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Small Fiber Neuropathy - Underlying Causes, Symptoms, Diagnosis, and Treatment

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Small fiber neuropathy is a condition where nerves outside the brain and spinal cord get damaged to cause pain, burning, numbness, and other ailments.

Written by

Dr. Jayasree S

Medically reviewed by

Dr. Prakashkumar P Bhatt

Published At September 26, 2022
Reviewed AtMarch 28, 2024

What Is Small Fiber Neuropathy?

It is a painful condition where the small nerve fibers of the body get damaged. These small fibers belong to the peripheral nervous system, including all the nerves that branch out from the brain and spinal cord. Small fiber neuropathy causes pain, tingling, and burning in different body parts. Affected individuals suffer altered sensations in their hands and feet on both sides. It tends to start in the feet and move up to the legs and eventually affects the hands. As time passes, the symptoms grow severe. Neuropathy may affect other areas and functions of the body as well, leading to issues with digestion, sweating, and urination. The symptoms associated with small fiber neuropathy can be mildly annoying to extremely painful and debilitating.

What Are the Causes for Small Fiber Neuropathy?

The small fibers of the peripheral nervous system belong to two categories. There are somatic nerves that go into the skin and muscles. And there are autonomic nerves that connect the brain and spinal cord to the internal organs such as; the heart, stomach, etc. Peripheral nerves send sensory information from various body parts to the brain and spinal cord. They also pass on the commands from the brain to different organs. Damage to these nerves can be the initial symptom of some undiagnosed disease conditions in the individual as well.

The affected individual is more sensitive to pain than an unaffected individual. This increased sensitivity is termed hyperalgesia. They even feel pain from simulations that are not normally painful. Also, they are seen to lose the ability to tell the difference between hot and cold. There are several other symptoms too. Following are the possible causes for small fiber neuropathy:

  • The most common cause of small fiber neuropathy is diabetes.

  • Hormone disorders, hypothyroidism (due to low thyroid levels), or immune system disorders.

  • Hereditary diseases such as; amyloidosis, sensory, autonomic neuropathy, and more.

  • Metabolic syndrome involves high blood pressure, high blood cholesterol, obesity, and abnormal glucose metabolism.

  • Syndromes such as Guillain-Barre syndrome or Sjogren’s syndrome.

  • Infectious diseases such as; hepatitis, human immunodeficiency virus (HIV), Lyme disease,

  • Conditions like Fabry disease, Tangier disease, celiac disease, inflammatory bowel disease, lupus, and mixed connective tissue disease.

  • Disorders like sarcoidosis, scleroderma, vasculitis, psoriasis.

  • Adverse reactions to medications like chemotherapy drugs.

  • Alcohol abuse.

  • Chronic kidney disease.

  • Vitamin deficiencies, specifically vitamin B12.

  • Those with impaired glucose tolerance (body’s response to sugar), age above 65 years, and male gender are at a higher risk.

  • Sometimes small fiber neuropathy starts without any known underlying cause too.

What Are the Symptoms Suggestive of Small Fiber Neuropathy?

Pain is the major symptom associated with small fiber neuropathy. In the early stages, symptoms may be mild. As it typically affects the feet first and then moves up to affect the hand, the condition is always mentioned as a ‘stocking-and-glove’ pattern of symptom distribution.

When the somatic nerve fibers are affected, one suffers the following symptoms:

  1. Sudden pain in the form of severe short bursts.

  2. Neuropathic symptoms such as itching, burning, prickling, tingling, and numbness on the hand and legs.

  3. Sensations like sunburn or frostbite.

  4. Tightening or squeezing sensation at the feet, as if there is a sock stuffed at the end of the shoe.

  5. Occasional spasms or cramps.

  6. Muscle weakness, lack of coordination, and tendency to stumble.

  7. Loss of sensation in the affected body part.

  8. Symptoms get worse at the end of the day.

  9. It is worse while sitting down or lying in bed.

  10. Even the slightest touches of bed linen or cool air trigger the pain.

  11. Cold weather makes the symptoms worse.

  12. Some suffer electric shock-like sensations on the face along with tingling in the arms, lasting for minutes to hours.

When autonomic nerve fibers are affected, one suffers:

  1. Dryness of mouth and eyes.

  2. Lack of sweat or too much sweating.

  3. Constipation.

  4. Incontinence.

  5. Sexual dysfunction.

  6. Discolorations in the skin.

  7. Occasional dizziness due to low blood pressure.

How Is Small Fiber Neuropathy Diagnosed?

