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What Is Small Fiber Neuropathy?

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small fiber neuropathy

What Is Small Fiber Neuropathy?

Small fiber neuropathy (SFN) is a condition that involves severe pain attacks, primarily in the hands and feet.

It is an aggressively expanding health condition that affected approximately 40 million people in the United States.

It occurs when the small fibers of the peripheral nervous system get impaired. The peripheral nerves link the brain and spinal cord to the muscles and cells that are involved in detecting feelings such as smell, pain, and touch.

Those small nerve fibers are characterized for detecting sensations in the skin such as tingling, itching, pain, and heat. Moreover, they also coordinate autonomic functions of the heart and the gastrointestinal tract.


How Serious Is Small Fiber Neuropathy?

Sometimes small fiber neuropathy is described as an underlying health ailment in diabetes and many autoimmune and inheritance diseases.

In this neuropathy condition, damage in small fibers produces burning pain and prickling or stinging-like sensations. These abnormal feelings usually start from the feet and spread up the legs to the entire body.

People feel general body pain at the start of the disease, but some also complain about severe pain at night and rest hours.

If you are feeling these signs and symptoms, promptly seek help from your physician.

Go for physical examination, nerve conduction studies and skin biopsy tests to make the early diagnosis possible.   More importantly, if you have uncontrolled diabetes, small fiber neuropathy screening is more necessary.



small fiber neuropathySymptoms

Small fiber neuropathy is also called peripheral neuropathy and small-fiber sensory neuropathy (SFSN).

The symptoms of small fiber neuropathies can generally vary in severity. Many affected individuals report onsets of ambiguous and painful sensory irritations in the feet.

These irritating sensations in the skin may include:

  • Feeling of sand or small pebbles in the shoe or creases in the socks
  • Prickling or Itching Sensation
  • Persistent Burning Pain that may fluctuate in intensity during the day.
  • Electric “shock-like” Pain for few seconds but multiple times in a day.
  • Needle prick-like feeling when the pain is concentrated in a small area of the body.
  • Hyperalgesia and Allodynia-like conditions.



Hyperalgesia refers to general and increased sensitivity to pain.



Allodynia is described as a type of pain stimulated via sources that usually do not trigger pain, such as touch. People bearing this medical condition are unable to differentiate between hot and cold things. Interestingly, individuals also have pain attacks triggered by a warm or cold stimulus.


Bedsheet Pain small fiber neuropathyBedsheet Pain

Some patients living with small fiber neuropathy also complain about the bedsheets they use. They find them painful for their feet and skin; therefore, they use foot tents and soft socks to avoid skin contact with bedsheets.  Hypersensitivity can result in pain and discomfort even from the touch of bed linens.  Bedsheet discomfort is also reported by patients suffering from arthritis, diabetes, restless legs syndrome, CRPD, and gout.



Common Symptoms of Small Fiber Neuropathy

  • Dry Mouth
  • Dry Eyes
  • Low Blood Pressure Upon Standing Up After Sitting Or Lying Down
  • Feeling Of Near Fainting Without Actually Fainting
  • Dizziness Due To Abrupt Drop In Blood Pressure
  • Excessive Or Abnormal Sweating Affects The Regulation Of Body Temperature (Autonomic Function)
  • Vomiting
  • Constipation
  • Diarrhea
  • Erectile Dysfunction (Sexual Problem) In Men
  • Vaginal Dryness And Low Sexual Desire In Women
  • Nausea/Heartburn (Autonomic)
  • Abdominal Bloating (Autonomic)
  • Unable To Eat A Complete Meal
  • Urinary Tract Problems Include Difficulty In Urination, Failure To Empty Bladder, Or Feeling A Full Bladder That Leads To Urinary Tract Diseases.
  • Wake Up All Night
  • Irregular Heartbeat (Autonomic Dysfunction)
  • Bowel Problems Or Ailments
  • Hypoglycemia Or Low Blood Sugar Levels
  • Exercise Intolerance Develops Due To A Steady Heart Rate That Does Not Adjust With The Activity Level Of The Person


All these symptoms may range from mild to severe. Initially, the affected individual ignores mild symptoms that may worsen and progress to other parts of the body.



