Can You Recover From Small Fiber Sensory Neuropathy?

No, you’re not going crazy. It may be small fiber sensory NEUROPATHY!

Are you one of the millions of Americans who suffer with a bizarre symptom complex of chronic widespread pain, numbness or tingling in your extremities, G.I. issues such as constipation, bladder problems, dry eyes and no doctor can tell you the cause? Possibly you have been given the diagnosis of fibromyalgia and/or peripheral neuropathy. You may have been treated with drugs such as Cymbalta, gabapentin or Lyrica. These drugs do nothing to correct the underlying cause of your disorder, but have potent side-effects. New research has now explained this baffling disorder and its causes.

The symptoms can start out as a numbness or tingling in the extremities, along with painful sensations such as stinging, burning, itching, aching, or electric shock-like feelings. Also, a normal stimulus can create unpleasant sensations such as the sheets across the feet feeling like pins and needles. Worst of all these symptoms can occur anywhere in the body including the arms, legs, torso, face or even the mouth.

Usually individuals have been everywhere and none of the exams or tests so far have come up with anything. If this happened to you, you may even begin to wonder if you’re going crazy! Well rest assured that you are not; you probably have a disorder now recognized as small fiber sensory neuropathy or SFSN. Maybe you have seen a neurologist and even had normal EMG and nerve conduction studies, and they have “ruled out” peripheral neuropathy. But not so fast, these tests only detect large nerve fiber neuropathy, which usually develops years after suffering with small fiber sensory neuropathy.

Well you can stop worrying because there are tests available that can diagnose this condition.

Can small fiber sensory neuropathy be reversed?

Small fiber sensory neuropathy can often be reversed if the underlying cause is discovered by a doctor who knows how to treat this condition with a holistic approach, more on this later. And you are not alone, some 20 million Americans over the age of 40 now suffer with some form of peripheral neuropathy. In most, this peripheral nerve impairment is predominately in the small nerve fibers (SFSN) which begins as pain, burning, tingling and numbness in the hands and feet but with normal EMG and nerve conduction studies. This disorder can even create more bizarre symptoms when it affects your autonomic nervous system, then it can really make you feel like you going crazy. Why? Because this part of the nervous system controls your heart rate, blood pressure, mucous membranes and even sexual function.

With small fiber neuropathy of your autonomic nervous system you may experience common symptoms such as dry eyes, dry mouth, dizziness when standing up, constipation, bladder problems, sexual dysfunction, trouble sweating and red or white skin discoloration. This mixture of nerve sensation and changes in body function can lead you, or even your doctor, to think it’s all in your head, but it’s not! It’s in your small fiber sensory nerves. And you need to be properly diagnosed and treated.

What causes small fiber sensory neuropathy?

Once diagnosed your doctor must then become a medical detective to find out the underlying causes. The underlying cause for the clear majority of these cases is abnormally high blood glucose and insulin spikes after eating. This happens in individuals with diabetes and those with prediabetes. Research has now established that many individuals with small fiber sensory neuropathy have normal fasting blood glucose on testing, but their blood glucose and insulin spikes high after meals. When this happens repetitively over time the small fiber peripheral nerves become damaged. Their doctor missed the cause because they did not do sufficient laboratory testing beyond the fasting blood glucose. I utilize serum HemoglobinA-1C, a glucose tolerance test and fasting insulin. There is a great deal more to be said on the subject, to learn more attend my upcoming FREE workshop on peripheral neuropathy.

The second most common cause is undetected nutritional deficiencies e.g. folate, B12, B6 and D3. There is a catch, your doctor cannot rely on a regular serum B 12 or folic acid to diagnosis problem, especially if you have numbness and tingling in your extremities. You need a more accurate form of testing for these deficiencies. For example, with folate and B 12 deficiency I utilize serum homocysteine and methylmalonic acid. Also, serum vitamin D3 must be checked to see that it is reaching adequate levels to treat peripheral neuropathy. Again, is a great deal more information to be explained so I highly recommend my FREE workshop, see below for details.

The third most common cause is that of autoimmune disorders that attack the peripheral nerves. Many times, this is missed because doctors are not screening for all the different autoimmune disorders that are growing in our society at an alarming rate. Once diagnosed you need a doctor schooled in a natural holistic approach in the reversal of autoimmune disorders. Central to this treatment is addressing “leaky gut”, food allergies and specific nutritional needs of the immune system.

Learn how you can get your life back, many others have done it and so can you! Do not believe it? Why not come and find out for yourself? What you got to lose but pain!

