TABLE 3

Pain management for small fiber neuropathy

Therapy	Dosages (per day)	Common adverse effects
Anticonvulsants
Gabapentin	300–3,600 mg	Sedation, dizziness, peripheral edema, weight gain
Pregabalin	150–600 mg	Similar to gabapentin
Topiramate	25–400 mg	Weight loss, sedation, cognitive slowing, depression with suicidal ideation, renal stones, paresthesias, glaucoma
Zonegran	100–400 mg
Antidepressants
Amitriptyline	20–100 mg	Sedation, weight gain, anticholinergic effects, sexual dysfunction, arrhythmia (side effects most prominent with amitriptyline)
Nortriptyline	20–100 mg
Desipramine	20–200 mg
Duloxetine	60–120 mg
Topical anesthetics
Lidocaine 5% patch	3 patches for 12 hours	Local edema, burning, erythema
Lidocaine 5% cream or gel	5 g to affected areas up to 20 g total	Local edema, burning, erythema
Capsaicin 0.75%	Apply up to 4 times daily	Burning
Capsaicin 8% patch	60–90 minutes (applied by the clinician)	Burning
Other
Tramadol	50–400 mg	Sedation, dizziness, seizures, nausea, constipation
Mexiletine	200–600 mg	Nausea, vomiting, abdominal pain, dry mouth (not helpful for diabetic neuropathy)