Small Fiber Neuropathy: All You Need to Know

Small fiber neuropathy (SFN) is a lesser-known neurological condition that can profoundly impact an individual’s quality of life. SFN affects 1.5 percent of the world population, approximately. Millions of people in the United States alone suffer from this disorder1.

The goal of this article is to provide you with a comprehensive understanding of small fiber neuropathy, addressing its symptoms, treatment options, and recent advancements. I have tried to cover this topic from a medical point of view along with trying my best to describe everything at a more basic level to help you navigate this complex condition with compassion and knowledge. So, if you encounter some medical jargon, keep on reading and you will find answers to your questions down the paragraphs.

In my days as a physician, I encountered patients from almost every age group presenting with small fiber neuropathy. Most of the patients with SFN were suffering from some underlying condition (e. g. diabetes mellitus) which proved to be the root cause of the problem. But there were cases, where SFN was the sole presentation without any other association. As per my experience, symptoms in the latter patient group were severe and management proved more challenging.

If you or your loved one is suffering from Small Fiber Neuropathy or any other illness, and are facing difficulty managing their healthcare needs, our team is here to lend a hand. Click here to learn more and book a free consultation session.

What is Small Fiber Neuropathy?

Small fiber neuropathy emerges when harm befalls the peripheral nerves, particularly targeting the small myelinated (Aδ) fibers or unmyelinated C fibers2. This intricate process encompasses an array of both small somatic and autonomic fibers. These fibers serve as messengers of sensation, responsible for tasks ranging from thermal perception to nociception. Moreover, their involvement extends to a gamut of autonomic and enteric functions, forming a complex network within the body.

In simpler terms, small fiber neuropathy is a disorder characterized by damage to the small nerve fibers in the body responsible for transmitting sensory (related to senses such as pain, touch, and temperature) and autonomic (involuntary messages to control various functions of the body such as sweating, digestion, etc.) signals. These fibers act as messengers, carrying vital information across the body to and from the brain. When these fibers are damaged, the ability of the nerves to carry those signals is diminished. Sometimes, rather than failing to carry the signals, these nerves distort the signal resulting in sensations that cannot be explained (such as feeling a burning sensation in cold weather.)

Small Fiber Neuropathy Symptoms

Living with small fiber neuropathy can present a unique set of challenges. Patients often describe symptoms such as:

Burning Sensation: A persistent burning or tingling sensation in the limbs, typically in the feet and hands.

Temperature Fluctuations: Abnormal sensitivity to temperature changes, leading to discomfort in both hot and cold conditions.

Pain: Sharp, stabbing, or shooting pain that can vary in intensity and may feel like electric shocks.

Numbness: Gradual loss of sensation, often described as wearing invisible gloves or socks.

Autonomic Dysfunction: Symptoms may extend beyond sensory issues, affecting automatic functions like blood pressure regulation, digestion, dry eyes and mouth, bladder problems, sexual dysfunction, and abnormal sweating.

Causes of SFN

While the exact cause of small fiber neuropathy can vary, it is often linked to underlying conditions such as diabetes, autoimmune disorders, infections, medications, vitamin deficiencies, alcoholism, or genetic predisposition. Sometimes, however, no clear cause can be identified. This is called idiopathic SFN.

The diagnosis of SFN can be challenging, as it may not show up on standard nerve tests such as nerve conduction studies or electromyography. Instead, doctors may use specialized tests such as skin biopsy or quantitative sensory testing to measure the density and function of the small nerve fibers.

It’s important to note that small fiber neuropathy itself rarely affects life expectancy directly. However, its impact on daily life can lead to emotional and physical challenges that necessitate careful management.

Treatment Options for Small Fiber Neuropathy

There are diverse treatment options for small fiber neuropathy. The treatment of SFN depends on the underlying cause. If possible, treating or managing the cause can help improve or prevent the progression of SFN. For example, people with diabetes or metabolic syndrome should control their blood sugar levels, maintain a healthy weight, and follow a balanced diet.