Author Dr. Greg Fors

About Dr. Greg Fors

Dr. Greg Fors, D.C. is a Board-certified Neurologist (IBCN), certified in Applied Herbal Sciences (NWHSU) and acupuncture. As the director of the virtual Pain and Brain Healing Center, he specializes in a functional medicine approach to fibromyalgia, fatigue, brain fog, digestive disorders, depression and anxiety. He is a sought after international lecturer for various post-graduate departments and state associations. Dr. Fors is the author of the highly acclaimed book, “Why We Hurt” available through booksellers everywhere.


  1. LINDA LENNON elfman on December 19, 2017 at 7:29 pm

    Can sfsn be reversed. I am getting worse each day. Covered head to toe. My brain even clenches and crawls. Medications burn the nerves. I can no longer read, be in stores. Use phone without speaker. Lost much quality of life, now loosing private areas. Have shaky “panic” under breast bone when crawling happens. D3 13 but skin crawls when take.

    • Lisa Pollock on November 21, 2018 at 11:34 pm

      How are you doing now? I too have SFN (full body) with severe nerve damage. I started LDN 3 weeks ago and it’s helped tremendously with my weird sensations and I’m hoping whatever fire in my body was causing it has calmed enough for my nerves to grow back. I just need to know if we can ever get our full feeling back again! Have you talked to anyone that has? I’m hoping this finds you improved!

      • Mark on December 11, 2018 at 3:26 pm

        What dose of LDN are you using?


      • Mark on December 14, 2018 at 7:17 am

        Hello Lisa,

        What does of LDN are you taking? I just recently started this medication and I’m slow titrating up from .5mg.

  2. John Kenny on January 27, 2018 at 4:52 pm

    Hello: Dr. Greg Fors

    I have all the symptoms of having Small FIber Sensory Neuropathy.
    I will soon be getting a biopsy at UCSF to be sure, but if there is something I can be doing besides
    just taking Gabapentin, please let me know?

    Poor circulation , Often cold hands & feet
    Face very sensitive as if recent burned or dry
    Numb & Tingling feet, arms and hands
    shortness of breath
    Underarms are itchy
    Difficult to sit down without butt pain and tingling/numbness to increase

  3. Carol Boyd on February 21, 2018 at 7:14 pm

    My son was first diagnosed with SFN when he was 29 after a biopsy that took a year and a half. My son was in construction and worked day and night and at times forgot to eat. He worked out in the gym, rode his bike, and ran all the time. He probably was exposed to toxins in the workplace as well. His doctor has him on percocete on a daily basis which I fear about addiction. Can holistic medicine help with his condition, as I’ve read about different vitamins that can help with pain and inflammation. If you know of anything that can take my son’s pain away I would be greatly appreciated.

    • Sue Spitz on July 14, 2018 at 7:13 pm

      My son has the same site.., so many doctors…. Said it’s not curable, come back when it gets worse. So I called a man I know who was a doctor, then he started a health food store instead of staying in practice. He had my son start taking …
      Alpha-Lipoic Acid 150 mg. 3x day
      Biotin 5,000 mcg 1xday
      Benfotiamine 300 mg. 1 am & 1 pm
      Citrus Bioflavonoid complex 1,400mg
      1 am & 1 pm
      He said my son should not eat any animal products.
      After one month he has noticed a huge difference. Hope this helps!

  4. Joan Miller on March 29, 2018 at 2:44 pm

    I have been diagnosed with SFSN and been on low dose of gabapentin for about 4 years – I have all the typical symptoms and had a biopsy done to verify the diagnoses. My most painful area is unfortunately the genital area and the burning prickling pain in the vulva area which is constant makes my life miserable and controls what I wear, where I go and how long I can sit – I carry cushions with me because hard surfaces make the pain worse – having tried all recommended treatment for Vulvodynia and seen a specialist for that with no relief from their recommendations and treatment I am at a lost as to how to get some relief. Wondering if anyone else has SFSN in this area and what they use or do to help with this constant pain.

  5. Nidia on May 17, 2018 at 10:38 pm

    Would like to be contacted I have SFN

  6. David stevens on June 1, 2018 at 10:25 am

    I’m just near death all I need to say it’s bad need help no one wants to help they don’t care so sad

    • Vegeta on December 11, 2018 at 2:48 am

      Try dry fasting and the snake diet, it could make your condition better. For me it helped a little until now.

  7. Audrey Greenhalgh on June 5, 2018 at 1:01 pm

    Thank you Dr.Fors. Your explanation of SFN is the most helpful so far. My husband was diagnosed by an On Line dermatologist after three trips to the ER and local doctors misdiagnosed shingles.
    In my husband’s case the burning, painful rash appears in tiny blisters on his sides and lately-after six months-on the palms of his hands and between the groin. The only relief he gets is from oatmeal compresses and ant-itch lotion, antihistamines and pain relievers. However, I will thoroughly check out the three probable causes you mentioned. He is 90 years old and this is very sad.

