Small Fiber Neuropathy - the inexplicable burning stabbing pain

Problems with pain management are almost always the primary complaint in patients suffering from Ehlers-Danlos Syndrome (EDS).  Much of this pain is musculoskeletal in nature such as a sprain, tendinosis or joint subluxation.  But often our patient's pain complaints are less clear.  This pain can be described as a burning, stabbing pain that moves throughout the body inexplicably and without identifiable causes.  Recent research by Cazzato, et al. has demonstrated that patients with EDS have a very high chance of manifesting small fiber neuropathy in the sensory fibers of their skin.  

Neuropathy is the inflammation or death of nerve fibers in the outer-layers of our bodies.  This is commonly seen in diabetic patients with changes in their blood chemistry.  However it has recently been identified that more than 90% of investigated EDS patients demonstrate evidence of localized small fiber neuropathy.  This has commonly been identified and treated in the fibromyalgia populations with medications such as Neurontin/Gabapentin, Amitriptyline, Pregabalin and Cymbalta.

This type of pain would be classified as neuropathic pain and is very different from mechanical type musculoskeletal pain.  Pain medications like NSAID, opioids and muscle relaxants that are prescribed for musculoskeletal pain are often unsuccessful for treating neuropathically induced pains.  

The Cazzato study reported 19 of 24 EDS patients complained of moderate to severe symptoms consistent with neuropathic pain.  When their research patients were examined via skin biopsy all 24 demonstrated findings consistent with small fiber neuropathy.  

When discussing pain medication with your providers it is important to identify what the underlying pain generators are in order to pick efficacious medicines and interventions.  If your pain is a diffuse burning discomfort that bounces around the surface levels of skin, fascia and muscle you may benefit from a medication specifically targeting neurogenic pain.

Not sure where you pain is coming from or why? That is a great reason to come see a Physical Therapist who can manually test your body and evaluate your symptoms to provide direction and advice about the best course of action. As a Doctor of Physical Therapy with advanced training it would be my pleasure to evaluate and assess what is going on to help you find relief and develop a plan of action that will lead to better quality of life. Email me or call 360-952-3074 to request an appointment today for more information.

~Brian Kitzerow, DPT, CMPT, OCS

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1. Small Fiber neuropathy is a common feature of Ehlers-Danlos syndrome.  Cazzato D, Castori M, Lombardi R, Caravello F, Bella ED, Petrucci A, Grammatico P, Dordoni C, Colombi M, Lauria G.  Neurology. 2016 Jul 12;87(2):155-9
2. Small-Fiber Neuropathy: Answering the Burning Questions. Fink E, Oaklander A. Science of Aging Knowledge Environment. 2006; 6
3. Pain in Ehlers-Danlos syndromes: manifestations, therapeutic strategies and future perspectives. Castori, M. Expert Opinion on Orphan Drugs, 2016 VOL. 4, NO. 11, 1145–1158