Small Fiber Neuropathy - Any New Treatments?

@kfrenc04, Sorry to hear that your tremors are getting worse every day. You will notice that we added to your discussion title to better describe your discussion and help members find it. I thought you might like to read about the latest research by the Peripheral Nerve Society (PNS). They held their annual meeting in May 2025 - Learn About the Latest in Peripheral Nerve Research: https://www.foundationforpn.org/learn-about-the-latest-in-peripheral-nerve-research/.

While you wait for other members with experience to respond, I did a search of Connect using "small fiber neuropathy tremors" and thought you might want to scan through the member comments and discussions - https://connect.mayoclinic.org/search/

@kfrenc04
It sounds like you have large fiber, not small fiber, peripheral neuropathy. Small fiber affects skin surface temperature and touch sensation plus autonomic function. Small fiber neuropathy is usually caused by diabetes, vitamin deficiencies/toxicities, alcoholism, smoking, chemotherapy, etc. Cause, if known, is treated but there really isn’t a treatment for small fiber neuropathy. Pain medication/neuropathy supplements/topical creams/roll-ons and patches can be used to help with symptoms.

Have you had EMG/nerve conduction studies of upper and lower limbs? Have you had MRI of your brain/cervical spine /lumbar spine? What were you officially diagnosed with by a neurologist and/or neurosurgeon/spine specialist as to the cause of your tremors?

What vitamins should I be taking? A neurologist did a spinal tap years ago and diagnosed me with small fiber neuropathy. I’ve had many tests through the years. The tremors started about 6 months ago. Getting worse not better. Seeing a rheumatology doctor tomorrow. Hoping he can help.

@kfrenc04
You haven't given much description of your tremors other than they started 6 months ago. Where are your tremors located? There are many causes of tremors. Your history as given is incomplete.
Why did you need a spinal tap "years ago"? What were your symptoms then?
You appear to have a long history of "problems" which may or may not be connected to your tremors.
Suggest you see a neurologist - preferably someone experienced in movement disorders which includes tremors.

40 years ago I started with fasciculations. Went to many doctors . No one knew what was wrong. Had the spinal punch 10 years ago and was told I had small fiber neuropathy. I ve had numbness in legs only on the top of the skin. Still a very active person. But then the hand only tremors started. I’ve had the itching all over my body as well. Neurologist told me that there is no cure and there was nothing she could do for me . I’m on gabapentin which I take each night. That is it. No one know why the tremors started. Are they part of small fiber neuropathy? Tremors are getting bad. Please help.

@kfrenc04, Sorry to hear the tremors are getting bad. I wished I could answer your question about whether or not the tremors are part of your neuropathy but it sounds like the many doctors you have seen haven't been able to tell you what is wrong.

Was the gabapentin prescribed to help with pain from your neuropathy? The reason I ask is that I was given gabapentin when I was first diagnosed but it did nothing to help and then when I discussed it further with my doctor and Mayo care team they told me it only helps to relieve the pain and does nothing for the numbness which is all I have with my neuropathy. So I stopped taking it.

There are other conditions that can cause the tremors. Have you discussed the hand tremors with your doctor or neurologist?

Hi John. Thanks for replying to my message. Yes and they don’t know why. I too on l y have numbness with my neuropathy. Tremors started this year. Slowly getting worse. A lot of cramping coming now. Are you on any special diet John?
Thank you !

Hi @kfrenc04, I'm not on any special diet but because I was overweight most of my adult life my doctors have told me I was in the pre-diabetic category and I sadly ignored it. It wasn't until several years ago when I learned about the metabolic syndrome which was never mentioned to me by any of my doctors. Anyone in the pre-diabetes stage is probably also in the metabolic syndrome category which can cause a lot of different conditions including neuropathy. The biggest change I made to help with my overall health and neuropathy was to manage my weight better. I shared my journey with my weight loss struggle in the Low-carb healthy fat living. Intermittent fasting. What’s your why? discussion here - https://connect.mayoclinic.org/comment/336050/. I eat pretty much anything I like but limit the carbs and try to eliminate as much sugar as possible for a guy that likes sweets 🙃

You mentioned that you have seen many doctors. Have you had tests for vitamin deficiencies or genetic traits that may also be the reason for some of the symptoms you have?

Thank you for sharing John. I have not had genetic testing but will ask my doctor if I can have that done. I did the Wahls Protocol and lost 25 lbs. Gained it all back when I went off. Need to lose weight again. First of the year, I will try again.

@kfrenc04, You might this webinar by the Foundation for Peripheral Neuropathy helpful to learn more about genetic testing.
-- https://www.foundationforpn.org/events/the-value-of-genetic-testing-for-inherited-neuropathies/