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Poor injection technique or trauma during administration may cause localised discomfort that radiates to nearby joints

doi:10.1161/CIRCHEARTFAILURE.115.002453 4.Kotchen T, Welch W, Lorenz J, Ott C

The most common switches are: POM to P : Occurs when the medicine no longer meets the legal criteria requiring prescription control (e.g., the risk of misuse or danger to human health without medical supervision is minimal)

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If those values are borderline, further testing may be needed to assess methylmalonic acid (MMA) and homocysteine levels