Skip to content
SFN info

Underlying Causes in Small Fiber Neuropathy

Identifying any underlying condition associated with Small Fiber Neuropathy (SFN) is crucial. Understanding the root cause offers the possibility to slow the disease’s progression. Additionally, treating these foundational conditions can prevent other potential complications. Moreo1ver, having this knowledge provides patients with clarity and direction in managing their health.”

The Importance of Finding the Underlying Cause

From the healthcare side, one can encounter the attitude that “there is nothing to be done about small fiber neuropathy, so we do not investigate the underlying cause.” At the same time, several scientific articles emphasize the importance of finding the underlying cause.

“Establishing a cause-based diagnosis is important for patients with SFN, as the underlying cause may need additional treatment and can influence prognosis.” 1

“Treatment of small fiber neuropathy should target the underlying cause and neuropathic pain. Cause-specific treatment is key in preventing small fiber neuropathy or slowing its progression.” 2

“The search for known causes of SFN is a crucial step in disease management.” 3

Identifying it can, in the best case, stop or slow the degeneration of small fiber nerves. Moreover, the underlying disease can create other problems that are important to address. In cases where an underlying cause is found, autoimmune diseases and diabetes are most common. In many of these cases, one can significantly affect the condition through lifestyle changes.

It is also psychologically important to know what is the cause.

An argument for not investigating is that “most cases are idiopathic” (unknown underlying cause). There seems to be a fairly large spread within scientific articles over what percentage of cases are actually idiopathic. In “Small fiber neuropathy: a disabling and underrecognized syndrome” 1 2, the text refers to two other articles, citing figures from 23 up to 47% as idiopathic.1

But it is somewhat of a Catch-22. How thoroughly are most cases actually investigated? If one does not delve deep and tick off the list of potential underlying diseases, it is difficult to know how many are “actually” idiopathic. Here, one would need to dig deeper into the figures and compile data from different reports, interesting then is to check if the studies in any way considered how thorough the investigations were on the patients where no underlying cause was found.

The list of underlying diseases

The next article presents a comprehensive list of underlying diseases. This compilation is based on insights gathered from two key articles: ‘Current diagnosis and treatment of painful small fiber neuropathy’ and ‘Current view of diagnosing small fiber neuropathy’. It’s important to note that the references included are not exhaustive, and the original sources have not been reviewed in depth.1

Added to this, I have proposed tests that can be done to investigate the different underlying diseases/causes. The list of tests was developed with the help of Chat GPT 4 (AI) and has not been investigated and verified. There is much work to be done here. For some conditions, tests can indicate whether one has it or not, while in many cases, a test is just a small puzzle piece that the doctor uses for diagnosis.4

The goal is to create a thorough list with “all” known underlying causes/diseases along with information on how to investigate this systematically. What tests/samples can one take? What kind of doctor should one consult?

Hopefully, it can be a good support to have a checklist with good references to science when discussing with doctors. But there is a lot of work left to go through the references, etc. Note that this is a living document that is updated continuously.

Detailed articles on many of these underlying conditions

In addition to the comprehensive list of underlying diseases for small fiber neuropathy, the site also features detailed articles on many of these conditions. For example, readers can find in-depth information on conditions such as diabetes mellitus and autoimmune disorders, which are known to be common causes of small fiber neuropathy. These articles delve into the specifics of each disease, including symptoms, diagnostic procedures, and treatment options. This resource aims to provide a broader understanding of the potential causes of small fiber neuropathy, aiding in more informed discussions with healthcare provider.

Footnotes

  1. Voortman, M., Fritz, D., Vogels, O.J., Eftimov, F., van de Beek, D., Brouwer, M.C. and Drent, M., 2017. Small fiber neuropathy: a disabling and underrecognized syndrome. Current Opinion in Pulmonary Medicine, 23(5), pp.447-457. ↩ ↩2 ↩3 ↩4

  2. Tavee J, Zhou L. Small fiber neuropathy: a burning problem. Cleve Clin J Med. 2009 May 1;76(5):297-305. ↩ ↩2

  3. Farhad, K., 2019. Current diagnosis and treatment of painful small fiber neuropathy. Current Neurology and Neuroscience Reports, 19 (12), pp.1-8. ↩

  4. Farhad, K., 2019. Current diagnosis and treatment of painful small fiber neuropathy. Current Neurology and Neuroscience Reports, 19 (12), pp.1-8. ↩