Neuropathic Pain in Small Fiber Neuropathy

Sensory symptoms are the most common symptoms in neuromuscular clinics, yet it is hard to capture them via video unless they have a very specific pattern and they are associated with objective loss of sensation. Distal sensory loss is a common neuropathic finding. It follows gloves and stocks distribution. Sensory neuropathies may present with ataxia which results in falls, or severe pain. Neuropathic pain with normal ankle reflexes and sural responses suggest small fiber neuropathy. Multifocal sensory loss is usually vascular. It can also be infectious (leprosy). Migratory neuritis is a poorly understood condition. Intercostal pain and numbness is usually due to radiculopathy (diabetic, zoster, or compressive radiculopathy). Foots ulcers and unfelt mosquito bites are markers for sensory loss. Loss of corneal sensation may led to keratitis and blindness.

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Evidence for Dietary Agmatine Sulfate Effectiveness in Neuropathies Associated with Painful Small Fiber Neuropathy. A Pilot Open-Label Consecutive Case Series Study

Nutrients ◽

10.3390/nu12020576 ◽

2020 ◽

Vol 12 (2) ◽

pp. 576 ◽

Cited By ~ 1

Author(s):

Michael L. Rosenberg ◽

Vahid Tohidi ◽

Karna Sherwood ◽

Sujoy Gayen ◽

Rosina Medel ◽

...

Keyword(s):

Neuropathic Pain ◽

Pain Intensity ◽

Treatment Options ◽

Case Series ◽

Small Fiber Neuropathy ◽

Consecutive Case ◽

Open Label ◽

Small Fiber ◽

Case Series Study ◽

Series Study

Peripheral neuropathies associated with painful small fiber neuropathy (SFN) are complex conditions, resistant to treatment with conventional medications. Previous clinical studies strongly support the use of dietary agmatine as a safe and effective treatment for neuropathic pain. Based on this evidence, we conducted an open-label consecutive case series study to evaluate the effectiveness of agmatine in neuropathies associated with painful SFN (Study Registry: ClinicalTrials.gov, System Identifier: NCT01524666). Participants diagnosed with painful SFN and autonomic dysfunctions were treated with 2.67 g/day agmatine sulfate (AgmaSet® capsules containing G-Agmatine® brand of agmatine sulfate) for a period of 2 months. Before the beginning (baseline) and at the end of the treatment period, participants answered the established 12-item neuropathic pain questionnaire specifically developed to distinguish symptoms associated with neuropathy and to quantify their severity. Secondary outcomes included other treatment options and a safety assessment. Twelve patients were recruited, and 11 patients—8 diagnosed with diabetic neuropathy, two with idiopathic neuropathy and one with inflammatory neuropathy—completed the study. All patients showed improvement in neuropathic pain to a varied extent. The average decrease in pain intensity was 26.0 rating points, corresponding to a 46.4% reduction in overall pain (p < 0.00001). The results suggest that dietary agmatine sulfate has a significant effect in reducing neuropathic pain intensity associated with painful SFN resistant to treatment with conventional neuropathic pain medications. Larger randomized placebo-controlled studies are expected to establish agmatine sulfate as a preferred treatment.

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Successful Use of Flupirtine in Refractory Neuropathic Pain Due to Small Fiber Neuropathy

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909112441387 ◽

2012 ◽

Vol 30 (1) ◽

pp. 91-93 ◽

Cited By ~ 6

Author(s):

Seema Mishra ◽

Prakash Choudhary ◽

Saurabh Joshi ◽

Sushma Bhatnagar

Keyword(s):

Neuropathic Pain ◽

Small Diameter ◽

Nerve Fibers ◽

Small Fiber Neuropathy ◽

First Line ◽

Small Fiber ◽

Peripheral Pain ◽

Multiple Drugs

Small fiber neuropathy typically involves the small diameter nerve fibers, is usually idiopathic, and presents with peripheral pain. It can be excruciatingly painful at times despite the best of treatments. We present the case of a 22-year-old postoperative case of right frontoparietal oligodendroglioma who received multiple drugs for his severe neuropathic pain without significant relief. However, the pain almost completely subsided once flupirtine was added and substituted for some of the currently recommended first-line drugs.

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Brain imaging signature of neuropathic pain phenotypes in small-fiber neuropathy

Pain ◽

10.1097/j.pain.0000000000002155 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Chi-Chao Chao ◽

Ming-Tsung Tseng ◽

Yea-Huey Lin ◽

Paul-Chen Hsieh ◽

Chien-Ho (Janice) Lin ◽

...

