@romans8 and @carolm23 Good morning to both of you. I want to join you two in your search for alternatives for Gabapentin that will help manage the progressive reality of SFN pain.
My loyalty to Gabapentin has been 10 going on 11 years. The brain fog from the medication has increased due to aging and cognitive decline. In essence, my life was shrinking and I was in denial as to the cause.

About 4 months ago, my PCP and I had one of our "health partner" sessions. We have also been together for 10 years and counting. She recommended that I taper off the 2400 mg a day of gabapentin down to 200 mg at bedtime. As a replacement and with her support I have increased my daily medical cannabis and added an as needed dose of Ibuprofen (600 mg). This is exactly the medication program I used two years ago for my second TKR surgery when my orthopedic surgeon took a special interest in my SFN condition. This collaborative relationship continued post-surgery when my PT at the orthopedic center discussed her exercise choices with my MFR (myofascial release) therapist. Because everyone was working together, I had an amazingly positive recovery with only modest discomfort.

Mayo Clinic is well known for its team approach to health care. By inquiring and explaining I was able to create the same team at three different facilities. Recently I read that Mayo Clinic is now making this kind of collaboration possible for others.

Give it a try.....you may be surprised how helpful the "team" you create can be for your current distress. Don't hesitate to ask questions.. I am here for you.

May you be safe, free and protected from inner and outer harm.
Chris