Small Fiber Neuropathy


marijuana for small fiber neuropathy
If you have small fiber neuropathy (SFN), also referred to as small fiber sensory neuropathy (SFSN), you know how uncomfortable and painful the condition can be. Cannabis for small fiber neuropathy is helping people combat this pain.

What Is Small Fiber Neuropathy?

Small fiber neuropathy affects the small sensory cutaneous nerves. Most individuals with the condition experience bouts of severe pain, tingling, numbness, burning and other unusual sensations primarily in the feet and possibly the hands. In some cases, SFSN patients may experience these sensations over a large percentage of their body, including areas such as the trunk and even the face.

This type of SFSN is known as length-dependent SFSN. It is typically due to diabetes or pre- or early diabetes, and it can eventually develop into diabetic polyneuropathy. For some individuals, however, there is no underlying cause of the condition.

Risk Factors for Small Fiber Neuropathy

A common risk factor for SFN is diabetes. Studies show almost 50 percent of individuals with diabetes end up with diabetic neuropathy in their life. While SFN is not as common as other forms of diabetic neuropathies, it is still cause for concern.

Research has also shown that individuals with idiopathic small fiber neuropathy have a greater chance than the general population of having impaired glucose tolerance. Impaired glucose tolerance links with prediabetes, so SFN might be one of the early signs of prediabetes.

Another risk factor is age. SFN is more commonly seen in individuals who are older than 65 years old than in younger people. It could also be more common in men.

Symptoms of Small Fiber Neuropathy

Symptoms of SFSN can vary. The most common symptom of small fiber neuropathy is pain. Others include sensations like:

  • Short bursts of pain
  • Tingling, burning or prickling (paresthesia)
  • Loss of sensation

External triggers can cause some sensory symptoms, too. For instance, some patients may experience foot pain when they touch bed sheets or wear socks.

Symptoms you experience can be mild, or they can be severe, although early symptoms are usually mild. SFN seems to affect the feet first and then progress upward. This is called a “stocking-and-glove” distribution. In its later stages, SFN can affect the hands.

Sometimes SFN disrupts autonomic functions. These are things your body automatically does like regulate blood pressure, digestion and urinary function.

small fiber neuropathy symptoms

When the condition affects autonomic nerve fibers, you could experience symptoms like:

  • Difficulty sweating
  • Constipation
  • Dry eyes
  • Incontinence
  • Dry mouth
  • Skin discoloration
  • Sexual dysfunction

Causes of Small Fiber Neuropathy

SFSN can be the first indication of an underlying illness or condition like diabetes. Many other conditions that could cause SFN are:

  • Hypothyroidism
  • Metabolic and endocrine disorders
  • Fabry disease
  • Hereditary diseases
  • Tangier disease
  • Hereditary amyloidosis
  • Psoriasis
  • Celiac disease
  • Hereditary sensory autonomic neuropathy
  • Inflammatory bowel disease
  • Guillain-Barre syndrome
  • Immune system disorders
  • Rheumatoid arthritis
  • HIV
  • Infectious diseases
  • Sjogren’s syndrome
  • Sarcoidosis
  • Lyme disease

Other causes may include:

  • Chemotherapy drugs and other medications
  • Alcoholism

Doctors don’t always find the underlying cause. In these cases, small fiber neuropathy is considered idiopathic.

Physical Effects of Small Fiber Neuropathy

Peripheral neuropathy is a growing public health concern, with almost 40 million people in the U.S. having it. Many of these people will have specific damage to unmyelinated and small myelinated nerve fibers, either in isolation or combined with an injury to bigger myelinated nerve fibers.

sfn effects

Several diseases could lead to small fiber neuropathy like diabetes and other glucose dysregulation conditions such as:

  • Metabolic syndrome and impaired glucose tolerance
  • Vitamin B12 deficiency
  • Thyroid dysfunction
  • Neurotoxic medications
  • Sarcoidosis
  • HIV
  • Paraneoplastic syndromes
  • Celiac disease
  • Paraproteinemias

More severe symptoms of SFN might include burning pain that’s often persistent, but varies in intensity. Many individuals also claim to have transient electric shock-like pain that lasts only seconds, but it is very severe and could occur several times a day.

Many symptoms become worse while resting and at night. Along with spontaneous pain, many patients report hyperesthesia and allodynia. Individuals with SFN often complain their bedsheets are extremely painful and they need to use “foot tents” or wear socks to keep the sheets from coming in contact with their feet.