  8. Julie Carter on July 8, 2018 at 7:41 am

    Can you talk more about the face and scalp when it comes to SFN. Also breathing, shortness of breath. Thanks

  9. Martin on August 10, 2018 at 5:55 pm

    I have sfn that has spread over my whole body over the past year from my feet all the way to my face. It is worse at night. I had neck surgery 18 months ago and the constant inflammation around my spinal cord since has most likely caused this. The intensity of the pain is spreading daily. My fingernails are grooved and my skin is slightly red and mottled. When you press fingers into the skin you can see the difference. I had to reduce my hours at work because I can’t sleep at night. I have had every blood test available, meg, nerve studies, qsart testing. I can’t get a skin biopsy in Australia as they don’t know how to interpret the results. My skin has aged about 10 years with lots of sagging and wrinkles. Has anyone else had skin changes. I contemplate suicide a lot which is a big call because I have 2 beautiful boys, a good job and nice house but I can’t live like this. I have had doctors say it’s all in my head until I had a bone scan of my neck which proved the inflammation. I’m scared of having another surgery to remove the implants and fuse my neck.
    I am really sensitive to medication and have tried them all eg endep, lyrica, gabapentin, cbd oil, mexilitine with little relief.

    My wife has been so unsupportive of me.
    I need help

  10. Donna on August 28, 2018 at 5:27 pm


    I had a skin biopsy and it showed I have SFN. Each night as soon as I laid down my hands and feet would burn. Impossible to sleep so i was always exhausted. I lost all feeling in my feet, very strange when walking. A couple times I couldn’t stand up from my chair at work. Terrifying. Dr wanted to put me on meds to mast the burning. I refused. Ends up I’m gluten intolerant. I stopped eating gluten. My brain fog lifted and no more painful burning hands and feet at night. The improvement was immediate. It’s been two months now and some nights I am very hot, but it’s not the same as before. Hopefully my nerves especially are coming back…

  11. Ann Norris on January 24, 2019 at 3:11 pm

    I have been diagnosed with small fiber neuropathy that has developed from a severe copper deficiency which developed due to gastric bypass surgery that I had over 40 years ago. I am some improved taking large doses of copper for a year and will have to take it the rest of my life. I am seeing a new neurologist in a month to hopefully get more improvements. I thought I would be dead by now but GOD stepped in to help. I am able to do things that I had totally been unable to like shower, tie my sneakers, go outside with my Walker, put on makeup. All kinds of things that I had taken for granted two years ago. Anyway I posted this to make aware of anyone who has had bariatric weight loss surgery to know to keep check of your labs. A simple blood test would have saved me from being like this and it took two years three neurologist and a neurosurgeon before I was diagnosed. Have a blessed day.

  12. Mustafa Utku on January 30, 2019 at 8:36 am

    I had levator ani spasm and pelvic floor problems for 2-3 months.

    A neurologist applied electroacupuncture to me saying it will help relaxing my muscles, 15 minutes after it finished later I started to experience tingling, allodynia, burning sensation on my legs, 1-2 days later it was all over my body: arms, legs, face, everywhere. I started to take Lyrica 75, 2-3 days past, still no change, feels like it’s getting worse, and I have extreme anxiety, I also had depression&anxiety before acupuncture due to my levator ani sydrome experience. Doctors say electroacupuncture cannot cause this but nobody told me anything about SFN.

    Is this permanent? Can electroacupuncture cause this?

  13. Lance H on February 23, 2019 at 6:17 pm

    At age 46 in New Hampshire USA and after 15 years of pain and seeing numerous doctors, I was just diagnosed with SFN via a skin biopsy done by a neurologist. Started in left ring finger, spread to other fingers, arm, eventually spread to right arm, now heels, toes, sometimes random parts of body. Pinching, burning, tingling, or throbbing pain in any tissue, skin, muscle, finger joints, finger tips. Left hand fingers extremely sensitive to winter cold, agonizing pain when the hand warms from being cold. Also severe hip/lower-back pain when sitting, sleeping on side. Also had a positive SIBO test and have GI issues, brain fog, weakening vision and zest for life. Neurologist ran a ton of blood tests, says the cause is unknown in 50% of cases and that is the case with me. So he says I have no hope for finding the root cause, and only thing to do is take Gabapentin. But I’m working towards a commercial pilots license and Gabapentin is not FAA approved so I’m not wanting to take it but will try a trial this week to see if it helps me get some sleep. I was THRILLED to find this web site and a functional med doctor who really understands this issue and I hope to make an appointment and visit him in MN.

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