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Repeated injections: For patients who undergo a series of injections, alcohol may contribute to cumulative health risks , such as delayed healing or increased liver strain, when combined with steroids and other medications

If the reason is less clear, the care team may recommend review of symptoms, outside records, or broader follow-up before turning B12 into a repeating plan

Given that GABA is generally sleep-promoting (Gottesmann, 2002), this suggests a potential behavioral homeostatic feedback loop, with nitrogen stress accumulation during chronic sleep loss promoting the synthesis of Put-GABA, and thus sleep

If the problem hasnt resolved after a maximum of two injections in one site, consideration should be given to other forms of treatment