People with autoimmune diseases may benefit from immunosuppressive drugs that reduce inflammation and immune activity. People with infections should receive appropriate antibiotics or antivirals. People with vitamin deficiencies should take supplements as prescribed by their doctors. People with medication-induced SFN should consult their doctors about changing or stopping their drugs.

In addition to treating the cause, there are also symptomatic treatments that can help relieve the pain and discomfort caused by SFN. These include pharmacological and non-pharmacological treatments.

Pharmacological Treatments for SFN

Antidepressants: These drugs can modulate the pain signals in the brain and spinal cord. Examples are amitriptyline, duloxetine, and venlafaxine.

Antiseizure medications: These drugs can stabilize the nerve membranes and reduce the excitability of the nerve fibers. Examples are gabapentin, pregabalin, and carbamazepine.

Lidocaine creams and patches: These topical agents can numb the skin and block the pain receptors. They can be applied to the affected areas as needed.

Opioids: These drugs can bind to the opioid receptors in the brain and spinal cord and reduce the perception of pain. Examples are tramadol, oxycodone, and morphine. However, these drugs have a high risk of addiction and side effects, so they should be used with caution and under close supervision.

Nonsteroidal anti-inflammatory drugs (NSAIDs): These drugs can reduce inflammation and pain by inhibiting the production of prostaglandins. Examples are ibuprofen, naproxen, and aspirin. However, these drugs can also cause stomach ulcers, bleeding, kidney damage, and cardiovascular problems, so they should be used with caution and under medical advice.

Non-pharmacological treatments that can help with SFN

Physical therapy: This can help improve blood circulation, muscle strength, balance, and coordination. It can also prevent muscle wasting and contractures.

Occupational therapy: This can help with daily activities such as dressing, bathing, cooking, and working. It can also provide adaptive devices such as braces, splints, or orthotics to protect the joints and prevent injuries.

Acupuncture: This is a traditional Chinese medicine technique that involves inserting thin needles into specific points on the body to stimulate the flow of energy (qi) and restore balance. It can help reduce pain and inflammation by releasing endorphins and serotonin.

Transcutaneous electrical nerve stimulation (TENS): This is a device that delivers low-voltage electrical currents to the skin through electrodes attached to a battery-operated unit. It can help reduce pain by interfering with the pain signals in the nerves.

Biofeedback: This is a technique that uses sensors to monitor physiological parameters such as heart rate, blood pressure, skin temperature, muscle tension, and brain waves. It can help people learn to control these parameters voluntarily and achieve relaxation and pain relief.

Recent Advancements: Exciting new research is uncovering potential therapies that target the underlying causes of small fiber neuropathy, offering hope for improved outcomes. More on them later in this article.

SFN is a chronic condition that can affect the quality of life of people who have it. However, with proper diagnosis, treatment, and self-care, it is possible to manage the symptoms and prevent complications.

Tips for living with SFN:

  • Protect your feet and hands from injuries, infections, and temperature extremes. Wear comfortable shoes, socks, gloves, and clothing. Check your feet and hands regularly for cuts, blisters, ulcers, or infections. Apply moisturizer to prevent dryness and cracking. Avoid walking barefoot, using hot water, or exposing yourself to cold weather.
  • Maintain good hygiene and hydration. Brush your teeth, floss, and rinse your mouth regularly. Drink plenty of water and use artificial tears or saliva substitutes if needed. Avoid smoking, alcohol, caffeine, and spicy foods that can irritate the mucous membranes.
  • Manage your stress and emotions. Stress can worsen the symptoms of SFN and affect your mental health. Find healthy ways to cope with stress, such as meditation, yoga, breathing exercises, hobbies, or social support. Seek professional help if you experience depression, anxiety, or other psychological problems.
  • Educate yourself and others about SFN. Learn as much as you can about your condition, its causes, treatments, and prognosis. Join a support group or an online community where you can share your experiences and learn from others who have SFN. Inform your family, friends, coworkers, and healthcare providers about your condition and how it affects you.

