vitamin b12 injection subcutaneous or intramuscular Injections at Home - Safety Guide for Self-Administration B-12 Intramuscular vs. Subcutaneous Injection

Bacteria-derived hydroxocobalamin (OHCbl) and CNCbl are converted in humans to useful coenzyme forms to support metabolic processes such as mitochondrial methyl malonyl coenzyme A mutase conversion of methylmalonic acid (MMA) to succinate to link lipid and carbohydrate metabolism, and activation of methionine synthase, the rate-limiting step in the synthesis of methionine

This increase in pain may last for a few days

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This suggests that non-responders were less severely affected by ME/CFS at baseline, and that the main positive effect of nasal B12 administration occurs in more severely affected patients