Individuals diagnosed with peripheral neuropathy, or with small fiber neuropathy, can understanding symptoms and causes help with potential treatments?
Small Fiber Neuropathy
Small fiber neuropathy is a specific classification of neuropathy, as there are different types, which are nerve injury, damage, disease, and/or dysfunction. Symptoms can result in pain, loss of sensation, and digestive and urinary symptoms. Most cases of neuropathy like peripheral neuropathy involve small and large fibers. Common causes include long-term diabetes, nutritional deficiencies, alcohol consumption, and chemotherapy.
Small fiber neuropathy is diagnosed after diagnostic testing showing it is clear that the small nerve fibers are involved.
The small nerve fibers detect sensation, temperature, and pain and help regulate involuntary functions.
Isolated small-fiber neuropathy is rare, but research is ongoing on the type of nerve damage and potential treatments. (Stephen A. Johnson, et al., 2021)
Small fiber neuropathy is not specifically dangerous but is a sign/symptom of an underlying cause/condition that is damaging the body’s nerves.
Pain – symptoms can range from mild or moderate discomfort to severe distress and can happen at any time.
Loss of sensation.
Because the small nerve fibers help with digestion, blood pressure, and bladder control – symptoms of autonomic dysfunction can vary and can include:
Constipation, diarrhea, incontinence, urinary retention – the inability to completely drain the bladder.
If there is progressing nerve damage, the intensity of the pain can decrease, but the loss of normal sensation and autonomic symptoms can worsen. (Josef Finsterer, Fulvio A. Scorza. 2022)
Hypersensitivity to touch and pain sensations can cause pain without a trigger.
The loss of sensation can make individuals unable to accurately detect sensations of touch, temperature, and pain in affected areas, which can lead to various types of injuries.
Although more research is needed, certain disorders that were not considered neuropathies may have small fiber neuropathy components involved.
A study suggested that neurogenic rosacea, a skin condition, could have some elements of small fiber neuropathy. (Min Li, et al., 2023)
These small nerve fibers are distributed throughout the body including the tops of the fingers and toes, trunk, and internal organs.
These fibers are usually located in the superficial areas of the body, such as close to the skin’s surface. (Mohammad A. Khoshnoodi, et al., 2016)
The small nerve fibers that get damaged are involved in transmitting pain and temperature sensations.
Most nerves have a special type of insulation called myelin that protects them and increases the speed of nerve impulses.
Small nerve fibers may have a thin sheath, making them more susceptible to injury and damage at earlier stages of conditions and diseases. (Heidrun H. Krämer, et al., 2023)
Individuals At Risk
Most types of peripheral neuropathy cause damage to the small and large peripheral nerve fibers. Because of this, most neuropathies are a mix of small-fiber and large-fiber neuropathy. Common risk factors for mixed fiber neuropathy include: (Stephen A. Johnson, et al., 2021)
Diabetes
Nutritional deficiencies
Overconsumption of alcohol
Autoimmune disorders
Medication toxicity
Isolated small-fiber neuropathy is rare, but there are conditions that are known to contribute to the cause and include: (Stephen A. Johnson, et al., 2021)
Sjogren Syndrome
This autoimmune disorder causes dry eyes and mouth, dental problems, and joint pain.
It can also cause nerve damage throughout the body.
Fabry Disease
This condition causes a buildup of certain fats/lipids in the body that can lead to neurological effects.
Amyloidosis
This is a rare disorder that causes a buildup of proteins in the body.
The proteins can damage tissues like the heart or nerves.
Lewy Body Disease
This is a neurological disorder that causes dementia and impaired movement and can lead to nerve damage.
Lupus
This is an autoimmune disease that affects joints, skin, and sometimes nerve tissue.
Viral Infection
These infections typically cause a cold or gastrointestinal/GI upsetness.
Less often they can cause other effects like small fiber neuropathy.
These conditions have been seen to cause isolated small-fiber neuropathy or begin as small-fiber neuropathy before progressing to the large nerve fibers. They can also begin as a mixed neuropathy, with small and large fibers.
Progression
Often the damage progresses at a relatively moderate rate, leading to added symptoms within months or years. The fiber nerves that are affected by the underlying condition usually progressively deteriorate, regardless of where they are located. (Mohammad A. Khoshnoodi, et al., 2016) Medications can help alleviate damage to the peripheral nerves. For individuals that are diagnosed in the early stage, it is possible to stop the progression, and potentially prevent involvement of the large fibers.
Treatments
Treatment toward preventing the progression requires controlling the underlying medical condition with treatment options depending on the cause. Treatments that can help prevent the progression include:
Blood sugar control for individuals with diabetes.
Immune suppression for control of autoimmune diseases.
Plasmapheresis – blood is taken and the plasma is treated and returned or exchanged for the treatment of autoimmune diseases.
Symptom Treatment
Individuals can get treatment for the symptoms that will not reverse or cure the condition but can help with temporary relief. Symptomatic treatment can include: (Josef Finsterer, Fulvio A. Scorza. 2022)
Pain management can include medications and/or topical analgesics.
Physical therapy – stretching, massage, decompression, and adjustments to keep the body relaxed and flexible.
