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(2) ROS activates NF-κB and MAPK signaling pathways, upregulating the expression of MMPs (MMP-13, MMP-3) and inflammatory factors (IL-1β, TNF- α ), thereby accelerating the degradation of type II collagen (Col-II) and proteoglycans

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In 2 randomized controlled trials conducted by Xu et al, 24,25 the administration of vitamin B12 in varying forms in patients with postherpetic neuralgia and acute ophthalmic herpetic neuralgia sustainably and significantly decreased their pain severity for up to 1 year compared with controls receiving intramuscular injection of vitamin B12 and lidocaine