@frankie7 Hello Ann, thank you for your private message. I chose to answer you here so others may benefit. I am sorry to hear of your SFN diagnosis. It's never pleasant to learn of, but can be managed. When I first began to learn of my SFN, I referred to a book co-authored by my neurologist and a Mayo Clinic doctor, as well as others prominent doctors. The book is called Small Nerves, Big Problems. Its a helpful guide to learn about small fiber neuropathy. Knowledge is power and I recommend learning all you can:

Nerve medication such as Gabapentin is a first line defense, as you already know and are tweaking. I adjusted to Pregabalin (Lyrica) and am thankful for its benefits although, its important to understand these medications are not miracle workers and the rest may be up to us to manage.

In addition to SFN I have a chronic pain syndrome called Central Sensitization Syndrome (CSS) which has mirroring symptoms to neuropathy, and then some. I have had CSS since childhood but was undiagnosed until last year. CSS was gaining steam around the time I was diagnosed with SFN from a B12 deficiency. This created mitigating circumstances and confusion as to what was really going on with me. I thought SFN was causing everything, but it was not. This confusion lead me to the Mayo Clinic Pain Rehabilitation Center to learn a better, more productive way to live in chronic pain:

What I learned is valuable to any chronic pain sufferer...there is no magic pill, no curing help from doctors, no miracle fix. SFN may always be chronic, or as my neurologist once told me, nerves may regenerate over time. Its my hope Ann, that your nerves may settle down as time goes on, but keep in mind neuropathy can simply be age related as well. In any case, here we are trying to feel better. How can we do that? Lifestyle change.

- Physically active: daily stretching, cardio, strength conditioning (all moderate accordingly).

- Healthy diet: learn what foods to avoid and what foods to increase.

- Healthy sleep: create healthy sleep habits, go to bed and get up the same time each day. Naps to 20 minute minimum.

- Mental health: speak to a therapist if you must for a healthier mind, create a gratitude journal, focus on what you do have not what you don't.

- Behavioral changes: stop pain behaviors -anything you do, say or think that reminds you of pain. This is called accessing the network (your central nervous system) and creates more pain.

- March before you feel like it: create a schedule and stick to it, hold yourself accountable.

- Distraction: we all need distraction from pain - humor, family, friends, movies, books.

- Modification and moderation: when in pain we can still do things but we may need to find a smarter way to do them, we may need to set time limitations.

- Minimize or eliminate unnecessary meds

- Set goals for yourself, even if small, then reward yourself for meeting your goal

- Work on coping skills - journal your positives.

- Relaxation: this should be scheduled throughout the day along with diaphragmatic breathing.

- Difficult day plan: write it out and give yourself grace

- Mindfulness: stay in the moment, work on the next 5 minutes

I've thrown a lot at you Ann, and believe me I know this is not easy. Chronic pain management is a challenge that takes discipline and perseverance. I hope I have given you hope, and ways to think about your path forward. What other ways might I be able to help? Do you mind letting me know how you are currently managing overall?