A Systematic Review of Pharmacologic and Rehabilitative Treatment of Small Fiber Neuropathies

Abstract

The aim of this systematic review is to guide the physician in defining the pharmacologic and rehabilitative therapeutic approaches for adopting the best strategies described in the current literature. The search was conducted in PubMed, EMBASE, Cochrane Library and Web of Science to identify the treatment of small fiber neuropathies. Two reviewers independently reviewed and came to a consensus on which articles met inclusion/exclusion criteria. The authors excluded the duplicates, animal studies and included the English articles in which the treatment of patients with small fiber neuropathies was described. The search identified a total of 975 articles with the keywords “small fiber neuropathy” AND “rehabilitation” OR “therapy” OR “treatment”. Seventy-eight selected full-text were analyzed by the reviewers. Forty-two publications met the inclusion criteria and were included in the systematic review to describe the rehabilitative and pharmacologic treatment of small fiber neuropathies. Despite the range of different protocols of treatment for small fiber neuropathy, other robust trials are needed. In addition, always different therapeutic approaches are used; a unique protocol could be important for the clinicians. More research is needed to build evidence for the best strategy and to delineate a definitive therapeutic protocol.

Case Report: Angiostrongylus cantonensis Infection Presenting as Small Fiber Neuropathy

“…Second, SFN is typically chronic and challenging to treat. 23,24 Thus, recognizing SFN may help clinicians and patients anticipate a prolonged clinical course for which a multidisciplinary approach to management (e.g., neurologists, pain specialists, physical, and occupational therapists) may be beneficial in improving the quality of life and functional status of patients.…”

Peripheral Neuropathy under Oncologic Therapies: A Literature Review on Pathogenetic Mechanisms

“…Neither drugs in therapy or prevention have succeeded in ameliorating sharply neuropathic symptoms and pain, nor quantitative assessment of neuropathy has been authorized or approved so far. Nevertheless, since taxanes and platinum salts are known to hit first small autonomic C-fibers, some efforts have been made to quantify neuropathic damagein the early steps of the anticancer treatment [ 133 , 198 , 199 , 200 ]. Recently, a sudomotor function testing has been suggested to screen early peripheral neuropathy, on the basis that sweat glands are innervated by small C-fibers,.…”

“…Recently, a sudomotor function testing has been suggested to screen early peripheral neuropathy, on the basis that sweat glands are innervated by small C-fibers,. Other assessment tools have already been reported in literature [ 198 , 199 , 200 ]: skin biopsy to determine the intradermal nerve fiber density and innervated skin structure; corneal confocal microscopy to quantify small nerve fibers in the cornea; sympathetic skin response, measured the unmyelinated nerve sudormotor function after a transient change in electrical skin potential; axon flare reflex tests, evidencing the hyperemic response of the axons; pain-related evoked potentials to assess the nociceptive system. …”

Intraepidermal Nerve Fiber Density as Measured by Skin Punch Biopsy as a Marker for Small Fiber Neuropathy: Application in Patients with Fibromyalgia

“…Evaluation of SFN will allow for an objective measurement of the effects of interventions and the information provided by the skin biopsies will further research on the inflammatory and immunological processes involved. Additionally, studies have shown improvement with specific rehabilitative treatments in SFN and this body of work may prove equally applicable to those with FM [ 73 , 74 , 75 ].…”