Small fiber peripheral neuropathy

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Small fiber peripheral neuropathy (SFSN/SFN) is a type of peripheral neuropathy that occurs from damage to the small unmyelinated[1] peripheral nerve[2] (any nerve of the nervous system outside the central nervous system) fibers.

It is common in Ehlers-Danlos syndrome (EDS),[3] fibromyalgia,[4][5][6] and postural orthostatic tachycardia syndrome (POTS).[7] Many other conditions can also cause small fiber peripheral neuropathy such as celiac disease, rheumatoid arthritis (RA), lyme disease, vitamin B12 deficiency, and more.[8]

Symptoms[edit | edit source]

Diagnosis[edit | edit source]

An examination and detailed review of the symptoms, the rate of progression, and complaints suggestive of autonomic fiber involvement are necessary for diagnosis.[10] Quantitative sensory testing (QST), quantitative sudomotor axon reflex testing (QSART), skin biopsy, and electromyography and nerve-conduction studies are useful.[10]

The Utah Early Neuropathy Scale (UENS) was developed to help diagnosis SFN.[11][10] The Neuropathic Pain Symptom Inventory (NPSI) can also help.[12][10]

Treatment[edit | edit source]

Gabapentin, pregabalin, amitriptyline, nortriptyline, 5% lidocaine patch, tramadol, and opioid analgesics are used to treat SFN.[13][14][10]

References[edit | edit source]

  1. ↑ "unmyelinated". TheFreeDictionary.com. Retrieved October 4, 2018.
  2. ↑ "peripheral nerve". TheFreeDictionary.com. Retrieved October 4, 2018.
  3. ↑ Cazzato, Daniele; Castori, Marco; Lombardi, Raffaella; Caravello, Francesca; Bella, Eleonora Dalla; Petrucci, Antonio; Grammatico, Paola; Dordoni, Chiara; Colombi, Marina (June 15, 2016). "Small fiber neuropathy is a common feature of Ehlers-Danlos syndromes". Neurology: 10.1212/WNL.0000000000002847. doi:10.1212/WNL.0000000000002847. ISSN 0028-3878. PMID 27306637.
  4. ↑ "Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia". PAIN®. 154 (11): 2310–2316. November 1, 2013. doi:10.1016/j.pain.2013.06.001. ISSN 0304-3959.
  5. ↑ "Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia". PAIN®. 154 (11): 2310–2316. November 1, 2013. doi:10.1016/j.pain.2013.06.001. ISSN 0304-3959.
  6. ↑ Levine, Todd D.; Saperstein, David S. (December 24, 2014). "Routine use of punch biopsy to diagnose small fiber neuropathy in fibromyalgia patients". Clinical Rheumatology. 34 (3): 413–417. doi:10.1007/s10067-014-2850-5. ISSN 0770-3198. PMID 25535201.
  7. ↑ Gibbons, Christopher H.; Bonyhay, Istvan; Benson, Adam; Wang, Ningshan; Freeman, Roy (December 27, 2013). "Structural and Functional Small Fiber Abnormalities in the Neuropathic Postural Tachycardia Syndrome". PLoS ONE. 8 (12): e84716. doi:10.1371/journal.pone.0084716. ISSN 1932-6203. PMID 24386408.
  8. ↑ 8.0 8.1 Vandergriendt, Carly; Weatherspoon, Deborah (January 4, 2018). "Small Fiber Neuropathy: Symptoms, Treatment, Causes, and More". Healthline. Retrieved October 4, 2018. Cite has empty unknown parameter: |dead-url= (help)
  9. ↑ "Peripheral Neuropathy -- Symptoms, Types, and Causes of Peripheral Neuropathy". WebMD. p. 3. Retrieved October 4, 2018. Cite has empty unknown parameter: |dead-url= (help)
  10. ↑ 10.0 10.1 10.2 10.3 10.4 Hovaguimian, Alexandra; Gibbons, Christopher H. (2011). "Diagnosis and Treatment of Pain in Small Fiber Neuropathy". Current pain and headache reports. 15 (3): 193–200. doi:10.1007/s11916-011-0181-7. ISSN 1531-3433. PMID 21286866.
  11. ↑ Singleton, J. Robinson; Bixby, Billie; Russell, James W.; Feldman, Eva L.; Peltier, Amanda; Goldstein, Jonathan; Howard, James; Smith, A. Gordon (2008). "The Utah Early Neuropathy Scale: a sensitive clinical scale for early sensory predominant neuropathy". Journal of the Peripheral Nervous System. 13 (3): 218–227. doi:10.1111/j.1529-8027.2008.00180.x. ISSN 1085-9489.
  12. ↑ Bouhassira, Didier; Attal, Nadine; Fermanian, Jacques; Alchaar, Haiel; Gautron, Michèle; Masquelier, Etienne; Rostaing, Sylvie; Lanteri-Minet, Michel; Collin, Elisabeth (2004). "Development and validation of the Neuropathic Pain Symptom Inventory". Pain. 108 (3): 248–257. doi:10.1016/j.pain.2003.12.024. ISSN 0304-3959. PMID 15030944.
  13. ↑ Sacks, Damon; Lloyd, Emma (September 10, 2010). "Facts about living with small fiber neuropathy - Also known as C fiber neuropathy or peripheral neuropathy it is often caused by diabetes or classically, Fabry disease". Health Guide Info. Retrieved October 4, 2018. Cite has empty unknown parameter: |dead-url= (help)
  14. ↑ McNamara, Lindsay. "Small Fiber Sensory Neuropathy". Retrieved October 4, 2018.

postural orthostatic tachycardia syndrome (POTS) - A form of orthostatic intolerance where the cardinal symptom is excessive tachycardia due to changing position (e.g. from lying down to sitting up).

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