So far, I've just been using Neurontin when the pain makes it hard to sleep, but honestly a sleeping pill gets me over the hump more quickly. And I find if I've gotten a good nights sleep, the symptoms lessen the next day.

I'm going to see a doctor at the local university hospital (OHSU, Oregon) in January and see if I can get a more specific diagnosis (right now it's "Ideopathic" PN). After that I'm going to try some of the nutritional supplement ideas from John Senneff's third book ("Nutrients for Neuropathy"). The effects are getting worse, its being more distracting and distressing during the day, so if that stuff doesn't help, I'll check out Cymbalta and go from there.

For me, mostly exercise helps. Yoga, weight training, even running, certainly stretching. Vibration and sitting in one spot makes it worse (I'm not looking forward to a cross country plane ride on Saturday). Being warm and unstressed helps. Have you tried some not-too-vigorous yoga and stretching? I'll often take an extra heater in the room where I'm stretching.

I'm not a doctor, but I would certainly want a skin punch biopsy before a sural nerve biopsy, specifically because the latter is more invasive and leaves permanent numbness.

I've got a certain amount of relatively constant numbness and pain, and then there's random spots of numbness or burning that come and go. For a while my gums will burn, or the spot between my upper lip and nose will be totally numb. Or a few days ago, the back of my right hand was totally numb for a day and a half -- like it had an injection of novocane. And then it returns to a 'normal' level of numbness. Odd.