Rehabilitation to help improve coordination, which can be impaired by loss of sensation.
Medications to relieve GI symptoms.
Wearing specialized clothes such as neuropathy socks to help with foot pain symptoms.
Treatment and medical management of neuropathies usually involve a neurologist. A neurologist may prescribe medication to help alleviate pain symptoms and provide medical interventions like immunotherapy if there is concern that an autoimmune process could be the cause. Additionally, treatment could include the care of a physical medicine and rehabilitation physician or a physical therapy team to provide stretches and exercises to help strengthen the body and maintain mobility and flexibility.
Peripheral Neuropathy Myths & Facts
References
Johnson, S. A., Shouman, K., Shelly, S., Sandroni, P., Berini, S. E., Dyck, P. J. B., Hoffman, E. M., Mandrekar, J., Niu, Z., Lamb, C. J., Low, P. A., Singer, W., Mauermann, M. L., Mills, J., Dubey, D., Staff, N. P., & Klein, C. J. (2021). Small Fiber Neuropathy Incidence, Prevalence, Longitudinal Impairments, and Disability. Neurology, 97(22), e2236–e2247. doi.org/10.1212/WNL.0000000000012894
Finsterer, J., & Scorza, F. A. (2022). Small fiber neuropathy. Acta neurologica Scandinavica, 145(5), 493–503. doi.org/10.1111/ane.13591
Krämer, H. H., Bücker, P., Jeibmann, A., Richter, H., Rosenbohm, A., Jeske, J., Baka, P., Geber, C., Wassenberg, M., Fangerau, T., Karst, U., Schänzer, A., & van Thriel, C. (2023). Gadolinium contrast agents: dermal deposits and potential effects on epidermal small nerve fibers. Journal of neurology, 270(8), 3981–3991. doi.org/10.1007/s00415-023-11740-z
Li, M., Tao, M., Zhang, Y., Pan, R., Gu, D., & Xu, Y. (2023). Neurogenic rosacea could be a small fiber neuropathy. Frontiers in pain research (Lausanne, Switzerland), 4, 1122134. doi.org/10.3389/fpain.2023.1122134
Khoshnoodi, M. A., Truelove, S., Burakgazi, A., Hoke, A., Mammen, A. L., & Polydefkis, M. (2016). Longitudinal Assessment of Small Fiber Neuropathy: Evidence of a Non-Length-Dependent Distal Axonopathy. JAMA neurology, 73(6), 684–690. doi.org/10.1001/jamaneurol.2016.0057
Stretching Objective: The body needs to be flexible to maintain a full range of motion. Stretching keeps the muscles supple, strong, and healthy; without it, the muscles shorten and become stiff and tight. Then, when the muscles are needed, they are weak and unable to extend fully. This increases the risk of joint pain, strains, injuries, and muscle damage. For example, sitting in a chair for a long time results in tight glute muscles and hamstrings, which leads to back discomfort symptoms and inhibits walking. Injury Medical Chiropractic and Functional Medicine Clinic can help individuals develop a personalized stretching program to maintain smooth mobility, flexibility, and function.
Stretching Objective
Benefits
The body needs to be flexible to maintain mobility, balance, and independence. The benefits of regularly stretching include:
When the muscles are stretched, so are the muscle spindles. The spindle records the change in length and speed and transmits the signals through the spinal cord, which conveys the information. This triggers the stretch reflex, which tries to resist the change by causing the stretched muscle to contract. Muscle spindle function helps maintain muscle tone and protects the body from injury. One of the reasons for holding a stretch for a specific amount of time is because, as the muscle stays in a stretched position, the spindle acclimates to the new condition and reduces its resistance signaling, gradually training the stretch receptors to allow greater lengthening of the muscles.
Chiropractic Stretch Training
However, stretching once won’t generate maximum flexibility. Tight muscles may have taken months or years to develop; therefore, it will take time to achieve flexibility and must be continually worked on to maintain it. Chiropractors and physical therapists are body movement experts and can assess individual muscle strength and develop a customized stretching program.
Muscle Spindle Activation
References
Bhattacharyya, Kalyan B. “The stretch reflex and the contributions of C David Marsden.” Annals of Indian Academy of Neurology vol. 20,1 (2017): 1-4. doi:10.4103/0972-2327.199906
Behm, David G et al. “Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review.” Applied physiology, nutrition, and metabolism = Physiologie applique, nutrition et metabolism vol. 41,1 (2016): 1-11. doi:10.1139/apnm-2015-0235
Berg, K. Stretching fundamentals. In: Prescriptive Stretching. 2nd ed. Kindle edition. Human Kinetics; 2020.
da Costa, Bruno R, and Edgar Ramos Vieira. “Stretching to reduce work-related musculoskeletal disorders: a systematic review.” Journal of rehabilitation medicine vol. 40,5 (2008): 321-8. doi:10.2340/16501977-0204
Page, Phil. “Current concepts in muscle stretching for exercise and rehabilitation.” International journal of sports physical therapy vol. 7,1 (2012): 109-19.
