RLS and Small-Fiber Neuropathy (SFN)

Quite a few years ago, a friend told me that in addition to sarcoidosis, he also had small fiber neuropathy (DVN). An additional complaint of his small fiber neuropathy was restless legs.

At that time, I didn’t have severe RLS myself. Now that restless legs are my daily reality, I find it interesting to take a closer look at small fiber neuropathy.

In this blog I will therefore first tell you more about small fiber neuropathy. Then I look at the relationship between DVN and restless legs.

What is small-fiber neuropathy

Small fiber neuropathy is a form of polyneuropathy. The small nerve fibers do not function properly. Pain and all kinds of other health problems can be the result. DVN is a fairly rare condition.

Nerve fibers are just under the skin and are the ends of the nerves. These fibers regulate pain and temperature, as well as autonomic functions such as blood pressure and sweating.

If the small nerve fibers are damaged, this can cause various complaints. Examples of this are burning, stinging or shooting pain, less feeling for heat, cold and painful stimuli, palpitations, stomach and intestinal complaints, fluctuations in blood pressure and sweating more or less.

Causes and treatment

Possible causes include underlying diseases such as diabetes mellitus, autoimmune diseases such as sarcoidosis or Sjogren’s disease, or celiac disease. It can also be related to a side effect of certain medicines (chemotherapy for cancer), a vitamin deficiency (vitamin B12 or vitamin B1) or vitamin surplus (vitamin B6), or alcohol abuse.

In less than a third of cases, DVN is hereditary. In about half of those who are not hereditary, no cause is found.

Treatment is usually in the form of pain relief and pain rehabilitation. Antidepressants, anticonvulsants (gabapentin and pregabalin), and opioids (such as tramadol and oxycodone) are commonly prescribed. Pain rehabilitation can include physiotherapy or occupational therapy. Treatment in a pain center is also an option.

Restless legs and small-fiber neuropathy

What strikes me when I read about small fiber neuropathy is that the pain or altered sensation usually starts in the feet and hands. Then in the lower legs and the forearms. The condition may spread further to the trunk, but that will vary from person to person. For example, the altered sensation could also be itching, sensitivity to clothes or sheets, or more pain than usual when you bump against something.

I have written several times in blogs that the symptoms you experience with RLS can closely resemble symptoms of neuropathy. In some cases, a person may be dealing with both conditions at the same time. I think the same story goes for small fiber neuropathy.

Symptoms very similar to restless legs are tingling, stinging sensations, a bit like ants walking over the skin. It can occur in hands and feet, arms and legs. Sometimes it feels like cramping. One difference is that RLS is not so much a burning, cutting pain.

My suspicion is that doctors sometimes confuse these conditions or choose one as the diagnosis when both are present at the same time. Unfortunately, it will also still sometimes be said that it is between the ears.