Iron Supplementation Brought Lasting Relief from Chronic Neuropathic Pain in a Rare Case

The findings of the case are published in the Indian Journal of Pain in April 2025 by Dr. Shrutika Bhagat and colleagues from the Department of Interventional Pain Medicine at Cheers Multi Speciality Hospital.

The case holds immense clinical significance because it urges medical practitioners to look beyond standard neuropathic medications when managing highly refractory pain conditions. The research highlights that specific micronutrient deficiencies can fundamentally alter nerve conduction and neurotransmitter activity, effectively masking themselves as intractable chemotherapy-induced neuropathies. Integrating basic nutritional profiling into chronic pain evaluations could provide a transformative therapeutic pathway for patients suffering from otherwise unmanageable long-term distress.

A sixty-one-year-old female patient presented with a fourteen-year history of constant, severe burning vaginal pain following breast cancer treatments, which physicians eventually diagnosed as chemotherapy-induced peripheral neuropathy complicated by severe iron and Vitamin B12 deficiencies after multiple failed interventions. Following intravenous ferric carboxymaltose, lignocaine, and intramuscular Vitamin B12 administration, the patient achieved a seventy-five percent pain reduction within two weeks, which subsequently improved to ninety percent relief after a second iron infusion and remained sustained over a nine-month follow-up.

Mechanistically, iron structurally supports the generation of adenosine triphosphate (ATP) within cellular mitochondria, the maintenance of protective myelin sheaths, and the optimal functioning of critical enzymes necessary for synthesizing pain-regulating neurotransmitters like serotonin and catecholamines. Decreased systemic iron levels profoundly impair these vital metabolic processes, thereby altering peripheral neuronal conduction, heightening central nervous system sensitization, and amplifying chronic nociceptive signals.

For modern clinical practitioners, these insights powerfully reinforce the necessity of meticulously evaluating serum ferritin and Vitamin B12 levels during the initial assessment of chronic pain, rather than relying exclusively on standard hemoglobin metrics. Moving forward, this report strongly advocates for more expansive clinical research to definitively map the biochemical mechanisms linking iron metabolism to central sensitization, while simultaneously aiming to establish standardized treatment guidelines for utilizing nutritional supplementation in comprehensive pain management.

Reference

Bhagat S, Munshi SA, Palanivelu SV. The overlooked role of iron deficiency in neuropathic pain: A case report and review. Indian J Pain 2026;40:30‑2.