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A cold spray is often used to help numb the patients skin to make the trigger point therapy as comfortable as possible

Your experts may suggest a maintenance therapy of 100 to 200 mcg

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Ethics declarations Competing interests SJW is the founder of Ridgeline Therapeutics, HN is a paid employee of Ridgeline Therapeutics and, since manuscript submission, ADW has also become a paid employee of Ridgeline Therapeutics

The British National Formulary (BNF), for example, differentiates the prescription of hydroxocobalamin according to presenting symptoms, eg, For neurological involvement, it is advised to administer hydroxocobalamin by intramuscular injection, initially 1 mg once daily on alternate days until no further improvement, then 1 mg every 2 months. In the Netherlands, pharmacotherapeutic guidelines 51 recommend (for the same neurological symptoms or abnormalities) administration of 1000 mcg once or twice weekly for up to two years