Why do Symptoms Worsen At Night?

In some patients, the small fiber neuropathy pain symptoms worsen at night. This kind of neuropathy prognosis may occur due to body temperature fluctuations at night. As most individuals tend to nap in cooler rooms, their body temperature slightly goes down.  Therefore, damaged small sensory nerve fibers in the skin may consider or interpret the temperature change as a tingling, pain, or burning sensation, which aggravates the symptoms of small fiber neuropathy.

Another factor that can worse small fiber neuropathy pain is poor sleep quality. Suppose the affected individual is not taking a proper nap or has poor sleep habits due to sleep-related health problems. In that case, they may also have enhanced pain perceptions.



There are many underlying causes of neuropathy that result in a diverse range of symptoms. Many other ailments, medical conditions, and metabolic syndromes also cause small fiber or small sensory neuropathy symptoms, such as:

  • Hepatitis C
  • Hiv (Human Immunodeficiency Virus)
  • Excessive Immunoglobulin Proteins In The Blood That Damage Kidney
  • Restless Leg Syndrome Is Also Called Willis Ekbom Ailment, Refers To Uneasy And Unpleasant Sensations In The Legs
  • Thyroid Dysfunction
  • Celiac Disease Or The Gluten-sensitive Enteropathy (Immune Reaction To Gluten-rich Foods)
  • Inflammatory Neuropathies
  • Amyloidosis (Abnormal Protein Buildup In Organs That Affects The Nervous System And The Organs)
  • Paraneoplastic Syndromes (Group Of Disorders Occurs Due To Abnormal Immune Responses To Neoplasm Or Tumor)
  • Use Of Neurotoxic Drugs
  • Complex Regional Pain Syndrome Type I Or Crps 1 Is Called Reflex Sympathetic Dystrophy (Rsd) (Clinical Syndrome Represented With Extreme Swelling, Pain, And Vasomotor Dysfunction).
  • Sjogren’s Syndrome (A Medical Condition Or Immune System Disorder That Is Characterized By Dry Eyes And Dry Mouth)
  • Autoimmune Diseases (I.E., Systemic Lupus Erythematosus)
  • Fabry Disease (A Genetic Disorder That Leads To Premature Death Due To Kidney And Heart Complications)
  • Fibromyalgia (A Clinical Condition Characterized By Whole-body Pains)
  • Deficiency Of Vitamin B12
  • Heredity Sensory Neuropathies
  • Lyme Disease (A Clinical Ailment Caused By Bacteria)
  • Chemotherapy
  • Psoriasis (A Skin Disease That Causes Redness Or Itching On Scaly Skin Patches)



Risk Factors

There may be many risk factors associated with small fiber neuropathy disease. Having any of the listed underlying causes or medical conditions may put you at risk of acquiring small fiber neuropathy. 



Diabetes is the most frequent risk element for this disease. Although the chances of developing small fibers neuropathy are less than many other diabetic neuropathies, it is still a significant concern for public health caretakers.

SFN is extensively linked to diabetes and prediabetes. According to the National Institute of Health (NIH), approximately 50 percent of individuals with these conditions also acquire small fiber neuropathy. 

Many researchers have also described a link between pain sensations and impaired glucose metabolism in affected individuals

Further, an increased risk of small fiber neuropathy is observed in diabetic patients with metabolic syndrome than people with diabetic issues only.



Aging is another risk factor. Many trusted sources have reported that advanced age increases the risk of neuropathy disease. It is also stated that people above 65 years of age are more prone to small-fiber sensory neuropathy (SFSN) than younger individuals. 

More Common in Females

Further, neuropathy risk is more common in males than females.




Patient History And Physical Examination

The diagnosis of small fiber neuropathy includes many steps. However, patient history and physical examination are the primary criteria against which other medical tests and assessments are compared. This initial step includes a detailed overview of the neuropathy symptoms, their rate of development, and progression. If the patient’s history is compelling for SFN disease and the physical exam is also appropriate, further diagnostic testing is unnecessary; however, this is rare. The diagnosis mostly remains unclear after a physical exam; therefore, doctors advise additional medical tests, including sensory nerve fibers conductance and skin biopsy tests.