Small nerve fiber neuropathies might also lead to enteric and autonomic dysfunction. Individuals often don’t identify the connection between these symptoms and their sensory complaints, but when asked, they might report:

  • Postural lightheadedness
  • Dry eyes
  • Dry mouth
  • Syncope
  • Presyncope
  • Erectile dysfunction
  • Syncope
  • Constipation
  • Diarrhea
  • Vomiting
  • Nocturia
  • A difficulty with urinary frequency
  • Early satiety
  • Voiding
  • Constipation
  • Diarrhea

Mental Effects of Small Fiber Neuropathy

Individuals with SFN often struggle with debilitating pain, and their quality of life is severely reduced. They also can have other issues such as depression, anxiety, fatigue and sleep deprivation that can significantly influence their quality of life.

Small Fiber Neuropathy Statistics

Facts about small fiber neuropathy according to Jama Neurology statistics include:

  • Sensory predominant peripheral neuropathy is a common condition that affects as many as 10 percent of people older than 40. Many of these individuals have SFN.
  • SFN continues to be a puzzling disorder that’s often hard to diagnose and successfully manage.
  • Around half of the individuals with SFN also have diabetic neuropathy, and many of the remaining patients have cryptogenic sensory peripheral neuropathy (CSPN).

Current Treatments Available for Small Fiber Neuropathy and Their Side Effects

sfn treatments

A small fiber neuropathy diagnosis is determined mainly by the physical exam and history, but skin biopsy evaluation of intraepidermal nerve fiber density and functional neurophysiologic testing can provide doctors with diagnostic confirmation. Treatment of SFN depends on the underlying cause with simultaneous treatment of associated neuropathic pain.

If SFSN is due to a pre-diabetic state or diabetes, then exercise, weight loss and optimum diabetic control to reduce insulin resistance are required. Doctors can treat painful sensory paresthesias with antidepressants, anti-seizure medications and analgesics, such as opiate drugs. If the patient’s pain is severe, they might be referred to a chronic pain clinic to undergo a multidisciplinary pain management approach.

Each of these medications can come with side effects.

Antidepressants can cause:

  • Weight gain and increased appetite
  • Nausea
  • Dry mouth
  • Drowsiness and fatigue
  • Loss of sexual desire or other sexual troubles like decreased orgasm and erectile dysfunction
  • Constipation
  • Blurred vision
  • Insomnia

Anti-seizure medications can cause side effects such as:

  • Nausea
  • Dizziness
  • Headache
  • Fatigue
  • Blurred vision
  • Vertigo
  • Tremor

Analgesics can cause:

  • Dizziness
  • Constipation
  • Upset stomach
  • Drowsiness
  • Ringing in your ears
  • Dry mouth
  • Skin rash or itching

Recent Developments in Small Fiber Neuropathy

An SFN diagnosis is difficult as the clinical picture can be hard to interpret, and nerve conduction study results are frequently normal. New techniques for diagnosing the condition (i.e., nociceptive evoked potentials and corneal confocal microscopy to measure nerve fiber density) might contribute to the diagnostic work-up.

Identifying the underlying systemic disease with SFN will help with the development of drugs that specifically target impacted pathways to improve the management of autonomic dysfunction and neuropathic pain.

How/Why Marijuana Can Be an Effective Treatment for Small Fiber Neuropathy

The main reason individuals turn to medical cannabis is to relieve their chronic pain. Usually, doctors will treat chronic pain with painkillers like opioids. However, as you may already know, these can be extremely addictive and can inflict a lot of damage to a person’s life. Because of this, doctors are now hesitant to prescribe opioids to their patients.

Although this is understandable, it still leaves patients who are struggling with chronic pain with limited treatment options to relieve their pain. One particular option is medical marijuana for small fiber neuropathy treatment, and numerous strains can be highly effective in the treatment of chronic nerve pain.

According to a study, just three puffs of cannabis (25mg) a day can help individuals with injury- or surgery-related chronic nerve pain. It also can help them sleep better. Anecdotal evidence regarding this has been around for a while, and around 10 to 15 percent of individuals attending a clinic for chronic pain use medical marijuana as part of their overall pain management approach.

This particular study adds to growing evidence that medical weed can help many of the individuals struggling with pain currently.

More recently, the herb has been shown to offer relief to patients who are unresponsive to other types of treatment. This is mainly due to the relationship of marijuana to your internal endocannabinoid system.

You have peripheral nerves in your body, and they:

  • Detect pain sensations.
  • Contain cannabinoid receptors.