Keyword(s):

Neuropathic Pain ◽

Brain Imaging ◽

Small Fiber Neuropathy ◽

Small Fiber

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Biopsy‐Proven Small‐Fiber Neuropathy in Primary Sjögren's Syndrome: Neuropathic Pain Characteristics, Autoantibody Findings, and Histopathologic Features

Arthritis Care & Research ◽

10.1002/acr.23762 ◽

2019 ◽

Vol 71 (7) ◽

pp. 936-948 ◽

Cited By ~ 8

Author(s):

Julius Birnbaum ◽

Aliya Lalji ◽

Aveen Saed ◽

Alan N. Baer

Keyword(s):

Neuropathic Pain ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

Primary Sjögren’S Syndrome ◽

Small Fiber Neuropathy ◽

Primary Sjogren’S Syndrome ◽

Primary Sjögren's Syndrome ◽

Small Fiber ◽

Pain Characteristics ◽

Histopathologic Features

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A Unique Case for Spinal Cord Stimulation: Successful Treatment of Small Fiber Neuropathy Pain Using Multiple Spinal Cord Stimulators

Case Reports in Medicine ◽

10.1155/2017/6969285 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Maxim Eckmann ◽

Alexander Papanastassiou ◽

Mark Awad

Keyword(s):

Spinal Cord ◽

Neuropathic Pain ◽

Case Report ◽

Poor Quality ◽

Small Fiber Neuropathy ◽

Entire Body ◽

Full Time ◽

Unique Case ◽

Small Fiber

Spinal cord stimulators have commonly been used to treat multiple pain conditions. This case report represents a unique case of using multiple spinal cord stimulators for widespread small fiber neuropathy pain. This case report concerns patient JJ who first presented with generalized neuropathic pain. His pain was an intermittent burning, stinging quality that originally focused in both of his feet and progressed to include his legs and arms and eventually involved his entire body. The pain would last moments to hours at least daily. He reported a poor quality of life. He was diagnosed with small fiber neuropathy with anhydrosis, suggestive of idiopathic erythromelalgia. He had a spinal cord stimulator trial involving both cervical and lower thoracic percutaneous leads. After two spinal cord stimulators were implanted, the patient began to report an improvement in pain. The patient continues to report excellent pain relief. The patient uses the stimulator intermittently as needed, in an abortive fashion for pain flares. The patient is very pleased and has increased his activity. He now attends graduate school full time. This case report hopes to illustrate a unique use of multiple spinal cord stimulators in treating widespread neuropathic pain caused by small fiber neuropathy.

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Ganglioside GM3 synthase depletion reverses neuropathic pain and small fiber neuropathy in diet-induced diabetic mice

Molecular Pain ◽

10.1177/1744806916666284 ◽

2016 ◽

Vol 12 ◽

pp. 174480691666628 ◽

Cited By ~ 5

Author(s):

Daniela M Menichella ◽

Nirupa D Jayaraj ◽

Heather M Wilson ◽

Dongjun Ren ◽

Kelsey Flood ◽

...

Keyword(s):

Neuropathic Pain ◽

Small Fiber Neuropathy ◽

Diabetic Mice ◽

Ganglioside Gm3 ◽

Gm3 Synthase ◽

Small Fiber

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Efficacious Dorsal Root Ganglion Stimulation for Painful Small Fiber Neuropathy: A Case Report

January 2018 - Pain Physician ◽

10.36076/ppj.2017.e463 ◽

2017 ◽

Vol 3 (20;3) ◽

pp. E459-E463 ◽

Cited By ~ 1

Author(s):

Eva Koetsier

Keyword(s):

Neuropathic Pain ◽

Case Report ◽

Dorsal Root Ganglion ◽

Dorsal Root ◽

Rating Scale ◽

Pain Treatment ◽

Small Fiber Neuropathy ◽

Intractable Pain ◽

Positive Trial ◽

Small Fiber

Small fiber neuropathy is a disorder of the peripheral nerves with typical symptoms of burning, sharp, and shooting pain and sensory disturbances in the feet. Pain treatment depends principally on the underlying etiology with concurrent administration of antidepressants, anticonvulsants, opioids, and topical treatments like capsaicin and local anesthetics. However, treatments for pain relief in these patients frequently fail. We describe the first case of intractable painful small fiber neuropathy of the foot successfully treated with spinal cord stimulation of the left L5 dorsal root ganglion. A 74-year-old man presented at our clinic with severe intractable pain, dysesthesia, and allodynia of the left foot caused by idiopathic small fiber neuropathy, confirmed by skin biopsy. His pain score was 8 on a standard 0 – 10 numeric rating scale. As the pain was not satisfactorily controlled by conventional therapy, dorsal root ganglion stimulation was proposed to the patient and, after informed consent, a specifically designed percutaneous stimulation lead was placed over the left L5 dorsal root ganglion and connected to an external neurostimulator. After a positive trial of 10 days, a permanent neurostimulator was implanted. Twenty months post-implantation the patient continued to experience stimulation-induced paresthesia covering the entire pain area and reported a pain rating of 4. Results from the case report demonstrate that the dorsal root ganglion is a promising neural stimulation target to treat neuropathic pain due to intractable small fiber neuropathy. Prospective controlled studies are warranted to confirm the efficacy of this treatment as an option for the aforementioned condition. Key words: Dorsal root ganglion stimulation, small fiber neuropathy, neuropathic pain

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