prolonged deficiency. Ongoing symptoms like numbness, pain and weakness can occur but are often mild. Good compliance with B12 therapy is key to preventing recurrence.

In Conclusion

B12 neuropathy is a consequence of vitamin B12 deficiency. Resulting damage to the nervous system can cause numbness, tingling and significant pain. Addressing deficiency with B12 injections or high-dose supplementation is critical. This can reverse symptoms if started promptly. Long-term maintenance therapy is needed to prevent recurrence of neuropathy.

Managing pain is an important part of treatment as well. A variety of medications, therapies and lifestyle approaches provide relief. While early cases often fully resolve with B12 therapy, residual symptoms are possible after prolonged deficiency. But progression of neuropathy can be halted with proper treatment.