Witvrouw, Erik, et al. “Stretching and injury prevention: an obscure relationship.” Sports medicine (Auckland, N.Z.) vol. 34,7 (2004): 443-9. doi:10.2165/00007256-200434070-00003
April Hermosillo has achieved overall health and wellness by following proper nutrition and engaging in exercises/physical activities. As a regular fitness participant, April Hermosillo can experience low back pain which affects even her most basic tasks. April Hermosillo struggled with spine health issues and sciatica before receiving chiropractic care.
Dr. Alex Jimenez is a chiropractor in El Paso, TX who has helped April Hermosillo achieve pain relief so she can return to her everyday fitness routines. April Hermosillo describes how Dr. Jimenez has tremendously helped improve her overall symptoms. April Hermosillo highly recommends Dr. Alex Jimenez as the non-surgical choice for personalized spine and sciatica treatment and rehabilitation.
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Nutrigenomics examines Relationships Between What We Eat
The risk/response to diseases
Genes and gene expression
Biomarkers
Uses A Variety of Tools In Identifying Disease Risk
Food diaries record nutrient input
Biomarkers: Example metabolite or hormone levels are examined to understand the body�s response
Genomic essays to identify relevant gene variations
Clinical data:
Age
Weight
Sex
BMI for monitoring the health impact of food
Applied to a Wide Range of Conditions
Risk of developing metabolic syndrome based on genetic variants and controlled by diet and lifestyle
Links between gut microbiota, obesity, and mental health
Correlation between specific nutrient intake and diseases
Example: Coffee and cardiac irregularities
Personalized Interventions
Identify, and provide supplements to a woman who metabolizes folate poorly in order to reduce neural tube defects in pregnancy.
Recommending a low fat diet versus low carbohydrate diet as the best way to lose excess weight.
As technology advances along with medical breakthroughs, there is not a day without there being a new cure or treatment to learn about. The trend is currently focused on the field of genetics and genomics, which consists of having personalized nutrition.
In the past recommending nutritional plans was population based. The only difference was between age, sex and pregnancy.
There is mounting evidence that nutrition throughout one’s life course modifies the epigenome.
There has been an increase in studies, which have reported associations between gene polymorphisms, nutrition, and disease risk.
Epigenetics
Epigenetic processes affect how the body uses nutrients.
The field of epigenetics explains unaccounted for variations in disease risk that is linked to the understanding of the interaction between nutrition and the genome.
A personalized nutrition dietary recommendation has the potential to decrease nutrition-related diseases.
There are still practical and economic challenges associated with this strategy.
Major epigenetic processes are DNA methylation, histone modification and noncoding RNAs.
This suggests the possibility that epigenotypes or (stable pattern of gene expression outside the actual base pair sequence of DNA) associated with disease risk can be changed.
Effects of Nutrients
The nature of an epigenetic change that is induced by specific nutrient/s intervention depends on the animal species, sex, genotype, and target gene, as well as, the timing of exposure and direction of the nutritional change.
There is also the possibility that epigenetic marks present at birth may act as predictors for future disease risk and pave the way to improve an individual’s health.
Terminology
Genes: Instructions written in our DNA sequence for making proteins that carry out all our biological functions.
Not all DNA is made up of genes; some are only used for spacing like the way the letters on a keyboard are arranged, so the buttons are easier to get to. Some are instructions for the instructions, like a content page that shows what to look for before beginning a chapter in a book.
Genetics: Study of gene inheritance how they vary from person to person and are passed on.
Genome: Is the collective term for all of our genes.
Genomics: A field of genetics that looks and analyzes the sequence of the genome.
Nutrigenetics: Is concerned with how our genetic variations affect the way we respond to nutrients.
Epigenetics: The modification to the expression of genes, not involving changes in the genetic code itself (mainly via histones and methylation), that occurs in response to environmental factors. This results in genes being switched �on� or �off.�
Nutritional Genomics goal is to prevent the onset and development of chronic diseases. This is done by targeting dietary recommendations based on an individual�s genetic profile. Discoveries being made in the field, demonstrate that individuals are benefitting from adhering to different nutritional guidelines. However, this also depends on their genotype.
Knowing an individual’s genetic code helps better understand the intricacies and complexities of a case and aids in guiding recommendations in line with an individual’s genetic requirements.
However, even knowing someone�s SNP does not tell if a gene is on or off. This is where functional testing and case history come into play. Therefore, genomic testing is just a portion of the bigger picture.
Epigenetics is still a new science with the availability of new tools continually emerging. The field is rapidly progressing, and the findings reflect these advances in understanding and analyzing technologies.
And while trying to wrap your head around all of this can be daunting, don’t worry, it takes a few reps before it starts to make sense. And because of this, one of Dr. Jimenez’ goals is to simplify as much as possible. The program, terminology, and diet. And one way is going to be through SMOOTHIES! Putting it all into one easy drink will make it easier for everyone.
The American Heart Association and American Stroke Association advocate that many of the effects of diet on cardiovascular disease (CVD) risk and the outcomes are mediated by changes in gene expression. This means that the utilization of global transcriptional profiling is an important tool in nutrigenomics, and therefore cannot be denied that nutrigenomics is being taken seriously by those in the field of medical research.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
Stretching Objective
