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Small Fiber Neuropathies

Posted by Sharon W on 6/20/03 at 11:17 (122436)

Here's an interesting article on small fiber neuropathies -- the kind of peripheral neuropathy that usually CANNOT be detected by nerve conduction testing, and therefore is often overlooked unless you happen to be diabetic. Check it out with this link (as usual, I'm including a few quotes, below):

Sharon

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http://thecni.org/reviews/13-2-p07-treihaft.htm

'A more enigmatic group of patients present with severe pain and a paucity of findings on clinical examination and electrophysiologic studies. Many of these patients have small fiber neuropathies. The disparity of subjective sensory complaints to objective signs sometimes leads to an erroneous diagnosis of psychogenic pain...' Patients with these syndromes are often difficult to treat...'

[A less technical translation of that quote: A stranger group of patients presents with seere pain but very few findings on clinical examination and neurologiscal testing. Many of these patients have small fiber neuropathies. The big difference between the level of pain and other symptoms felt by the patient, and the objective signs discovered by the doctor in his examination and testing, sometimes leads to a misdiagnosis of it being 'all in the patient's head'...]

'...patients with small... fiber involvement complain of severe pain and diminished thermal and pain perception. Due to difficulty characterizing the discomfort, orthopedists, podiatrists, and rheumatologists may initially evaluate patients for arthritic disorders. Pain is described as burning, prickling, stabbing, jabbing, or tight band-like pressure... The examination can be normal and reveal a stocking-glove distribution sensory loss with preserved strength...'

'Systemic conditions associated with small fiber neuropathies include HIV, antiretroviral therapy for HIV1, Fabry's disease2, Hereditary Sensory Autonomic Neuropathy3, Friedrich ataxia4, systemic amyloid5, vasculitis6, and DIABETES7. For many patients no specific etiology is defined.'

'Electromyography and nerve conduction studies... Reduced sensory nerve action potential may be the earliest signs of large fiber co-involvement in mixed disorders. The large fiber component may become evident as the neuropathy progresses.'

'...treatment with capsaicin reduces cutaneous pain sensitivity and is associated with small epidermal nerve fiber loss.'

Re: Small Fiber Neuropathies

SteveG on 6/20/03 at 14:23 (122460)

Sharon - Are you any closer to a diagnosis or are they labeling it idiopathic? I also seem to recall that you have been having problems with your hands, is that right?

Re: Small Fiber Neuropathies

Sharon W on 6/20/03 at 20:38 (122495)

Steve,

You're right, on both accounts. And they are still calling my peripheral neuropathy 'idiopathic'. I just got back from seeing my (family) doctor and discussed with her my herbicide exposure as a child. She said she thought it might well be the cause of my peripheral neuropathy, but it would be very hard to prove because she didn't think it would show up in my blood at this point. (It's hardly an area of special expertise or special interest for her, anyway!)

She did agree to send me to a rheumatologist... just because rheumatologists usually know lots about auto-immune diseases.

Sharon
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Re: Small Fiber Neuropathies

marie on 6/20/03 at 21:06 (122497)

Sharon did you check out the site Ii posted for you below?

marie

Re: Small Fiber Neuropathies

Sharon W on 6/20/03 at 21:30 (122500)

Yes - thanks, Marie!

I do know what toxins I was exposed to, by the way. They were the combination of herbicides and pesticides that composed the herbicide compound, Sylvex. It was sprayed around the hills and canyons just outside my home town -- and our family lived just outside town.

About 12 years ago, they unburied some barrels of Sylvex that had been hastily hidden when people started having terrible reactions to being exposed to it. The EPA did the cleanup, and it cost about $100,000. Now they have a fence around the place, and nobody can walk in there.

Dioxin, one of the components of Sylvex, is known to cause neuropathy. And it's not the ONLY really nasty chemical in that compound...

Sharon

Re: Small Fiber Neuropathies

SteveG on 6/20/03 at 22:39 (122503)

Sharon - if you have not had them, make sure he/she gives you a complete autoimmune workup - CBC, Rheumatoid factor, erythrocyte sedimentation rate, Anti-nuclear antibodies - the whole shibang.

Re: Correction

Sharon W on 6/21/03 at 07:13 (122515)

MMm, I can't subtract. Make that, about 24 years ago...

Sharon
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Re: Small Fiber Neuropathies

Sharon W on 6/21/03 at 07:17 (122516)

Steve,

I've had CBC and sed rate -- I THINK she did rheumatoid factor -- but not the anti-nuclear antibodies, or any of the more specific antibody tests. I do want to check that out. I think I talked my PCP into sending me to a rheumatologist, who would probably be more knowledgable about that kind of thing...

Sharon
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Re: Small Fiber Neuropathies

wendyn on 6/22/03 at 14:52 (122622)

Hey Steve..those tests names bring back some memories.

It sounds like my lumpy shins are sending the doctors off to order them again.

Why why why can't I get someone to just look at my whole right leg (from SI joint to big toe) and say - 'You have one screwed up leg - no wonder you're having some funny things happen'

I can only get someone to look at a toe, or an ankle, or a knee, or a shin. But never the whole thing. Oh well, the blood tests won't hurt I suppose. But I'm still planning on putting my foot down (so to speak) on the bone scan.