Small fiber neuropathy is really an interesting condition because it consists typically of just burning, numbness, pain of the feet, sometimes the hands later on without necessarily having any abnormalities on your EMG or nerve conduction study. So what I tell patients and actually residents or students who train under us is that a normal nerve conduction study does not exclude a neuropathy. And we will confirm this by doing additional testing, specifically the nervous the the examination at the bedside asking patients about their symptoms, for example, loss of sensation to cool or or hot temperatures, loss of pain.
Sensation and also doing skin biopsies where we look at nerve densities in the skin both from the calf and the thigh as well as doing a special test that looks at sweat function both in your foot in in the legs as well as the feet to gauge the level of small fiber nerve damage. Small fiber neuropathy typically will progress unless the underlying cause is identified and reversed. Diabetes of course being the most common cause is always screened for. But once the more common causes are excluded and the focus becomes on excluding any underlying.
Secondary disease process but also controlling pain because if patients’ symptoms of pain are generally controlled they tend to do pretty well and really have no other major functional deficits. I’ve really become interested over the years is how interconnected neurology and rheumatology are and one thing I often do on patients who have unexplained small fiber even autonomic neuropathy is have them see rheumatology or get evaluated for connective tissue disorders like lupus or Sjogren’s or sarcoid and sometimes even if we are not directly involved in treating the patients, this can be the first sign of an underlying connective.