Small Fiber Neuropathy: Causes, Symptoms, Diagnosis & Treatment Options

Small Fiber Neuropathy: Symptoms, Causes, Diagnosis, and Relief Options

Conditions Treated

Small fiber neuropathy (SFN) affects the small unmyelinated C fibers and thinly myelinated Aδ fibers that regulate pain perception and temperature sensation.

These fibers do not appear in standard nerve conduction studies.
Damage leads to neuropathic pain with no visible inflammation or structural issues.
SFN is often misdiagnosed or missed entirely in early stages.

Prevalence: SFN affects 53% of idiopathic neuropathy cases (Oaklander & Klein, 2013).

Conditions We Treat

What Causes Small Fiber Neuropathy?

Root causes of small fiber neuropathy include:

Cause Category	Specific Triggers
Metabolic	Diabetes, prediabetes, glucose intolerance
Autoimmune	Lupus, Sjögren’s, sarcoidosis, celiac disease
Infectious	HIV, Lyme disease, Hepatitis C
Toxic	Chemotherapy, alcohol abuse, heavy metal exposure
Genetic	Familial amyloid polyneuropathy, Fabry disease
Idiopathic	No identifiable cause in up to 30% of cases

Key Insight: 50% of patients with SFN have impaired glucose tolerance or diabetes (Smith et al., 2005).

What Are the Symptoms of Small Fiber Neuropathy?

Patients with small fiber neuropathy report sensory disturbances that often begin in the feet and progress proximally.

Common symptoms include:

Burning or stabbing pain
Electric-shock sensations
Tingling or “pins and needles”
Allodynia (pain from light touch)
Hyperesthesia (increased sensitivity)
Nocturnal pain
Symmetric symptoms in feet or hands

Pattern: A “stocking-glove” distribution is typical, starting in the distal extremities.

How It Works

How Is Small Fiber Neuropathy Diagnosed?

Diagnosis of SFN requires specialized tools because routine nerve studies are often normal.

Diagnostic Process:

Clinical History & Symptom Review
- Pattern recognition (length-dependent vs. non-length-dependent)
- Sensory mapping
Skin Biopsy
- Gold standard for measuring intraepidermal nerve fiber density (IENFD)
- Confirms fiber loss
Quantitative Sensory Testing (QST)
- Assesses temperature and pain thresholds
Autonomic Testing (if applicable)
- Evaluates sweat response and heart rate variability
Laboratory Screening
- Rule out metabolic, autoimmune, infectious, or genetic causes

Note: Up to 90% of SFN diagnoses rely on skin biopsy and QST (Devigili et al., 2008).

What Are the Treatment Options for Small Fiber Neuropathy?

There is no one-size-fits-all cure, but symptom control is achievable with proper management.

Treatment categories:

Treatment Type	Examples
Pharmacological	Gabapentin, pregabalin, duloxetine, amitriptyline
Lifestyle Modifications	Blood sugar control, alcohol cessation, exercise
Physical Therapy	Desensitization, gait training, pain reduction techniques
Neuromodulation Therapies	Scrambler Therapy, TENS, spinal cord stimulation
Complementary Therapies	Acupuncture, mindfulness, cognitive-behavioral therapy

Scrambler Therapy for Neuropathic Pain

FDA-cleared, non-invasive device
Sends “non-pain” electrical signals via surface electrodes
Aims to retrain the brain’s pain response
Drug-free and does not involve surgery or sedation

Clinical Insight: Patients with drug-resistant pain have shown positive responses in clinical trials of Scrambler Therapy (Marineo et al., 2012).

What We See in Clinic

Most patients visiting our clinic have a history of:

Years of unexplained symptoms
Multiple failed medications
Feeling dismissed or misunderstood by providers

Our team conducts:

Detailed pain history and pattern review
Neurological screening
Evaluation of Scrambler Therapy candidacy based on individual nerve profiles

Many patients experience pain relief after just a few sessions of targeted therapy.

Verified Patient Testimonials

“After months of burning foot pain with no clear diagnosis, this was the first place that explained what might be happening.”

“Nothing helped my nerve pain until I explored non-invasive options here.”

Each testimonial reflects real experiences of individuals navigating years of undiagnosed nerve pain and finding relief through customized therapy approaches.

Frequently Asked Questions About Small Fiber Neuropathy

What causes small fiber neuropathy?

Causes vary and may include metabolic, autoimmune, or idiopathic factors.

Why don’t standard nerve tests always detect it?

Many tests focus on large nerve fibers, not small sensory fibers.

Is small fiber neuropathy dangerous?

It is not life-threatening but can significantly affect quality of life.

Can it be treated without medication?

Some patients explore non-invasive, drug-free options depending on their case.

Who may not be a candidate for certain therapies?

Candidacy depends on medical history and requires a consultation.

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Medical Disclaimer

This article provides general information for educational purposes. It does not replace medical advice. Always consult with a qualified clinician for diagnosis and personalized care.

Experiencing Chronic Pain in South Florida?

Discover South Florida Scrambler Therapy is one of the nation’s leading clinics for noninvasive chronic pain relief, offering FDA-cleared Scrambler Therapy® for adults and children. Co-founded by Dr. Rick Markson, one of the few practitioners worldwide to receive advanced certification directly from the therapy’s inventor in Rome, our clinic delivers globally recognized expertise with compassionate, personalized care. If you or a loved one is living with treatment-resistant nerve pain, we invite you to schedule a consultation and explore a life beyond pain.

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