Small fibre neuropathy (SFN) is a condition that affects the small sensory nerve fibres responsible for detecting pain and temperature, and in some cases, controlling automatic (autonomic) functions such as heart rate, blood pressure, and sweating.
Unlike larger nerve fibre damage, small fibre neuropathy often causes pain and sensory disturbances without significant weakness. Symptoms can be widespread or localised, and often fluctuate in intensity.
Typical symptoms include:
Common causes include diabetes or prediabetes, autoimmune diseases, vitamin deficiencies, thyroid disorders, chemotherapy, genetic factors, and infections. However, in some patients, the cause remains unknown (idiopathic small fibre neuropathy). Because symptoms can be distressing yet standard nerve tests may appear normal, expert evaluation is crucial.
At Wessex Pain Clinic, diagnosis begins with a thorough history and examination, focusing on pain characteristics, associated medical conditions, and autonomic symptoms.
Since small fibre neuropathy may not show up on standard nerve conduction studies, diagnosis often requires:
Our consultants interpret results within a multidisciplinary context, ensuring that both the underlying cause and pain mechanisms are addressed.
We believe effective management requires a holistic approach. Our physiotherapy and rehabilitation team helps maintain strength, balance, and confidence in movement, especially where pain or sensory loss affects mobility.
Hydrotherapy provides a low-impact way to stay active without aggravating symptoms.
Our pain psychology specialists help patients manage chronic pain, fatigue, and anxiety through pacing, relaxation, and cognitive behavioural strategies.
When appropriate, we liaise with neurologists, endocrinologists, and dietitians to address underlying causes and promote nerve health.
At Wessex Pain Clinic, we work as a team and meet regularly to discuss complex, treatment resistant or unusual cases. As such you will often receive the expertise of several pain consultants. We believe that we are one of very few pain clinics to offer this.
We may recommend:
All medication plans are reviewed regularly to optimise symptom control and minimise side effects.
Botox is a recognised treatment for peripheral neuropathy. It works at a nerve level to subdue overactive peripheral nerves. This is done in clinic with a very small needle, minimising discomfort. We also offer Qutenza Patches. These are high strength capsaicin patches that are only licensed for specialist use. They are applied to the area and can cause nerve die-back, reducing the areas sensitivity. They are an NHS approved and recognised treatment option for peripheral nerve pain. Wessex Pain clinic are one of very few clinics in the UK offering this privately.
In severe or treatment-resistant cases, we may consider nerve blocks, intravenous lidocaine infusions, or neuromodulation (spinal cord stimulation) to reduce abnormal nerve signalling and improve pain control.
Our approach is comprehensive and patient-focused, combining medical treatment, interventional therapies, and lifestyle support to manage symptoms and prevent progression.
Our friendly team is on hand to support you every step of the way. Please get in touch at any time.
