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We recommend a mix of clinician competence and patient responsibility

In this study, B12 levels were 244 pmol/l or more in all patients at baseline, but in those who improved, B12 levels almost quadrupled, whilst in non-responders B12 levels went up by only 50%

Depner C, Zum Buttel H, Brc N, Cuesta AM, Aburto MR, et al

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How much of this is backed by solid research in humans

Giannantoni A, Porena M, Costantini E et al: Botulinum a toxin intravesical injection in patients with painful bladder syndrome: 1-year followup