Medical Services

Diagnosing & Treating Neuropathy

"It feels like I’m walking on pins and needles."
"I can’t feel my feet when I walk."

These are two of the common ways that patients describe a conditon called Small Fiber Neuropathy.

Peripheral neuropathy, in its most common form, can cause pain, numbness and bizarre sensations in your feet. Until recently, there wasn’t much that could be done to relieve these symptoms. There are very exciting developments that are improving the lives of people suffering from Small Fiber Neuropathy.

What is Small Fiber Neuropathy?

Until recently, pain, numbness, tingling in the feet, or the inability to determine if something is hot or cold was generally classified as peripheral neuropathy. Small fiber neuropathy is a specific type of peripheral neuropathy. Determining the level of neuropathy is helping doctors identify the problem and establish protocols for new treatments.

What Causes Small Fiber Neuropathy?

Neuropathy may be caused by many different conditions, and in some cases is the first manifestation of an underlying, generalized problem. It can be associated with diabetes, high cholesterol, circulatory problems, thyroid dysfunction and even nutritional deficiencies. About 60 percent of diabetic patients will develop Small Fiber Neuropathy.

What Are The Symptoms?

Small Fiber Neuropathy affects the small, unmyelinated nerve fibers in the sensory nerves and is first noticed as a gradual onset of numbness and tingling in your feet, and sometimes hands, which may also spread upward into your legs. These fibers convey pain and temperature sensations from the skin, as well as maintain autonomic nerve function. These nerve fibers are near the skin's surface which is why the symptoms deal with sensation, including numbness, stinging, burning, freezing, itching, aching, pulling, squeezing, and/or electric shock-like sensations that can be quite intense. Clothes can feel like sandpaper against the skin and the skin may become hypersensitive to touch. Pressure from shoes or socks can cause severe pain in the feet.

Diagnosing Small Fiber Neuropathy

Until recently there was no effective diagnostic procedure for this condition. Now, neuro-diagnostic skin biopsy is the emerging standard for the diagnosis of small fiber neuropathy. During a visit to the doctor’s office a small skin specimen is obtained for analysis; the wound is so small that it does not require sutures. The test measures intra-epidermal nerve fiber density, and determines if patients are suffering from Small Fiber Neuropathy. It integrates clinical information with microscopic observations of the patient’s biopsy to provide diagnostic information to the treating physician.

This diagnosis can be made with certainty by demonstrating a reduction in the density of small nerve fibers within the epidermal layers of the skin. The accurate microscopic interpretation of the biopsy is important in the selection of appropriate therapies, and has increased our understanding of these disorders. Neuro-diagnostic skin biopsy has an excellent safety profile and can be repeated multiple times. This is helpful in monitoring small-fiber nerve loss over time to assess disease progression. It is also important to help determine the effectiveness of treatment, and helps the physician adjust medications over time to maintain a proper course of treatment.

How is Small Fiber Neuropathy Treated?

In the past, treatment for Peripheral Neuropathy involved controlling the symptoms with pain medications, anti-depressants and/or neuro-modulating medicines. However now, there is a new group of specially formulated vitamin prescription medicines that contain the active, naturally occurring forms of folate, vitamin B6 and vitamin B12 used by the body. It promotes the development of new blood vessels and also provides increased nutrition to the nerves, allowing nerve regeneration to occur. The thing that is exciting about this newer medication is that it is safe and doesn’t react with other medications, and a great majority of patients have clinical improvement. Patients notice a difference within six weeks of starting the therapy. The burning and tingling is lessened, especially at night, and my patients are telling me that they are even sleeping better. The texture of their skin is improved, and overall they are feeling better.

Before receiving any treatment, the first step is to have an evaluation by one of our physicians. The doctor will then be in a position to make a recommendation.

How Do I Make an Appointment?

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