I was diagnosed in 2011 with small fiber neuropathy, although I have had it now at least going back to summer of 2010. The current diagnosis is idiopathic. I think if if my neuro had to hazard a guess right now his most likely one would be something of an autoimmune cause, but there's no "smoking gun" there. Also, I had a history of either high normal or pre-diabetic fastings. My latest A1C btw was 5.3. I drank too much for many years. But I have been alcohol free for over a year now and a skin biopsy I had in Nov. 2012 actually showed the sfn was worse than it was a year ago. So I think my neuro now thinks it is less likely related to alchohol.

With regards to the autoimmune consideration, I have had the following red flags: a consistently moderately positive ANA, small pleural and pericardial effusions that were detected by accident in spring of 2012 and which I'm pretty certain can be caused by autoimmune disorders such as lupus, my capillaries under my pinky are "splintered" or something like that which my rheumatologist says are sometimes seen with people with autoimmue conditions, and bouts of unusual/don't make sense fatigue. There were one or two other suspicious things, but the ones I named are the main ones that I remember. My current diagnosis from the rheumy is I believe undifferentiated connective tissue disorder.

At any rate ,here is kind of where I stand. I was taking gabapentin but it does not seem to help me much so I've recently had Lyrica called in for me by my neuro and I'm probably about to give it a try. My rheumatologist and neurologist have talked and they think that it is worth it to try me on plaquenil. This under the theory that if I do have an autoimmune disorder that is causing the SFN, that the plaquenil might help with autoimmune situation which in turn might help with the SFN. Might. But they think it is worth trying.

I have been taking 600 mg of alpha lipoic a day for about a month and a half and for while thought it MIGHT be helping. But the last couple of days have been rather hellish with a major flare up. I don't know why it is but sometimes I can go a couple of weeks or more with few problems, and then it's like someone hits a switch and hits it hard.

I'm thinking about adding in either benfiotiamine or methyl b-12, or both. I have had both b12 and b1 checked in the past. B12 was a little over 500. B1was normal, but I can't remember the exact number.

So here's what I'm thinking about adding in summation...Lyrica for the pain, Plaquenil to try and help the possible autoimmune connection and Benfiotiamine and/or methyl b12.

Any thoughts on any of this would sure be appreciated. I'm sure there is something I left out but this is all I could think of. Not been a good day.

Thanks so much in advance!