Small fibre neuropathy treatment

Small fibre neuropathy is a type of neuropathy affecting small myelinated Aδ and unmyelinated C nerve fibres of the peripheral nervous system which innervate cutaneous structures and contribute to maintenance of the autonomic nervous system. 



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What is it for?

For the treatment of small fibre neuropathy

Treatment overview

Until recently there was no objective test to help establish the diagnosis of the small fibre neuropathy. 

This has significantly changed with the introduction of the measurement of intraepidermal nerve fibre density.

The sensitivity and specificity of the intraepidermal nerve fibre density measurement has been shown to be high (78 - 92% and 65 - 90% respectively) in a number of clinical studies. The test is done by taking a skin biopsy.

A skin biopsy is typically conducted at two sites: 10 cm above the right outer ankle and 20cm below the right outer hip joint. 

The procedure involves using a local anaesthetic and then taking two 3mm punch skin biopsies.

The biopsy sites are closed with steristrips and covered with a dressing, which should be removed in seven days. 

Neuropathologists investigating the biopsy will take particular note of the density of the nerve fibres in the skin, which is reduced in small fibre neuropathy.

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Identifying the causes 

If the skin biopsy confirms small fibre neuropathy, your consultant will look for the cause, which can only be identified in around 50% of cases. 

Small fibre neuropathy is associated with a number of common diseases such as diabetes or metabolic syndrome (hyperlipidemia, hypertension, obesity and abnormal glucose metabolism). 

It can be also seen in patients with abnormal thyroid function, vitamin B12 deficiency or chronic kidney disease. 

Other conditions associated with small fibre neuropathy include: 

  • immune disorders such as Sjogren’s syndrome and systemic lupus erythematosus rheumatoid arthritis
  • sarcoid
  • coeliac disease
  • paraproteinemia
  • amyloid
  • inflammatory bowel disease
  • paraneoplastic syndromes
  • infections such as hepatitis C or HIV
  • neurotoxic drug use (anti-retrovirals, antibiotics – Metronidazole, Nitrofurantoin, Linezolid, chemotherapy – Bortezomib, Flecainide, statins, alcohol, excess vitamin B6)

Small fibre neuropathy can be genetic as a part of Fabry disease but can also occur in sodium channelopathies associated with SCN9A and SCN10A gene mutations.  

Why choose The London Clinic

Excellence in one place

We operate as teams of experts with world-class resources dedicated to maintaining the highest standards of medical care. You are surrounded by the latest treatments and advice with everything you need to get back to your best health.

Personal care, every time

Exceptional patient care is a way of life for us. Our nurses, clinicians and support teams are dedicated to the care of a very small number of patients, so have more time for you. They’ll be with you every step of the way, tailoring your care around you and giving the peace-of-mind that comes with knowing you’re in the best hands.

Effortlessly simple

We work together as one to guide you through each step of your experience, with complexities unravelled and answers readily to hand. Your personal treatment plan will be laid out for you, with all the details taken care of so you can focus on you.

What's included in your package?

Choosing The London Clinic means your treatment plan will be laid out for you, with all the details taken care of so you can focus on you.


Your treatment package will include:

  • Enhanced pre-admission assessment
  • Your treatment with our complete care team at your fingertips
  • Personalised aftercare and follow-up

We want you to be in control of your health. That’s why we also offer optional services such as comprehensive recovery packages and extra touches for you to choose from during your stay with us.

How to pay

  • You can use private medical insurance (PMI) to access this treatment. We work with all major PMI providers in the UK and many internationally
  • You can pay for yourself (self-pay)
  • If you’re paying for yourself, we have finance options available with Chrysalis


Small fibre neuropathy typically causes a painful and burning sensation, often in the feet, but also in other parts of the body including the arms, face and trunk. 

The pain is usually constant but can vary throughout the day and it can be worse during rest or at night.

The patients are sensitive to touch and may get pain from bed sheets touching their feet. 

Patients may also report transient electric shock-like pain lasting for seconds but many times during the day. Cramps can also occur. 

Patients also report: 

  • light-headedness
  • postural hypotension
  • presyncope
  • syncope
  • abnormal sweating
  • gastrointestinal and sexual dysfunction

 Patients with small fibre neuropathy may be misdiagnosed as having a plantar fasciitis, fibromyalgia or psychosomatic syndrome.

Once the cause has been identified, the treatment should focus on treating the cause. 

There are no specific guidelines for management of pain associated with small fibre neuropathy although consensus guidelines for neuropathic pain have been adapted for pain management associated with small fibre neuropathy.


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