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The nurse remained in the treatment room for a considerable portion of the total time discussing products, expected results, time until effects felt, and related medical issues because she had time to do so

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NICE and British Society for Haematology guidelines recommend: Initial treatment with hydroxocobalamin (the preferred form in the UK) via intramuscular injection For patients without neurological involvement: 1 mg IM three times a week for 2 weeks For patients with neurological involvement: 1 mg IM on alternate days until no further improvement Maintenance: 1 mg every 3 months for patients without neurological involvement

But the benefits are not as long lasting: Most patients start to feel pain again in 2 to 3 months

Because the symptoms are often non-specific, they are easy to attribute to other causes