Small fiber neuropathy

Small fiber neuropathy

Ross Hauser, MD

Doctors at the Center for Autonomic and Peripheral Nerve Disorders, Beth Israel Deaconess Medical Center, Harvard Medical School give an excellent summary in their research paper published in the medical journal Current pain and headache reports of the problems of Small fiber neuropathy.

Before you read on, if you have questions about Small fiber neuropathy, get help and information from Caring Medical 

In summary, the Harvard researchers write:

  • Small fiber neuropathy manifests in a variety of different diseases and often results in symptoms of burning pain, shooting pain, allodynia (over sensitization to pain and pain from stimuli that should not cause pain), and hyperesthesia (over sensation of the skin).
  • Diagnosis of small fiber neuropathy is determined primarily by the history and physical exam, but functional neurophysiologic testing and skin biopsy evaluation of intraepidermal nerve fiber density can provide diagnostic confirmation.  Intraepidermal nerve fiber density testing is a skin biopsy where the visual examination of the number or density of nerve fibers is performed.
  • Management of small fiber neuropathy depends on the underlying etiology with concurrent treatment of associated neuropathic pain.
    • A variety of recent guidelines propose the use of antidepressants, anticonvulsants, opioids, topical therapies, and nonpharmacologic treatments as part of the overall management of neuropathic pain.
    • Unfortunately, little data about the treatment of pain specifically in small fiber neuropathy exist because most studies combine mixed neuropathic pain syndromes in the analysis. Additional studies targeting the treatment of pain in small fiber neuropathy are needed to guide decision making.1

The above report was published in June 2011. Six years later, publishing in July 2017, doctors writing in the medical journal Current opinion in pulmonary medicine discuss the challenges of  the cause, clinical manifestations, diagnostics, and treatment of small fiber neuropathy. They also suggest the diagnosis is difficult and can be easily missed.

In their paper, the team lead by Dutch researchers described small fiber neuropathy as a condition causing significant and disabling symptoms and impact on quality of life. They speculate that patients may benefit from being diagnosed with small fiber neuropathy, even if no underlying cause is identified and no specific treatment is yet available. (In other words the patient is given a diagnostic tag and categorized).

Clinical diagnostic criteria have been proposed for small fiber neuropathy, but no gold standard exists, and each test has its limitations, as pointed out by the Harvard team above. The diagnosis requires a combination of typical symptoms, abnormal neurologic findings, and absence of large fiber involvement (large fibers control motor function). Clinicians should be aware of overlapping symptoms of small fiber neuropathy and fibromyalgia.

Treatment is often difficult, even when the underlying cause is identified and appropriately treated. Usually, only symptomatic relief of complaints is available.2 (Unfortunately doctors admit that they cannot get to or even find the root of the problem to determine a curative treatment, they can only treat the symptoms.)

A paper published in the French language journal La Revue de médecine interne (The Journal of Internal Medicine), also cited the difficult in figuring out what small fiber neuropathy is. They write:

Small fiber neuropathy is still unknown. Characterised by neuropathic pain and can could lead to paresthesia (numbness or a feeling of pins and needles in the skin) and autonomic dysfunction which could lead to problems of unregulated heart rate, body temperature, problems with digestion, breathing and sensation. For some burning mouth syndrome will develop.

Small fiber neuropathy can be caused by  diabetes, impaired glucose metabolism, vitamin deficiency, alcohol, auto-immune disease, sarcoidosis etc.

Treatment is based on multidisciplinary management, combining symptomatic treatment, psychological management and treatment of an associated etiology.3

It should be clear that these three sample studies of many published reports outline that there are symptoms, doctors are not sure what is causing them, they are not sure how to treat the symptoms but can offer little else.

Small fiber neuropathy could be caused by ligament laxity

When we have a difficult to determine or treat problem such as small fiber neuropathy, we look for a solution. A possible solution may be cervical ligament laxity or simply, neck instability. If the cervical vertebrae are hypermobile they can press down and disrupt sensitive blood and nerve pathways. This problem is typically seen in patients exhibiting the symptoms described above in addition to a few other symptoms we see including dry eyes, dry mouth, postural lightheadedness, and dizziness. These are typical symptoms of a patient suffering from cervical neck instability. These are also symptoms of autonomic dysfunction and small fiber neuropathy.

Please view these videos which describe upper cervical instability also view our article nerve release injection therapy.

If you have questions about Small fiber neuropathy, get help and information from Caring Medical 

1 Hovaguimian A, Gibbons CH. Diagnosis and treatment of pain in small-fiber neuropathy. Current pain and headache reports. 2011 Jun 1;15(3):193-200. [Pubmed] [Google Scholar]

2 Voortman M, Fritz D, Vogels OJ, Eftimov F, van de Beek D, Brouwer MC, Drent M. Small fiber neuropathy: a disabling and underrecognized syndrome. Current Opinion in Pulmonary Medicine. 2017 Jul 20. [Pubmed] [Google Scholar]

3 Langlois V, Millet AL, Lebesnerais M, Miranda S, Marguet F, Benhamou Y, Marcorelles P, Lévesque H. La neuropathie des petites fibres. La Revue de Médecine Interne. 2017 Apr 11. [Pubmed] [Google Scholar]


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