Office approach to small fiber neuropathy

Abstract

Small fi ber neuropathy is often characterized by neuropathic pain in the feet with normal nerve conduction studies and neurologic examination. Diagnosis requires specialized nerve tests, including autonomic studies and a skin biopsy study showing reduced intraepidermal nerve fi ber density. Small fi ber neuropathy has numerous causes but is often idiopathic. A practical approach to identifying an underlying cause is to fi rst screen for common ones and then proceed with further testing as needed. Treatment consists of correcting the underlying cause, managing pain, and modifying lifestyle.