There is neuropathy, and then there is small-fiber neuropathy! These conditions are different. Do not dismiss what I’m about to share because you think it’s no different from typical neuropathy.

This is a very important article because it will help so many people who are suffering and don’t know what they have! You might very well have small-fiber neuropathy, and if you ignore it, in time it will lead to bigger problems all over your body.

But if you read this today and get proper treatment and help, it is very treatable. I want to give you hope while educating you about the disorder.

Only the small cutaneous (skin) nerves are affected in SFN. The main difference between SFN and typical peripheral neuropathy is that SFN attacks the small, unmyelinated fibers — hence the name “small-fiber neuropathy” — and it begins with sensations in your toes and feet.

Most other types of neuropathy have some degree of demyelination occurring (damage to the protective myelin sheath that surrounds nerve fibers), but again, the fibers destroyed in SFN are not myelinated, so this condition does not respond to methylated vitamin B12 like you might suspect.

Here are a few common symptoms of SFN:


• Internal vibration or restlessness

• Pins and needles

• Numbness

• Muscle aches

• Electric-shock sensations in the body

• Trigeminal neuralgia

• Redness on the feet, termed erythromelalgia

• GI motility problems

• Postural orthostatic hypotension (POTS)

• Bladder problems

• Dysautonomia


Erythromelalgia is fairly hallmark, and the condition is characterized by episodes of redness, heat, pain, or mild swelling, usually in the feet, although it could be the hands or anywhere in the body.

It’s usually triggered by raising your body temperature, which means you may exit a nice, hot shower, hot tub, or steam room and discover one or both feet have turned red, for example. It’s temporary and likely goes away in a few minutes.

Testing for SFN requires a skin biopsy, and there are now amazing new test kits available that a physician can order. If your doctor does a regular EMG (electromyography) study on you, it will be normal. That’s the frustrating and confusing part: SFN does not show up on conventional EMG studies or nerve-conduction studies.

The causes of SFN vary and may be tied to infections, such as Lyme disease or shingles, or endocrine conditions like diabetes. Another frequent but hard-to-pinpoint cause is autoimmunity.

Furthermore, 40% of people with fibromyalgia are thought to suffer with some degree of SFN. One more interesting cause for this uncomfortable condition is the use of (or withdrawal from) SSRI antidepressants.

As for treatment, it varies based upon the etiology. We see best effects from intravenous immunoglobulins (IV IG), as well as anti-seizure drugs like pregabalin and gabapentin.

I’ve written a more comprehensive article discussing more symptoms and treatments, as well as proper testing. I will email it to you if you sign up for my free newsletter. To do that, visit my website,


This information is not intended to diagnose, prevent, or treat your disease. For more information about the author, visit

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