Any form of cannabis consumption, therefore, impacts these receptors. When CBD and THC enter your body, they activate both your CB1 and CB2 receptors that:

  • Mitigate your central nervous system.
  • Regulate neurotransmitters.
  • Help in the management of your pain levels.

Taking medical marijuana for small fiber neuropathy might not cure the underlying disorder causing your neuropathy, but it can help with the management of the pain sensations.

Compounds known as cannabinoids are present in medical cannabis, and they interact with your body, providing pain relief. CBD and THC seem to impact pain the greatest. As mentioned, they activate your body’s natural endocannabinoid system’s receptors.

Your endocannabinoid system is responsible for many body functions, and this includes your immune system response that leads to inflammation. Medical pot strains containing CBD and THC help your body lower the levels of pain by binding to your endocannabinoid system’s receptors to prevent inflammation, making it simpler to handle your neuropathy.

Another benefit of medical cannabis for small fiber neuropathy is its relaxing effect. When you can maintain a relaxed feeling, it can help minimize the pain you’re experiencing. It might also help you sleep better when you use certain sleep-inducing strains.

Cannabis does come with some side effects. Not all individuals will experience the same side effects, though, and it will depend on the type of marijuana you use and the method in which you use it. Still, it would be best if you took the time to learn the potential side effects medical cannabis could cause. While each person is different, the side effects you could experience include:

There are other side effects of cannabis that you’ll want to discuss with your doctor. Not everyone experiences these side effects, but it’s a good idea to know what to expect.

Also, you’ll want to realize some strains are stronger than others. While more strength is beneficial to eliminating your pain, it could also be a little stronger than you expected if you’re not used to using medical weed.

What Side Effects/ Symptoms of Small Fiber Neuropathy Can Medical Marijuana Treat?

Some side effects marijuana for small fiber neuropathy can help with are:

  • Painful sensations
  • Trouble sleeping
  • Depression
  • Anxiety

Best Strains of Marijuana to Use for Symptoms of Small Fiber Neuropathy

The best strains of medical marijuana for the treatment of chronic nerve pain are hybrids, with a high content of both tetrahydrocannabinol (THC) and cannabidiol (CBD). These cannabinoids are beneficial in bonding to your body’s own natural receptors for cannabinoids. Thus, they can be helpful in modulating the body’s pain responses. A few good hybrid strains to treat chronic pain are:

  • Blue Dream (Sativa-dominant Hybrid)
  • ACDC (Hybrid)
  • Girl Scout Cookies (Hybrid)
  • Grandaddy Purple (Indica)

Strains for neuropathy pain include:

  • White Widow
  • Purple Kush
  • Chem Dawg
  • Super Silver Haze
  • Jack Herer

Strains to help treat anxiety are:

  • Grandaddy Purple (Indica)
  • Northern Lights (Indica)
  • Amnesia Haze (Sativa)

Strains for depression are:

  • Jack Herer (Sativa)
  • Harlequin (Hybrid)
  • Pineapple Express (Hybrid)

Best Methods of Marijuana Treatment to Use to Treat Side Effects and Symptoms of Small Fiber Neuropathy

Medical marijuana for small fiber neuropathy is a flexible medication used by individuals all across the country to relieve symptoms and side effects of countless medical disorders, including SFN.

Many new patients aren’t sure how to take medical cannabis as a medication.

If you’re starting out, there will be a learning curve to using medical weed. You may only associate the herb with smoking, but there are various other methods to achieve the medical benefits of cannabis.

strains for sfn

Experimenting with different methods of medical marijuana consumption is a simple way to find a treatment approach that works for you. Each method of use provides a unique experience. Some methods of medical marijuana and small fiber neuropathy treatment use are:

  • Smoking
  • Topicals
  • Oils
  • Vaping
  • Edibles
  • Suppositories
  • Tinctures
  • Infused beverages
  • Transdermal patches
  • Pills/supplements
  • Eating raw cannabis
  • Dabbing

People with small fiber neuropathy may especially find topicals soothing,

Acquire Medical Marijuana for Small Fiber Neuropathy

If you’re concerned about the negative effects of traditional pain-relieving medications, you may want to check into a cannabis dispensary.

You’ll first need to verify your state laws on medical weed for neuropathy pain. Then you must consult with a certified cannabis doctor to receive your medical marijuana card to move forward with your medical cannabis treatment.

At, we can set you up with a qualified medical marijuana doctor in your legal state. Alleviate your SFN chronic pain and improve your quality of life by searching for a cannabis doctor now.

Find A Doctor Find A Dispensary