Skin Biopsy

In the neuropathy condition, a skin biopsy is considered a gold standard diagnostic test.  In this procedure, doctors use invasive methods to take small skin tissue biopsy used for diagnosis of small fiber neuropathy. Skin biopsy helps to detect the loss of nerve supply in the skin or fewer nerve fibers than the normal skin. In other muscles and nerve tissues, a biopsy is rarely needed. People are concerned about the speed of diagnostic procedures.

They usually want to know that how long does it take to get small fiber neuropathy biopsy results? And how will it be helpful in the early diagnosis of small fiber neuropathy using skin biopsy? Is skin biopsy painful? How is accurate skin biopsy testing? Despite skin biopsy observational comparisons, many other medical tests are also performed.

Skin biopsies are also tested for small nerve fiber density that helps diagnose small fiber sensory neuropathy. This test is also called intraepidermal nerve fiber density.


Nerve Fibers Testing

Some peripheral neuropathy cases are also referred to a nerve conduction and electromyography test. These tests are performed to eradicate the contribution of motor and large nerve fibers. Electromyography mainly detects the muscles and the nerve cell’s health that control them. That’s how doctors or physicians rule out peripheral nerves damage and other muscle problems.


Reflex Testing

Reflex testing such as Quantitative sudomotor axon reflex testing is also an important diagnostic test for autonomic functions. It measures sweat production when the connective tissue, skin is exposed to a minor electric shock. Individuals with small fiber neuropathy usually have low sweat output or production. This kind of testing can help in the diagnosis of autonomic small fiber neuropathy. It can also help in diagnosing underlying autonomic functions.


Other Diagnostic Tests

Further, if necessary, the doctor recommends other medical tests such as blood tests, urine profiles, glucose tolerance and intolerance, vitamin deficiency, immune system disorders, kidney and liver function, and genetic tests.

Here many important questions arise that what is the small fiber neuropathy life expectancy? Can small fiber neuropathy reverse? Can you die from small fiber neuropathy? Any new treatment for small fiber neuropathy?



Treatment for Small Fiber Neuropathy

Eliminating the underlying cause or disease

After skin biopsy, nerve conduction, and other confirmation tests, small fiber neuropathy treatment is planned. Eradication of the underlying causes of small fiber neuropathy is the most effective treatment for pain in small fiber neuropathy. If peripheral neuropathy is associated with diabetes or prediabetes, optimal diabetes control, weight loss, eating a healthy and balanced diet are needed to reduce insulin resistance. Moreover, regular exercise can help improve blood supply and nutrients to all the skin’s small and large nerve fibers, restoring their normal functioning.



Many cases are considered idiopathic small fiber neuropathy (unknown cause); however, they still require treatment for pain relief. Prickling and burning sensations or pains can be treated with anti-depressant, anti-seizure, and pain-relieving medications, including opioid drugs, lidocaine dermal creams, anticonvulsants, and corticosteroids.


Multi-disciplinary Treatment

In severe cases, patients are referred to multi-disciplinary treatment approaches. In immune system-related peripheral neuropathies, a doctor may suggest immunosuppressive drugs to patients, which help in reducing inflammation by suppressing immune system activity.



Other treatments of painful small fiber neuropathy include physiotherapy and spinal cord stimulation. These treatments are effective in prominently managing the disease.

Can you reverse small fiber neuropathy?




Besides traditional treatments, extensive research is carried out to develop an effective and new treatment for small fiber neuropathy. A therapy called the intravenous (injection within the veins) application of immunoglobulin proteins or IVIG was administered in patients with small fiber neuropathy. Interestingly, this treatment showed a slight decrease in the patient’s painful sensory symptoms. Clinical trials are taking place further to investigate the effectiveness and feasibility of this treatment. Thereby, it can successfully help in reversing painful small fiber neuropathy.

