A Systematic Review of Pharmacologic and Rehabilitative Treatment of Small Fiber Neuropathies.

Michele Vecchio,Rita Chiaramonte,Giuseppe Musumeci,Marcello Romano,Giulia Letizia Mauro,Piero Pavone

doi:10.3390/diagnostics10121022

Abstract

The aim of this systematic review is to guide the physician in defining the pharmacologic and rehabilitative therapeutic approaches for adopting the best strategies described in the current literature. The search was conducted in PubMed, EMBASE, Cochrane Library and Web of Science to identify the treatment of small fiber neuropathies. Two reviewers independently reviewed and came to a consensus on which articles met inclusion/exclusion criteria. The authors excluded the duplicates, animal studies and included the English articles in which the treatment of patients with small fiber neuropathies was described. The search identified a total of 975 articles with the keywords “small fiber neuropathy” AND “rehabilitation” OR “therapy” OR “treatment”. Seventy-eight selected full-text were analyzed by the reviewers. Forty-two publications met the inclusion criteria and were included in the systematic review to describe the rehabilitative and pharmacologic treatment of small fiber neuropathies. Despite the range of different protocols of treatment for small fiber neuropathy, other robust trials are needed. In addition, always different therapeutic approaches are used; a unique protocol could be important for the clinicians. More research is needed to build evidence for the best strategy and to delineate a definitive therapeutic protocol.

Highlights

Small Fiber NeuropathySmall fiber neuropathy (SFN) is caused by the impairment of unmyelinated C and thinly myelinated Aδ fibers
Our systematic review defined the different rehabilitative and pharmacological approaches for Small-fiber neuropathies (SFN) and to guide the physician to delineate a therapeutic protocol adopting the best strategies described in the current literature
Significant beneficial effect of rhNGF on diabetic polyneuropathy Plasma exchange is effective for patients with severe long-standing complex regional pain syndrome Daily insulin injection group showed no significant change, but the subcutaneous insulin infusion group showed an improvement in corneal nerve morphology, consistent with regeneration

Summary

Introduction

Small Fiber NeuropathySmall fiber neuropathy (SFN) is caused by the impairment of unmyelinated C and thinly myelinated Aδ fibers. Neuropathic symptoms have a negative impact on the quality of life [1]. The symptoms and signs can be present as spontaneous (e.g., burning, deep, itching and paroxysmal) or evoked (e.g., thermal allodynia, light tough allodynia and hyperalgesia) pain. Our systematic review defined the different rehabilitative and pharmacological approaches for SFN and to guide the physician to delineate a therapeutic protocol adopting the best strategies described in the current literature. We analyzed all the therapeutic approaches we found in the current literature to realize a guide to provide a common language to the multidisciplinary team such as physiatrists, neurologists, physiotherapists, nurses and neuropsychologists that must treat this disorder. The current literature did not describe a unique therapeutic approach, use arbitrarily different therapies. A therapeutic protocol should make more objective, reproducible, repeatable the outcomes and could help the multidisciplinary team to manage the patients

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