Good afternoon @resage. Welcome to Connect and particularly Connect for neuropathy. I notice that you did not mention a skin test biopsy. That, so far, is required to confirm small fiber neuropathy (SFN). It is a simple test, not painful, and very quick. The sample is then sent to a special lab that measures the percentage of nerve cells that you have in the sample. Mine was .09%.....hardly enough to do even a mediocre job of calming down the symptoms.

I notice that you are what is called "idiopathic" meaning the cause is unknown. Gabapentin was my first medication. I still use 600 mg a day to reduce the numbness and tingling in my hands, wrists, and arms. The cold, icy legs and feet are just part of my daily visit from Mr. Neuropathy. As of this moment, I have only one other medication and that is duloxetine. It prevents me from letting anxiety take away my attempts to tolerate and control the painful and annoying symptoms.

You asked about other treatments. My #1 choice is MFR.....myofascial relief therapy. Because fascia is the material that covers all connective material in our bodies....when it is restricted and all stuck together....you have significant difficulties getting everything all straightened out. Pay a visit to http://www.myfascialrelease.com to learn more. I now have 2 sessions a week.

Exercise is still an essential part of feeling the best we can. I do Yoga every morning....using a routine designed for me and my SFN. I also practice mindfulness meditation every day, belong to a sangha, and attend two retreats a year to hone my skills. All I can say about these helpful activities is that they make a huge difference in my life and allow me to just be more human.

As for pain meds...I do not use them. In fact, I refuse to use them. I don't need the digestive issues and the discomfort that they can cause. My pain is totally controlled by medical cannabis. I use tinctures and topicals only. I have different types and different dosages for the time of day and activity level. I sleep well and if it weren't for the darn icy legs, would wake up ready to mow the lawn.

At this point, I would like to introduce one of my partner mentors in this group, @johnbishop. He, like you, has no pain with his neuropathy and just lots of information and experience to share.

May you be safe, protected, and free of pain and discomfort.
Chris