Diagnosis and Treatment of Pain in Small-fiber Neuropathy

Abstract

Small fiber neuropathy manifests in a variety of different diseases and often results in symptoms of burning pain, shooting pain, allodynia, and hyperesthesia. 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. 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.

Pain in primary Sjögren's syndrome

“…SFN involves small, narrow-diameter myelinated (Ad) and unmyelinated (C) nerve fibres that are the neurological structures responsible for conveying cold and nociceptive input (Ad fibres), innocuous warm and cold sensations, as well as high threshold mechanical, thermal and chemical stimuli (C fibres) [29].…”

Evidence of peripheral large nerve involvement in fibromyalgia: a retrospective review of EMG and nerve conduction findings in 55 FM subjects

“…We, and others, have recently shown that FM is highly associated with findings of small fiber neuropathy (SFN), a lesion frequently accompanied by severe peripheral pain (1,2). Such a SFN is, therefore, an attractive candidate to serve as one of the peripheral nociceptive generators capable of maintaining the putative central (brain and spinal cord) sensitization thought to be integral to the production of FM painful symptomatology (3).…”

High Plasma Pentraxin 3 Levels in Diabetic Polyneuropathy Patients with Nociceptive Pain

“…Assessment of only large fiber function in DM patients is the main limitation in conventional nerve conduction stud-ies. Firstly, diagnosis of small fiber neuropathy is determined by history and physical exams, and then functional neurophysiological testing and skin biopsy evaluation can provide diagnostic confirmation of the disease (Hovaguimian and Gibbons 2011).…”