Progress in the treatment of small fiber peripheral neuropathy

Abstract

Small fiber neuropathy is a syndrome of diverse disease etiology because of multiple pathophysiologic mechanisms with major presentations of neuropathic pain and autonomic symptoms. Over the past decade, there has been substantial progress in the treatments for neuropathic pain, dysautonomia and disease-modifying strategy. In particular, anticonvulsants and antidepressants alleviate neuropathic pain based on randomized clinical trials.

Keywords:

• anticonvulsants
• antidepressants
• autonomic disorders
• Fabry disease
• familial amyloid polyneuropathy
• fibromyalgia
• gastroparesis
• neuropathic pain
• opioids

Acknowledgements

This study was supported by Ministry of Science and Technology, Taiwan (100-2320-B-002-083-MY3, 102-2221-E-010-007-MY3, and 100-2321-B-002-007) and National Health Research Institutes, Taiwan (NHRI-EX104-10219EC and NHRI-EX101-10119NC).

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Neuropathic pain because of small fiber neuropathy results from peripheral sensitization and maladaptation of the central nervous system.

• Randomized clinical trials have documented the efficacy of anticonvulsants, antidepressants, and opioids on neuropathic pain of small fiber neuropathy.

• Autonomic dysfunctions of small fiber neuropathy are treated symptomatically according to the involvement of autonomic target organs. The development of new therapies for autonomic symptoms depends on research progresses of molecular mediators underlying the pathophysiology of each symptom.

• Orthostatic hypotension can be treated satisfactory to a certain degree with pyrigostigmine, mestinon or in combination of droxidopa.

• Disease-modifying treatments are a new direction for small fiber neuropathy because of specific etiologies or mechanisms, such as Fabry disease, fibromyalgia and familial amyloid polyneuropathy of transthyretin mutations.