Understood Care
Living with burning tingling or electric shock sensations can steal your sleep and your calm. If medicines have not helped yet or your symptoms feel worse than expected you may be dealing with small fiber neuropathy. This guide explains what it is how clinicians confirm the diagnosis which treatments are commonly used and how a patient advocate can help you move forward when you are tired of going in circles.
To keep this article easy to use you will find short sections plain language and checklists that you can act on today.
Small fiber neuropathy is a condition that affects the thinnest sensory and autonomic nerve fibers. These A delta and C fibers help you sense pain and temperature and also support automatic body functions such as sweating and heart rate. When they are injured you may feel burning pain pins and needles numbness or itch often starting in the feet and sometimes in the hands. Quality of life can drop because symptoms are constant or flare at night. Treating the underlying cause when one is found and relieving pain are the two main goals.
Common causes include diabetes or prediabetes autoimmune disease vitamin deficiencies certain infections thyroid disease kidney disease chemotherapy and some medications. In many people no clear cause is found which is called idiopathic. Research also suggests that some small fiber neuropathies have an immune component.
Common sensory symptoms
Possible autonomic symptoms
If this sounds like you, do not self diagnose. The next step is a conversation with your clinician and targeted testing to confirm what is going on.
A careful history and exam come first. Standard nerve conduction studies and EMG can be normal because they test large fibers. When small fiber neuropathy is suspected, clinicians may order specialized tests.
Tests commonly used
Your clinician will also consider other explanations for nerve symptoms and may refer you to a neurologist. A stepwise approach helps avoid unnecessary tests while still confirming the problem so treatment can be tailored to you.
The video that accompanies this article speaks directly to a common experience. You might be taking medicines but still facing the same pain numbness or pins and needles. Your quality of life suffers. What matters next is a clear plan with defined steps and a willingness to change course when something does not help.
Here is how to translate that message into action
Make a stepwise plan with your clinician
Bring the right support
Treatment is personalized. The plan usually combines finding and treating any underlying cause, relieving pain with medicines or topical therapies, and adding non medicine supports such as physical therapy, sleep care, and mental health support.
Treat the cause when possible
Medicines used for neuropathic pain
International and US guidelines for neuropathic pain including painful diabetic neuropathy recommend similar first line options. Your clinician may consider
Opioids are generally not first line because benefits are limited and risks are significant. Tramadol or tapentadol may be considered selectively with careful monitoring, but most people can find relief using the options above in the right sequence and dose. Work with your clinician to find your best fit.
What to know about the capsaicin eight percent patch
A single application in a clinic can reduce localized nerve pain for weeks to months in some people. It may cause temporary burning or redness during and shortly after treatment which the team can manage. Evidence continues to grow for several peripheral neuropathic pain conditions.
Non medicine supports that help many people
Before your visit
During your visit
After your visit
If you want help preparing or coordinating, our team can handle the logistics and keep your clinicians in sync so you can focus on living your life https://understoodcare.com/care-types/care-coordination and https://understoodcare.com/care-types/appointments
Care starts with listening to your story and building a simple plan together. If a step does not work we help you move on to the next one.
Diabetes and prediabetes are common causes. Other causes include autoimmune disease such as Sjogren disease, infections, thyroid disease, kidney disease, vitamin deficiencies, toxins and some medicines. Sometimes no cause is found which is called idiopathic. Treatable causes should be checked early.
Diagnosis is based on symptoms and exam plus targeted tests. Skin punch biopsy that shows reduced intraepidermal nerve fiber density supports the diagnosis. Autonomic testing such as QSART can provide additional evidence. Standard EMG and nerve conduction studies may be normal.
Plans usually combine treating the cause if found with pain relieving medicines such as gabapentin pregabalin duloxetine venlafaxine or tricyclics and topical therapies like lidocaine patches or the capsaicin eight percent patch. Opioids are not first line. Physical therapy sleep care and safety steps are important.
Some people improve when the cause is treated for example better glucose control or vitamin replacement. When no cause is found the focus is symptom control, function, and safety. Early confirmation and a stepwise plan improve your odds of feeling better.
Ask about dose adjustments, switching to another first line option, adding a topical treatment, or trying the clinic applied capsaicin eight percent patch for localized pain. Set a reassessment date so you know when to move to the next step.
Small fiber neuropathy is usually not life threatening, but pain and loss of temperature sensation raise fall and injury risk. Autonomic symptoms such as lightheadedness or sweating changes deserve attention. Sudden weakness, loss of bladder control, high fever, chest pain, or trouble breathing need urgent care.
Clinically indicated testing and visits are often covered when ordered by your clinician. Prior authorization rules vary by plan. If you want help confirming coverage and scheduling, our team can assist you https://understoodcare.com/care-types/appointments
See a neurologist when symptoms are progressive severe or not responding to initial steps, when autonomic symptoms limit your day, or when your primary clinician wants support with specialized testing and treatment.
The video emphasizes three ideas. First, if your current plan is not helping do not stay stuck. Second, there are multiple steps to try and people respond differently. Third, coordinated support makes it easier to reach the next step. Use the visit plan and advocate support above to turn those ideas into concrete actions this month.
This content is for education only and does not replace professional medical advice. If you have new weakness sudden severe pain fever with confusion chest pain or trouble breathing call emergency services.
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