What causes small fiber neuropathy?

Small Fiber Neuropathy (SFN) is the result of damage to the peripheral nerves. The nerves that are affected control temperature and pain perception and help to control autonomic symptoms. Symptoms typically include burning, numbness, tingling, and sensitivity to heat. SFN typically affects only the small cutaneous nerves that start in the feet and progress upwards. 

The underlying pathology of SFN is poorly understood but one of the main causes is related to diabetes. Other potential causes include imparted glucose tolerance, autoimmune diseases like Sjogrens, lupus, celiac disease, chemotherapy-induced, B12 deficiency, or idiopathic (no known cause). In regard to celiac disease patients who had symptoms of peripheral neuropathy, 50% of them had normal nerve conduction studies, suggesting that celiac disease may also be linked to SFN. However, it is still controversial if people with idiopathic peripheral neuropathy symptoms should be screened for celiac disease.

For suspected polyneuropathy, typically patients are referred to neurologist and EMG study is performed to examine nerve function. If that test is normal and symptoms continue to progress, additional work-up maybe indicated including a skin biopsy to rule out small fiber neuropathy. 

What can be done for small fiber neuropathy?

The first step should be to identify the underlying cause and reduce symptoms. Pain management and help with controlling other symptoms is key for helping to maintain quality of life. It is reported that patients with SFN, pain management can be achieved by up to 50% but resolution of pain is not typically achieved. This may be due to limited evidence on therapies for neuropathic pain. A common drug that is prescribed to help is Gabapentin but in most cases does not help to reduce symptoms. Another therapy that is often recommended in addition to Gabapentin are antidepressants or SSRI’s. However, these also can come with unwanted side effects as well as having monitored tapering if patient wants to discontinue taking the drug. 

Can acupuncture help SFN?

The short answer is absolutely! One of the ways acupuncture helps to reduce pain and promote healing of the nerves is to increase blood flow to areas that need it. With SFN, the small blood vessels in the skin need blood flow to help bring nutrients to help heal and repair the tissues, nerves, and blood vessels. Acupuncture helps to relieve pressure on the nerve and restore normal function. There is more research being done, specifically on how acupuncture can help with neuropathy but how it can help with specific types of neuropathy. a recent study looked at how acupuncture can help both large and small nerve fiber neuropathy and found that specific Acupuncture point protocols can help with both types by improving not only clinical signs and symptoms but visual analogue scale (VAS) measurements for neuropathy.

If you suffer from small fiber neuropathy or any type of neuropathy and looking for safe, effective ways to help reduce pain and improve function. Give our office a call today at (425) 686-4498 to schedule your initial consultation to learn more about how we can help.

Dr. Ellie Heintze, ND, LAc, is a naturopathic doctor and acupuncturist in Bothell, WA at her practice Starting Point Acupuncture. She specializes in chronic and complex cases and commonly treats neuropathy, fibromyalgia, migraines, autoimmune, and infertility cases. Dr. Ellie Heintze is also the author of the book, A Starting Point Guide to Going Gluten-Free  and Keep Calm and Zen Out available on Amazon.

Sources:

Uptodate.com

https://onlinelibrary.wiley.com/doi/abs/10.1002/mus.27458

Neuropathy and Celiac Disease: https://jamanetwork.com/journals/jamaneurology/article-abstract/789587

SFN causes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5912271/pdf/10.1177_1179573518771703.pdf

https://synapse.koreamed.org/articles/1026219

https://www.liebertpub.com/doi/abs/10.1089/acu.2017.1242