As small fiber neuropathy may be the starting symptom of an undetected disease condition, the diagnosis often aims at identifying the underlying cause. The doctor will review the medical history and family history of the affected individual and listen to their symptoms. There are several tests conducted to diagnose small fiber neuropathy, such as:

  • Skin Biopsy - This is the most effective test of all. The doctor will obtain small samples of skin tissue from the affected areas. These samples are microscopically examined to identify signs of neuropathy. The test aims to look at the number of nerve cells present in a given quantity of skin (intraepidermal nerve fiber density). Usually, the samples are taken from the legs where the symptoms often start.

  • Reflex Testing - This tests the neuropathy involving the autonomic nerves. Here, a mild electric shock is used to stimulate the skin to measure the sweat output. If the amount of sweat produced is low, it is indicative of small fiber neuropathy.

  • Electromyography Test - Is done to evaluate the nerve function by measuring the electrical signals sent from the nerve to the muscles.

  • Lab Tests - Additionally, one may order necessary lab tests to identify the underlying causes of diabetes and others.

What Are the Treatment Strategies for Small Fiber Neuropathy?

The primary goal of treating small fiber neuropathy is alleviating the symptoms by treating the underlying cause of the disease. The treatment involves:

  1. Medical management of diabetes or glucose tolerance issues by drugs to regulate blood sugar levels, lifestyle changes, and special diet plans.

  2. The agonizing pain caused by small fiber neuropathy can be treated with topical pain creams and pain-relieving drugs. In addition, immunosuppressive drugs like corticosteroids help reduce nerve damage by suppressing the immune system.

  3. Doctors may prescribe antidepressants and anticonvulsants as well, according to the individual's requirements.


Small fiber neuropathy is a slowly progressing condition in most affected individuals. The pain symptoms may worsen as the disease progresses, though some people have shown spontaneous recovery. Treating the underlying disease condition is the best way to resolve the symptoms. There are several methods available to manage pain medically. Discussing the symptoms with a qualified medical practitioner is the first step toward managing the complications of small fiber neuropathy.

Frequently Asked Questions


What Is the Severity Level of Small Fiber Neuropathy?

The severity level of small fiber neuropathy can vary from person to person. Some individuals may experience mild symptoms, such as occasional tingling or discomfort, while others may have more severe symptoms, including constant pain, numbness, and significant impairment of daily activities. The severity will depend on the underlying cause, the extent of nerve damage, and how well the condition is managed through treatment and lifestyle changes.


What Are the Primary Causes of Small Fiber Neuropathy?

The primary causes of small fiber neuropathy may include:
- Diabetes causes high blood sugar levels that can damage small nerve fibers over time
- Autoimmune disorders like Sjögren's syndrome, lupus, and celiac disease can lead to the immune system attacking nerve tissues
- Infections like viral or bacterial infections can trigger inflammation that affects small nerve fibers
- Hereditary/genetic factors
- Vitamin deficiencies like a lack of specific vitamins, such as B12, can contribute to nerve damage
- Toxic exposure
- Idiopathic (cause remains unknown)


How Is Small Fiber Neuropathy Defined?

Small fiber neuropathy is a neurological disorder characterized by damage to the small nerve fibers that transmit sensory and autonomic signals throughout the body. These tiny nerve fibers relieve pain sensations, temperature, and touch and control involuntary body functions, including heart rate, blood pressure, and digestion.


Is There a Cure for Small Fiber Neuropathy?

There is no definitive cure for small fiber neuropathy. Treatment focuses on managing symptoms, addressing underlying causes, and improving quality of life through medications, lifestyle changes, and physical therapy. Successful management can enhance daily functioning and alleviate pain, but a cure remains elusive.


Can Individuals With Small Fiber Neuropathy Lead a Normal Life?

With proper management and support, individuals with small fiber neuropathy can lead a relatively normal life. Symptom management, lifestyle adjustments, and adherence to treatment plans can significantly improve their quality of life and daily functioning. While challenges may exist, many can find fulfillment by focusing on self-care and necessary lifestyle changes.


What Is the Recommended Medication for Small Fiber Neuropathy?

Here are the recommended medications for small fiber neuropathy listed in bullet points:
- Gabapentin: An anticonvulsant that alleviates neuropathic pain.
- Pregabalin: Another anticonvulsant effective in treating nerve-related pain.
- Duloxetine: An antidepressant that reduces pain by targeting certain nerve pathways.
- Amitriptyline: A tricyclic antidepressant that helps relieve neuropathic pain.
- Topical Medications: Creams or patches with lidocaine or capsaicin for localized pain relief.
- Over-the-counter Pain Medications: Acetaminophen or ibuprofen will help with milder neuropathic pain.


