Small fiber neuropathy affects small nerve fibers near the skin, causing sensitivity to heat or cold and a stinging burning sensation. It is a type of peripheral neuropathy, which can affect various parts of the body. Diagnosis can be difficult, but underlying causes may include Fabry disease, diabetes, HIV, and neuralgia. Treatment involves symptom management and plasma protein replacement therapy.
Small fiber neuropathy — also known as peripheral small fiber neuropathy, C-fiber neuropathy, and small fiber sensory neuropathy (SFSN) — is a type of peripheral neuropathy that affects small nerve fibers near the surface of the skin. The characteristic symptoms of this particular condition are a particular sensitivity to heat or cold, although other symptoms consistent with general neuropathy are often also present. A patient suffering from this condition may be troubled by a stinging burning sensation that comes and goes without any obvious cause.
Peripheral neuropathy is the name given to damage to the nervous system as a result of disease or illness in all areas other than the brain and spinal cord. It can affect various parts of the body, but most commonly the legs and feet. In addition to small fiber neuropathy, which as the name indicates affects the small fiber nerves, there can also be large fiber neuropathy. Small-fiber nerves generally only conduct sensations of pain and temperature from the surface of the skin, while large-fiber nerves are responsible for things like motor functions.
Although a large proportion of peripheral neuropathy cases are considered idiopathic—that is, having no single, identifiable cause—small fiber neuropathy has several underlying causes. Diagnosis isn’t always easy, however, as the condition is considered completely separate from large fiber neuropathy, which often also affects a portion of the small fiber nerves.
A diagnostician must therefore determine that only the small fibers are affected for small fiber neuropathy. This is typically done through a process of ruling out all other possible causes first. The most common underlying cause of proper small fiber neuropathy, when it’s not simply considered an idiopathic case, is a condition known as Fabry disease. Other causes may include diabetes, human immunodeficiency virus (HIV), and neuralgia, although these are less commonly responsible.
Fabry disease is a rare genetic disorder that, if left undiagnosed and untreated, can lead to kidney damage, heart attacks and strokes, among other problems. Small fiber neuropathy is one of the main early warning signs of the disease. The relationship between neuropathy and Fabry disease is important, therefore, as a way to avoid the later, more serious outcomes that can occur.
As of 2010, there was no cure for small fiber neuropathy, in part because it is often caused by Fabry disease. When diagnosed as such, it is treated symptomatically with techniques such as intravenous immunoglobulin (IVIG) and plasmapheresis, which are plasma protein replacement therapies. These are typically done in combination with treatments for Fabry disease. When diagnosed as idiopathic, plasma protein replacement is used in conjunction with various antidepressant and antiepileptic drugs that have been shown to reduce general neuropathic symptoms.
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