In most cases there is no cure, but that is not the end of the answer. Small nerve fibres can regenerate slowly when the condition driving the damage is identified and controlled early. Where no cause is found, treatment aims at the pain and the function rather than at reversal.
In most cases there is no cure, but that is not the end of the answer. Small nerve fibres can regenerate slowly when the condition driving the damage is identified and controlled early. Where no cause is found, treatment aims at the pain and the function rather than at reversal.
Small fibre neuropathy affects the thinnest nerves: unmyelinated C fibres and thinly myelinated A-delta fibres. These carry pain and temperature sensation, and they also serve autonomic functions such as sweating and vascular tone. That anatomy explains the presentation. Burning or scalding pain in the feet, often worse at night, with pins and needles and sometimes an unpleasant sensitivity to bedsheets. Strength and reflexes are usually preserved, because the large fibres that serve them are spared. Some people also report dry eyes and mouth, altered sweating, or lightheadedness on standing.
This surprises people, and it is worth stating plainly: nerve conduction studies test large myelinated fibres, so a normal study does not exclude small fibre neuropathy. What it does is exclude a large-fibre neuropathy and rule out mimics such as radiculopathy or nerve entrapment, which is genuinely useful information rather than a wasted test. Both offices run their own AANEM-accredited electrodiagnostic laboratory for that purpose. Skin biopsy to count intraepidermal nerve fibres and autonomic testing are not performed at these offices; where they are needed they are arranged elsewhere.
Diabetes and prediabetes together account for a large share of cases, and impaired glucose tolerance short of diabetes is enough. Other contributors include vitamin B12 deficiency, thyroid disease, coeliac disease, Sjogren's syndrome and other autoimmune conditions, alcohol, chemotherapy and certain other medicines, and hereditary causes. Some cases are associated with sodium channel gene variants. A substantial proportion remain idiopathic after a thorough search, which is an honest finding rather than a failure, and it does not change the management much.
Where a cause is found, treating it comes first, because that is the only route to any recovery of nerve fibres. Glucose control matters most often. Beyond that, treatment is symptomatic: agents from the gabapentinoid, tricyclic and SNRI classes are used for neuropathic pain, topical options suit some people, and doses are set individually rather than by rule. Regular walking, foot inspection and sensible footwear matter more than they sound. Expectation-setting is part of treatment: fewer bad nights is a realistic target.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: peripheral nerve disorders; MedlinePlus: numbness and tingling; National Institute of Neurological Disorders and Stroke.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.