Treatments

Several types of medicine can help reduce nerve pain. Your doctor will usually start with medicines that work well for nerve pain. These medicines work differently than regular pain relievers like ibuprofen or Tylenol.

The most common first medicines are called anticonvulsants. Although they were made to treat seizures, they can be very effective at treating nerve pain too. The two main ones are gabapentin and pregabalin (Lyrica).

Topical treatments can be helpful because they work right where you put them. Lidocaine patches can numb the area, while capsaicin cream (made from hot peppers) can reduce pain signals over time. These might cause fewer side effects than pills.

Some supplements may help reduce nerve pain and support nerve health. While supplements aren't a cure, research shows that certain vitamins and nutrients can be helpful when used with other treatments. Always talk to your doctor before starting any supplements, especially if you take other medicines.

The most studied supplements for nerve pain are alpha-lipoic acid and B vitamins. These work as antioxidants, which means they help protect your nerves from damage. Some people notice less pain and tingling after taking these for several weeks.

Quality matters when choosing supplements. Look for brands that have been tested by third parties for purity and strength. Some supplements can interact with medicines, so it's important to tell your doctor about everything you're taking.

The choices you make every day can have a big impact on how you feel. While lifestyle changes won't cure your neuropathy, they can help reduce your pain and keep your nerves as healthy as possible. Small changes can add up to make a real difference.

If you have diabetes, keeping your blood sugar levels steady is one of the most important things you can do. High blood sugar can damage your nerves even more. Work with your healthcare team to find the best ways to manage your blood sugar.

Physical therapy can teach you exercises and techniques to manage pain and stay active. Some people find that alternative treatments like acupuncture, massage, or TENS units help with their pain.

Some people with SFN find help from treatments that are "off-label" or not yet widely accepted as standard care. These alternative treatments might be worth discussing with your doctor, especially if standard treatments haven't given you enough relief. Always work with your healthcare provider before trying any new treatment.

Two alternative treatments that some people with neuropathy find helpful are Low Dose Naltrexone and medical cannabis. While research is still ongoing, some studies show promising results for nerve pain relief.

Low Dose Naltrexone (LDN) is a medication that was originally used at higher doses to treat addiction. At very low doses (1-5mg daily), it may help reduce inflammation and pain. Recent research specifically in patients with biopsy-confirmed cryptogenic Small Fiber Neuropathy (SFN) found that LDN may improve symptoms, especially in sensory and autonomic domains. However, the evidence is limited by small sample size and variable dosing, and more research is needed to confirm its benefits.

Research on LDN for SFN is ongoing. The latest studies suggest it may be especially relevant for cryptogenic SFN, with improvements seen in pain and autonomic symptoms. LDN may also work by blocking inflammation pathways in the central nervous system, but its effectiveness for diabetic neuropathy and other neuropathic pain conditions is still being evaluated.

Medical Cannabis is legal in many states for treating chronic pain. Some people with neuropathy find it helps with pain and sleep, though the evidence is mixed.

Research suggests medical cannabis can be effective for nerve pain, and some studies show it can help chronic neuropathic pain without severe side effects. However, side effects like impaired thinking and breathing problems are common, especially at higher doses.

Scientists are working hard to find better treatments for Small Fiber Neuropathy. While these new treatments are still being studied, they give us hope for better options in the future.

Researchers are looking at ways to help nerves grow back and heal themselves. They're also studying how the immune system might play a role in SFN and whether medicines that affect immunity could help.

Some promising areas of research include nerve growth factors, stem cell therapy, and new ways to deliver medicines directly to damaged nerves. Clinical trials are testing these treatments to see if they're safe and effective.