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
Post COVID-19 syndrome associated with orthostatic cerebral hypoperfusion syndrome, small fiber neuropathy and benefit of immunotherapy: a case report