I started taking alpha-lipic acid--600mg/day, in two divided 300mg/day doses--very early in my neuropathy (which is body-wide, acute onset, burning small-fiber predominant). Of course, on the advice of many on these and other boards, I was taking many other vitamins/supplements as well, so it is hard to tease out the effects of alpha lipoic from those of others, but I do believe it does help with small-fiber types of nerve pain.

In Europe, alpha lipoic has an extensive history of being used for diabetic neuropathy--in fact, in Germany it is a prescription item--and there have been some studies that show effectiveness. These studies, though, have used larger doses than I was taking--often in the 1200mg/day range--and the best effectiveness was for intravenous, rather than oral, dosing. (The evidence is spottier for smaller doses taken by mouth.)

One of the discussions that generally comes up with alpha lipoic is how to take it--it is an acid, and some people have trouble with that gastrically (I take it with meals, and that seems to buffer)--and whether to take it in seperate doses or in one large dose each day (there are differing opinions as to how bioavailable it is). One newer development--I now take the "second generation" R-lipoic acid, which is created from the active isomer in alpha lipoic acid (alpha lipoic is composed of two mirror-image molecule shapes, but only the "right-handed one"--the R--is bioavailable for most people); this enables me to take less for the same effect. (Most people say that the ratio is in the range of 6:1 to 10:1--one can take one-sixth to one-tenth the amount of R-lipoic compared to alpha-lipoic; I now take 100mg R-lipoic daily. Helps with the acidity issues, too.)

One thing--lipoic has significant blood sugar lowering properties; this is definitely a consideration for diabetics, especially those on glucophage or other meds. One's blood sugars should be closely monitored to make sure that the lipoic does not have synergystic effects that drive blood glucose levels too low/lead to hypoglycemic episodes. (But you can see why it has been used by those with impaired glucose tolerance who would like to avoid strong meds.)