SFN is a condition that can cause a lot of pain and discomfort, but with proper care and support, you can live a fulfilling and productive life.

Can You Die from Small Fiber Neuropathy?

Rest assured, small fiber neuropathy itself is not a life-threatening condition. However, its impact on your well-being and quality of life is what truly matters. By seeking timely medical attention and adhering to a personalized treatment plan, you can manage symptoms effectively and focus on living a fulfilling life.

Hope for the Future:

As medical knowledge continues to evolve, so too do the possibilities for managing small fiber neuropathy. Researchers and healthcare professionals are dedicated to enhancing our understanding of this condition and developing innovative treatments that offer new avenues of hope.

One recent study conducted by Kristian L. Hedstrom, Joshua C. Murtie, Kathryn Albers, Nigel A. Calcutt, and Gabriel Corfas, found that overexpression of glial cell line-derived neurotrophic factor (GDNF) in skin keratinocytes or topical application of XIB4035, a reported nonpeptidyl agonist of GDNF receptor α1 (GFRα1), are effective treatments for small-fiber neuropathy (SFN)3. The study also demonstrated that XIB4035 enhances GFRα family receptor signaling in conjunction with ligand stimulation. The results indicate that topical application of GFRα/RET receptor signaling modulators may be a unique therapy for SFN, and XIB4035 is identified as a candidate therapeutic agent.

In simpler terms, a molecule named XIB4035 can be applied topically to treat small fiber neuropathy. Although the study is in preclinical trials, it still demonstrates that there is hope for the treatment of SFN in the future.

Celebrities with Small Fiber Neuropathy:

It’s worth noting that small fiber neuropathy can affect individuals from all walks of life, including some well-known figures. Celebrities such as Morgan Freeman, the famous Hollywood actor known for his iconic roles in films like ‘The Shawshank Redemption’, Yolanda Hadid, a model and star of the reality TV show ‘The Real Housewives of Beverly Hills’, Cyndi Lauper, a singer, songwriter and winner of two grammy awards, Kristin Chenoweth, a Tony and Emmy-winning actress best known for her role in ‘Pushing Daisies’ and ‘Glee’, Tom Stewart, a Scottish rugby player, and Karen Duffy, a former MTV VJ and actress have bravely shared their experiences, shedding light on the challenges of living with this condition and inspiring others to seek support and treatment4.

Small fiber neuropathy is a complex condition that calls for empathy, understanding, and expert medical care. It is a disorder that can cause significant pain and discomfort. However, with the right treatment and management, it is possible to live a full and healthy life. If you are experiencing symptoms of small fiber neuropathy, it is important to speak with your doctor to determine the best course of action for your individual needs. If you would like us to help you manage this disease, click here to learn more about our Personalized Health Coordinator Services.

  1. Hoitsma E, Reulen JP, de Baets M, Drent M, Spaans F, Faber CG. Small fiber neuropathy: a common and important clinical disorder. J Neurol Sci. 2004 Dec 15;227(1):119-30. doi: 10.1016/j.jns.2004.08.012. PMID: 15546602.
  2. Hovaguimian A, Gibbons CH. Diagnosis and treatment of pain in small-fiber neuropathy. Curr Pain Headache Rep. 2011 Jun;15(3):193-200. doi: 10.1007/s11916-011-0181-7. PMID: 21286866; PMCID: PMC3086960.
  3. Hedstrom, Kristian L., et al. “Treating small fiber neuropathy by topical application of a small molecule modulator of ligand-induced GFRα/RET receptor signaling.” Proceedings of the National Academy of Sciences, vol. 111, no. 6, 2014, pp. 2325-2330. doi: 10.1073/pnas.1308889111
  4. Celebrities with Small Fiber Neuropathy. Disease Maps, 2021, Accessed 20 Aug. 2023.
Dr. Muhammad Hussain
Dr. Muhammad Hussain

MD, Entrepeneur & Administrator. Six years of experience, working in the field of clinical care, medical administration, and healthcare business.

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