As diagnostic facilities, research and development are advancing, new treatments strategies are also developing. Despite these, people also have concern for changes in their lifestyle to routinely manage the symptoms and underlying diseases in small fiber neuropathy and live a healthy life.

Keep going to learn the preventive measures, diet, and many more to manage this peripheral neuropathy disease.




Though many diseases that are associated with the risk of developing small fibers sensory neuropathy cannot be prevented, you can slow the disease development and its progressing symptoms by managing your general health and medical conditions.

For this, you must go for regular checkups, follow your doctor’s recommendation and advice to manage your diseases and medical conditions. 


Healthy Lifestyle

A few most common things to control small fiber neuropathy include:

  • If You Have Diabetes Mellitus, Control Or Maintain Your Blood Sugar Levels.
  • Do Not Consume Alcohol.
  • Avoid Smoking.
  • If You Have Any Autoimmune Disease, Get Proper Treatment To Manage The Disease.
  • Take Steps To Control Your Blood Pressure In Both High And Low Cases.
  • Eat A Healthy Diet.
  • Maintain And Achieve A Healthy Weight.
  • Do Regular Exercise.


Is Exercise Good For Small Fiber Neuropathy?

We know that many aerobic and flexibility exercises have obvious and well-known health benefits. Patients with small fiber neuropathy include some beneficial and easy exercises in their routine. 

It increases heart rate and movement in affected individuals. Moreover, exercise also enhances physical activity that improves blood circulation to nerves and other body tissues. This enhanced blood flow helps strengthen nerve tissues via increasing oxygen supply.

Further, aerobic exercises help neuropathy patients in managing stress, depression, and anxiety. It also improves their body functioning, maintains their ideal body weight, and enhances pain tolerance. 

Exercise also lowers blood sugar levels, maintains glucose metabolism in diabetic patients, and reduces insulin needs.



Healthy Diet

A balanced and healthy diet is the first line of defense against many diseases, including small fiber neuropathy. It is the best way to manage underlying conditions that trigger or cause small fiber neuropathy symptoms. 

If the affected person has diabetes mellitus, they can control or manage their diabetes while consuming a healthy diet. 

Diabetic people should avoid candy, soft drinks, fruit juices, and pastries, etc. 

Whether there is no medical condition associated, the affected individual should take a healthy diet rich in fruits, whole grains, and vegetables. It is better to keep a diary for your diet management.

High gluten foods such as white bread, pizza, pasta, and canned mashed potatoes should be avoided by affected individuals. Gluten sensitivity is directly linked with nerve pains. It produces itching, pins, needle-like sensations, headache, and many digestive problems.

Potato chips, processed or canned meals, fast food, and other salty foods can be problematic for small fiber sensory neuropathy patients. It can impede the blood flow in the body and cause numbness or other symptoms of small fiber neuropathy.

Diet rich in antioxidants and vitamin B12 can help manage small fiber neuropathy symptoms and improve the individual’s quality of life. Such as many celebrities with small fiber neuropathy are living their life.



Celebrities With Small Fiber Neuropathy


Eric Clapton

The iconic guitarist of the rock era who made his name over the instrument was struggling to play due to small fiber neuropathy. He was facing a problem in playing the guitar due to damaged nerves because of this illness. He said that he felt a lot of pain in his lower back that turned into neuropathy and felt like electric shocks going down his legs. He did not feel his finger tingling. Hence it was not linked with guitar playing. Therefore, it was considered that he got it due to worse habits of alcoholism and addiction to drugs. 

After diagnosis, he kept struggling and recovering from alcoholism and drug addiction and thought it a great thing to be alive at all. He also said that he should have left these things a long time ago.


Dave Ball 

From The Procul Harum Rock Band

Another guitarist, Dave Ball from Procul Harum rock band, got peripheral neuropathy while undergoing chemotherapy sessions back in 2012. He shared his feelings in an article for Macmillan Cancer Support. He said he feels the sensation of finger tingles. 

He added that it feels like your small nerve fibers in the skin are bare and directly exposed to the outside. Any contact can arise unpleasant feelings, and you end up wearing gloves all the time.