Small Fiber Neuropathy: Symptoms, Treatment, Causes, and More

What Is Small Fiber Neuropathy?

Dealing with long and severe pain conditions is one of the most difficult experiences in life. Each and every individual might have suffered from pain once in life whether it is small.

Small fiber neuropathy is one of the severe pain conditions that is actually rare but treated more along with other diseases. This pain condition is different from other pain conditions. People with small fiber neuropathy often can’t feel the pain when pricked by a thorn. But the individual experiences pain all over the body without a reason.

What Is Small Fiber Neuropathy?

Small fiber neuropathy is a type of peripheral neuropathy causing severe pain in the whole body. The pain may initially begin to affect the feet or hand but gradually moves along the whole body.

The pain condition is generally experienced as itching, burning, or stabbing sensation in the skin.

The small fiber in the body can regulate the cardiovascular system and intestinal tract. The small fiber situated in the peripheral nervous system can detect pain, heat or temperature, and itching sensations in the body. The damage to the small fibers results in the small fiber neuropathy condition.

Small fiber neuropathy conditions can begin to show its effect from adolescence into mid-adulthood.

The same condition may also signal underlying health problems like diabetes and autoimmune.


The early symptom of small fiber neuropathy is the pain starting from the feet or hand.

The symptoms may expand as severe pain in the whole body, not in an exact or concentrated area. People with small fiber neuropathy may bleed or have their skin injured without noticing them.

Other symptoms include:

  • Burning and itching
  • Loss of sensation including sensation to heat and cold (some people may have pain triggered by cold) also signals small fiber neuropathy.
  • Numbness in the feet and leg
  • Sexual dysfunction
  • Abnormal sweating
  • Dry eyes and mouth
  • Drop-in blood pressure
  • Dizziness and blurred vision or having skin injuries without noticing it.


Small neuropathy can be caused by different health conditions or genetic conditions.

The small fiber neuropathy can be caused due to the mutation in the SCN9A or SCN10A gene in the human chromosome. The above genes instruct to make pieces of sodium channels which help the cells to produce and transmit the electrical signals;

Other causes include:

  • Diabetes
  • familial amyloidosis
  • Sarcoidosis sarcoidosis
  • Lupus
  • Sjogren’s syndrome immune disorders
  • Celiac disease immune disorders
  • primary systemic amyloidosis
  • Fabry disease     metabolic disorder
  •  Hypothyroidism 
  • hereditary sensory autonomic neuropathy
  • Guillain-Barre syndrome
  • inflammatory bowel disease
  • Tangier disease
  • Scleroderma
  • hepatitis C
  • Vasculitis

Other causes include Chemotherapy drugs, Vitamin b12 deficiency, Alcohol use, Physical injuries.

Related: Neuropathy Facebook Chat


The diagnosis of small fiber neuropathy often involves ancillary testing. The tests are mentioned below one by one

Electro Conduction studies and electromyography

The tests are conducted to evaluate large motor nerve fibers and myelinated sensory fibers. The test can find out large fiber peripheral neuropathies, though they are not effective in finding small fiber neuropathies. If the result of large fiber neuropathies using electron conduction and electromyography are diagnosed normal, then other treatment methods listed can be used.

Quantitative sensory testing (QST)

The quantitative sensory testing technique can be used to measure the temperature and vibratory sensation of the body. An abnormal result in the test shows dysfunctions in the central nervous system (CNS).

Electrochemical skin conductance and quantitative sub motor axon reflex testing g (QSART)

The test is used to measure the sweat production of the individual’s body by stimulating the skin with electrical shock.  The small fiber neuropathy is likely to be shown in people with less sweat output.

Medical History

You will be asked about your previous medical condition, family history, and symptoms by your Doctor. This will help greatly to find out more about your conditions and the underlying causes.

Skin Biopsy

Skin biopsy is an increasingly used technique to test Small fiber neuropathy. Physicians use skin biopsy to measure the density of epidermal nerve fiber. The skin after biopsy is then fixed with 2% paraformaldehyde lysine-periodate or Zamboni’s fixative. The specimens are immediately sent to the laboratory. The samples are then examined for detecting any signs of small fiber neuropathy.


Treatment may be based on the underlying health condition that caused the small fiber neuropathy.

Small fiber neuropathy caused by diabetes can be treated by a healthy diet and managing blood levels.

But if the cause has not been discovered yet, treatment may include with:

  • antidepressants
  • anticonvulsants
  • corticosteroids
  • topical pain creams
  • Analgesics


Long-Lasting and severe pains will always make the life of people problematic and disturbing. The small injured pain can be treated with ointments or antibiotic creams. but what if the pain is unlocatable and unimaginably severe?!

Small fiber neuropathy is one of such severe painful medical conditions that has altered the living conditions of affected people. Searching and going through remedies and various treatments, people have suffered from severe pain due to this one condition.

The small fiber neuropathy affects the whole body part, and can’t actually choose a specific body part to locate the pain. Ongoing treatments can actually improve the condition and reduce the pain afterward.

Frequently asked questions (FAQ)

PainPathways Magazine

PainPathways Magazine

PainPathways is the first, only and ultimate pain magazine. First published in spring 2008, PainPathways is the culmination of the vision of Richard L. Rauck, MD, to provide a shared resource for people living with and caring for others in pain. This quarterly resource not only provides in-depth information on current treatments, therapies and research studies but also connects people who live with pain, both personally and professionally.

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