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There is neuropathy, and then there is small fiber neuropathy. These conditions are different.

I hope this column will help many people who are suffering and don’t know what they have. You might very well have small fiber neuropathy (SFN), and if you ignore it, in time it will lead to bigger problems all over your body. But if you 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 (PN) is that SFN attacks the “small unmyelinated fibers,” hence the name “small fiber neuropathy,” and it begins with sensations in your toes and feet. [Ed. Note: Myelinated fibers are nerve fibers in your brain, optic nerves and spinal cord that are covered by a protective sheath of myelin.]

Most other types of neuropathy have some degree of demyelination occurring, but again, the fibers destroyed in SFN are not myelinated; therefore, 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

-GI motility problems

-Postural orthostatic hypotension (low blood pressure when you stand up)

-Bladder problems

-Dysautonomia

-Redness on the feet, termed erythromelalgia

Erythromelalgia is fairly hallmark — episodes of redness, heat, pain or mild swelling in the feet usually, although it could be in 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.

The bottom line: If you notice unusual tingling, weakness or pain in your hands or feet, or any of the symptoms above, see your doctor.

Testing for SFN requires a skin biopsy, and there are amazing new test kits available now that a physician can order.

However, 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 like Lyme disease or shingles, or endocrine conditions like diabetes.

Another frequent but hard-to-pinpoint cause is autoimmunity. About 40% of people with fibromyalgia, an autoimmune disorder, 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 (cause). 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, www.SuzyCohen.com.

This information is opinion only. It is not intended to treat, cure or diagnose your condition. Consult with your doctor before using any new drug or supplement.

Suzy Cohen is a registered pharmacist and author of The 24-Hour Pharmacist and Real Solutions from Head to Toe.