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) |