Small fibre neuropathy pain is treated with the same medications used for other neuropathic pain: certain anti-seizure drugs and specific antidepressants, plus topical agents for localised areas. Treating any identified cause matters separately. Ordinary painkillers work poorly for this mechanism, and topical agents suit well-localised areas while avoiding systemic effects.
Small fibre neuropathy pain is treated with the same medications used for other neuropathic pain: certain anti-seizure drugs and specific antidepressants, plus topical agents for localised areas. Treating any identified cause matters separately. Ordinary painkillers work poorly for this mechanism, and topical agents suit well-localised areas while avoiding systemic effects.
Gabapentin and pregabalin, duloxetine, and tricyclics such as amitriptyline or nortriptyline are the established options, the same group used across neuropathic pain generally. Each is started low and increased gradually because starting high produces side effects that end the trial before benefit appears. Response varies considerably between individuals, so trying more than one is normal. Topical lidocaine patches or capsaicin suit well-localised areas and avoid systemic effects entirely.
Where light touch itself has become painful, some of the most useful measures are not medications at all: loose clothing, seamless socks, keeping bedding off the feet, and a cooler room. Topical agents can be difficult to apply to skin that is painful to touch, which is worth mentioning rather than abandoning them silently. Ordinary painkillers work poorly for this mechanism, and knowing that early prevents months spent on them.
Pain treatment does not slow the process. Where a cause is found it is treated in its own right: glucose control including for impaired tolerance short of diabetes, correcting vitamin B12 deficiency, reducing excess vitamin B6 which causes neuropathy in overdose, treating thyroid disease, addressing autoimmune conditions, and reviewing culprit medications. Autonomic symptoms including dry eyes, altered sweating and light-headedness on standing have their own treatments and are worth reporting.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: peripheral nerve disorders; National Institute of Neurological Disorders and Stroke; MedlinePlus, National Library of Medicine.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.