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Analgesic use reduced significantly in the local group (94% at baseline vs 6% at endpoint) but not in systemic groups (intramuscular 97% vs 86%, oral 94% vs 80%). Health-related Quality of Life was higher in the local group than in the systemic groups. In mixed modelling, increased age was associated with a lower response to methylcobalamin. CONCLUSIONS This study indicates that the local injection of methylcobalamin produces significant pain relief from SOHN and is superior to the systemic administration. This article is protected by c