David:

If you have not already had one done, I would recommend that you do the skin biopsy test through "Therapath" (Google them). A postive skin biopsy would then give you a firm dignosis of "Small-Fiber Neuropathy".

In terms of symptom relief, I have found that during the six years I have battled on and off with Small-Fiber Neuropathy (yes, it can go into long remissions), the antidepressent "Cymbalta" has been very effective for me. I would estimate that I receive roughly 75% overall pain and discomfort relief over time.

The other major class of useful medication are the anticonvulsants, of which "Lyrica" seems to be the major player. I have personally used Lyrica over very short periods of time and at relatively low daily doses (50 mg day and 50 mg evening - total 100 mg daily). Even at these low doses I have still found relief.

Another approach would be to combine both Cymbalta and Lyrica, but at lower doses than you would take for either alone.

For example, the standard dosage of Cymbalta is 60 mg / day (after you first take 30 mg / day to titrate up for one week).

What might do if you find insufficent relief on just one alone is combine both. Perhaps Lyrica at a single 50 mg dose at bedtime each day against a stable background of either 30 or 60 mg of Cymbalta also taken daily.

There are also numerous other effective medications available, and I am sure that some of the experts here will point those out shortly on this thread.

Feel better!

David