Which Type of Doctor Specializes in Treating Small Fiber Neuropathy?

Neurologists are the type of doctors who specialize in treating small fiber neuropathy. Neurologists are the doctors who focus on diagnosing, managing, and treating nerve disorders, including conditions that affect the peripheral nerves, such as small fiber neuropathy. They have the expertise to conduct comprehensive evaluations, order necessary tests, and develop personalized treatment plans for small fiber neuropathy or any other neuropathy.


At What Age Do People Typically Develop Small Fiber Neuropathy?

Small fiber neuropathy can develop at any age but is more commonly diagnosed in adults, particularly in middle age or older. While it can affect people of all ages, certain underlying causes make it more prevalent in older adults. Regardless of age, early detection and intervention are essential for an improved quality of life.


Is Small Fiber Neuropathy Capable of Spreading?

Small fiber neuropathy is not known to spread from person to person. It is a localized condition that affects specific nerves in the body, specifically the small nerve fibers responsible for transmitting sensory and autonomic signals. However, within an individual, it can progress if the underlying cause needs to be addressed or if left unmanaged.


Why Does Small Fiber Neuropathy Worsen During the Night?

At night, small fiber neuropathy worsens due to reduced distractions, changes in blood flow affecting oxygen supply to nerves, pressure on sensitive nerves from certain sleeping positions, active nerve repair processes, increased sensitivity to temperature changes, fluctuations in pain perception based on circadian rhythms, and heightened psychological factors like anxiety and stress during quiet periods.


Which Foods Should Be Avoided for Small Fiber Neuropathy?

The following foods should be avoided:
- Limit sugar intake to manage blood sugar levels.
- Reduce saturated fats, as they may contribute to inflammation.
- Watch sodium intake, especially for those with autonomic neuropathy.
- Stay hydrated to support nerve function.
- Whole grains are better than refined grains for nutrient intake.
- Consume more fruits and vegetables for antioxidants and essential nutrients.
- To reduce inflammation, include omega-3 fatty acids from sources like fatty fish and flaxseeds.
- Limit alcohol and caffeine, as they can affect nerve function.
- Consider vitamin supplements like B vitamins or alpha-lipoic acid under medical supervision.
- Identify and avoid food allergens if associated with an autoimmune condition.


How Can the Progression of Small Fiber Neuropathy Be Halted?

To halt the progression of small fiber neuropathy:
- Address underlying causes promptly
- Control blood sugar levels (if diabetic)
- Manage symptoms with prescribed medications
- Maintaining a healthy lifestyle through regular exercise and a balanced diet is essential
- Consider physical therapy and pain management techniques
- Avoid exposure to harmful toxins
- Supplement with B vitamins or alpha-lipoic acid if necessary
- Treat autoimmune conditions if present
- Regularly monitor and adjust treatment as needed under healthcare professional guidance


Does Small Fiber Neuropathy Have the Potential to Regenerate?

Yes, small fiber neuropathy has the potential for nerve regeneration, depending on the extent of nerve damage, early intervention, and effective management of underlying causes. While complete recovery may not always occur, symptom improvement and enhanced nerve function can significantly improve an individual's quality of life.


What Is the Expected Recovery Time for Small Fiber Neuropathy?

The recovery time for small fiber neuropathy can vary significantly from individual to individual. Some may experience gradual improvement over weeks or months with appropriate treatment, while others may have a more extended recovery period or ongoing symptoms.
Complete recovery may not always be possible, but managing symptoms and improving quality of life are important treatment goals. Factors such as the underlying cause of the illness, severity of nerve damage, response to treatment, the health of the individual, and adherence to the treatment plan can influence the recovery timeline. Regular follow-up with healthcare professionals is crucial for optimizing recovery outcomes.


Is Small Fiber Neuropathy Considered a Neurological Disorder?

Small fiber neuropathy is considered a neurological disorder. It is a condition that affects the peripheral nervous system, specifically the small nerve fibers responsible for transmitting sensory and autonomic signals throughout the body. As a neurological disorder, small fiber neuropathy involves damage to these nerves, leading to sensory and autonomic symptoms, such as pain, tingling, numbness, and abnormalities in temperature regulation, blood pressure, and digestion.
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Dr. Prakashkumar P Bhatt
Dr. Prakashkumar P Bhatt



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