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Small fiber peripheral neuropathy is a type of peripheral neuropathy that occurs from damage to the small unmyelinated and myelinated peripheral nerve fibers. These fibers, categorized as C fibers and small Aδ fibers , are present in skin , peripheral nerves , and organs. [ 1 ]
Peripheral neuropathy may be classified according to the number and distribution of nerves affected (mononeuropathy, mononeuritis multiplex, or polyneuropathy), the type of nerve fiber predominantly affected (motor, sensory, autonomic), or the process affecting the nerves; e.g., inflammation (), compression (compression neuropathy), chemotherapy (chemotherapy-induced peripheral neuropathy).
The gold standard for diagnosing small fiber neuropathy as the etiology of neuropathic pain is skin biopsy. Sudomotor assessment, through electrochemical skin conductance, an accurate objective technique, could be considered as a good screening tool to limit skin biopsy in patients in whom it is not suitable. [8] [9]
Small cell lung cancer is the most common anti-Hu antibody associated paraneoplastic syndrome associated sensory neuropathy. [1] But other cancers which may cause paraneoplastic sensory neuropathy include bronchogenic carcinoma , breast cancer , ovarian cancer , Hodgkin lymphoma , prostate cancer , bladder cancer , neuroendocrine tumors , mixed ...
Secondary erythromelalgia can result from small fiber peripheral neuropathy of any cause, polycythemia vera, essential thrombocythemia, [1] hypercholesterolemia, mushroom or mercury poisoning, and some autoimmune disorders. Primary erythromelalgia is caused by mutation of the voltage-gated sodium channel α-subunit gene SCN9A.
A gain-of-function mutation in Na v 1.7 located in the DRG sensory neurons was found in nearly 30% of patients with idiopathic small fiber neuropathy in one study. [41] This gain-of-function mutation causes an increase in excitability (hyperexcitability) of DRG sensory neurons and thus an increase in pain.
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Megavitamin-B 6 syndrome is predominately a large fiber neuropathy characterized by sensory loss of joint position, vibration, and ataxia. [18] [26] Although it has characteristics of small fiber neuropathy in severe cases where there is impairment of pain, temperature, and autonomic functions. [61] [62] [14] [12] [58] [63] [17]
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