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Review
. 2015 Aug;32(8):611-21.
doi: 10.1007/s40266-015-0283-8.

Neuropathic Pain due to Small Fiber Neuropathy in Aging: Current Management and Future Prospects

Brigitte A Brouwer  1 , Bianca T A de Greef, Janneke G J Hoeijmakers, Margot Geerts, Maarten van Kleef, Ingemar S J Merkies, Catharina G Faber
Affiliations
Review

Neuropathic Pain due to Small Fiber Neuropathy in Aging: Current Management and Future Prospects

Brigitte A Brouwer et al. Drugs Aging. 2015 Aug.

Abstract

Over the last 10 years, the diagnosis small fiber neuropathy (SFN) has gained recognition worldwide. Patients often suffer from severe neuropathic pain that may be difficult to treat. A substantial subset of patients with SFN is aged 65 years or older, and these patients often exhibit comorbidities and usage of multiple drugs, making neuropathic pain treatment more challenging. In this review, we highlight relevant pathophysiological aspects and discuss currently used therapeutic strategies for neuropathic pain. Possible pitfalls in neuropathic pain treatment in the elderly will be underlined.

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Figures

Fig. 1
Fig. 1
Comorbidities and use of drugs in the elderly. a Number of comorbidities at initial presentation. b Number of drugs used at initial presentation in patients with SFN aged 65 years or older (n = 117). Concomitant disorders were hypertension (60 %), cardiovascular disease (44 %), immune-mediated diseases (20 %), malignancy (16 %) and diabetes mellitus (9 %). SFN small fiber neuropathy
Fig. 2
Fig. 2
Treatment algorithm for SFN in the elderly. In addition to physical factors, psychological, neurophysiological, socio-economic and cultural aspects may influence the experience and maintain pain; a multidisciplinary approach in line with the biopsychosocial model is required in optimizing treatment for the individual patient [41]. Asterisks see also Fig. 3 (contra-indication algorithm for drugs prescription) and Table 1 (Practical tips for the best treatment strategy for SFN in the elderly). Hash in contrast with first-line neuropathic pain treatment in adults <65 years, TCAs should be avoided in older adults, because of the risk of adverse events, such as cardiac arrhythmia, somnolence, hypotension with increased risk of falls and injury, cognitive impairment, and anticholinergic side effects [62]. SFN small fiber neuropathy, SNRI serotonin-noradrenalin reuptake inhibitor, TCA tricyclic antidepressant
Fig. 3
Fig. 3
Contra-indication algorithm for drugs prescription. For every drug considered, it is advisable to go through these steps to make a deliberate decision. Be aware of comorbidities such as kidney and liver impairment or cardiac disease. Yrs years
See this image and copyright information in PMC

References

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