Small fiber peripheral neuropathy

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history

Small fiber peripheral neuropathy or or small fiber sensory neuropathy or SFPN or small fiber neuropathy or 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 tests 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, duloxetine, 5% lidocaine patch, tramadol, and opioid analgesics are used to treat SFN.[13][14][10][15]

See also[edit | edit source]

Learn more[edit | edit source]

References[edit | edit source]

  1. "unmyelinated". Retrieved October 4, 2018.
  2. "peripheral nerve". 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.
  9. "Peripheral Neuropathy -- Symptoms, Types, and Causes of Peripheral Neuropathy". WebMD. Retrieved October 4, 2018.
  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.
  14. McNamara, Lindsay. "Small Fiber Sensory Neuropathy". Retrieved October 4, 2018.
  15. Lunn, Michael Pt; Hughes, Richard Ac; Wiffen, Philip J. (October 7, 2009). "Duloxetine for treating painful neuropathy or chronic pain". The Cochrane Database of Systematic Reviews (4): CD007115. doi:10.1002/14651858.CD007115.pub2. ISSN 1469-493X. PMID 19821395.