Pharmacotherapy for Small Fiber Neuropathy

Purpose of review: Small fiber neuropathy (SFN) is a condition that affects small nerve fibers leading to a variety of symptoms, including pain, discomfort, tingling, and sensory loss. The development of new drugs is commonly complicated by variable medication pharmacokinetics and patients’ response to treatment due to comorbidities. In this review, we discuss currently used drugs, including the evidence about their efficacy. We also mention the medications with a questionable response in SFN treatment and those that are potential emerging therapies. Recent findings: SFN treatment is aimed towards addressing the cause of neuropathy and alleviating its symptoms. Determining the best treatment option may be challenging. Current drug treatments include antiseizure drugs, antidepressants, opioids, immunomodulating agents, topical medications, and NMDA antagonists. Each of these drugs has different molecular targets, efficacy, and adverse effect profiles. In some cases, the exact underlying mechanisms are not well understood. Summary: Current drug treatments provide patients with varying, often suboptimal, relief of symptoms. The need for new, effective, and safe therapies for SFN warrants intensive development and testing of new agents.