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Pharmacotherapy for Small Fiber Neuropathy

  • Neuromuscular Disorders (C Fournier, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

Small fiber neuropathy (SFN) is a condition that affects small nerve fibers leading to a variety of symptoms, including pain, discomfort, tingling, and sensory loss. The development of new drugs is commonly complicated by variable medication pharmacokinetics and patients’ response to treatment due to comorbidities. In this review, we discuss currently used drugs, including the evidence about their efficacy. We also mention the medications with a questionable response in SFN treatment and those that are potential emerging therapies.

Recent findings

SFN treatment is aimed towards addressing the cause of neuropathy and alleviating its symptoms. Determining the best treatment option may be challenging. Current drug treatments include antiseizure drugs, antidepressants, opioids, immunomodulating agents, topical medications, and NMDA antagonists. Each of these drugs has different molecular targets, efficacy, and adverse effect profiles. In some cases, the exact underlying mechanisms are not well understood.

Summary

Current drug treatments provide patients with varying, often suboptimal, relief of symptoms. The need for new, effective, and safe therapies for SFN warrants intensive development and testing of new agents.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Devigili G, Tugnoli V, Penza P, Camozzi F, Lombardi R, Melli G, et al. The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology. Brain. 2008;131(Pt 7):1912–25. https://doi.org/10.1093/brain/awn093.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Gemignani F, Ferrari G, Vitetta F, Giovanelli M, Macaluso C, Marbini A. Non-length-dependent small fibre neuropathy. Confocal microscopy study of the corneal innervation. J Neurol Neurosurg Psychiatry. 2010;81(7):731–3. https://doi.org/10.1136/jnnp.2009.177303.

    Article  CAS  PubMed  Google Scholar 

  3. Chan AC, Wilder-Smith EP. Small fiber neuropathy: getting bigger! Muscle Nerve. 2016;53(5):671–82. https://doi.org/10.1002/mus.25082.

    Article  PubMed  Google Scholar 

  4. Oaklander AL, Herzog ZD, Downs HM, Klein MM. Objective evidence that small-fiber polyneuropathy underlies some illnesses currently labeled as fibromyalgia. Pain. 2013;154(11):2310–6. https://doi.org/10.1542/peds.2012-2597.

    Article  PubMed  Google Scholar 

  5. Kafaie J, Kim M, Krause E. Small fiber neuropathy following vaccination. J Clin Neuromuscul Dis. 2016;18(1):37–40. https://doi.org/10.1097/CND.0000000000000130.

    Article  PubMed  Google Scholar 

  6. Adams CP, Brantner VV. Estimating the cost of new drug development: is it really 802 million dollars? Health Aff (Millwood). 2006;25(2):420–8. https://doi.org/10.1377/hlthaff.25.2.420.

    Article  Google Scholar 

  7. Abdulla A, Adams N, Bone M, Elliott AM, Gaffin J, Jones D, et al. Guidance on the management of pain in older people. Age Ageing. 2013;42(Suppl 1):i1–57. https://doi.org/10.1093/ageing/afs200.

    Article  PubMed  Google Scholar 

  8. Berger A, Dukes EM, Oster G. Clinical characteristics and economic costs of patients with painful neuropathic disorders. J Pain. 2004;5(3):143–9. https://doi.org/10.1016/j.jpain.2003.12.004.

    Article  PubMed  Google Scholar 

  9. Cohen SP, Mao J. Neuropathic pain: mechanisms and their clinical implications. BMJ. 2014;348:f7656. https://doi.org/10.1136/bmj.f7656.

    Article  PubMed  Google Scholar 

  10. Vo T, Rice AS, Dworkin RH. Non-steroidal anti-inflammatory drugs for neuropathic pain: how do we explain continued widespread use? Pain. 2009;143(3):169–71. https://doi.org/10.1016/j.pain.2009.03.013.

    Article  PubMed  Google Scholar 

  11. Woolf CJ, American College of P, American Physiological S. Pain: moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med 2004;140(6):441–451. Doi: https://doi.org/10.7326/0003-4819-140-8-200404200-00010.

  12. Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015;7:CD008242. https://doi.org/10.1002/14651858.cd008242.pub3.

    Article  Google Scholar 

  13. Farhad K. Current diagnosis and treatment of painful small fiber neuropathy. Curr Neurol Neurosci Rep. 2019;19(12):103. https://doi.org/10.1007/s11910-019-1020-1.

    Article  CAS  PubMed  Google Scholar 

  14. Turcotte JE, Debonnel G, de Montigny C, Hebert C, Blier P. Assessment of the serotonin and norepinephrine reuptake blocking properties of duloxetine in healthy subjects. Neuropsychopharmacology. 2001;24(5):511–21. https://doi.org/10.1016/S0893-133X(00)00220-7.

    Article  CAS  PubMed  Google Scholar 

  15. Attal N. Pharmacological treatments of neuropathic pain: the latest recommendations. Rev Neurol (Paris). 2019;175(1–2):46–50. https://doi.org/10.1016/j.neurol.2018.08.005.

    Article  CAS  Google Scholar 

  16. Wong DT, Bymaster FP, Mayle DA, Reid LR, Krushinski JH, Robertson DW. LY248686, a new inhibitor of serotonin and norepinephrine uptake. Neuropsychopharmacology. 1993;8(1):23–33. https://doi.org/10.1038/npp.1993.4.

    Article  CAS  PubMed  Google Scholar 

  17. Durand JP, Deplanque G, Montheil V, Gornet JM, Scotte F, Mir O, et al. Efficacy of venlafaxine for the prevention and relief of oxaliplatin-induced acute neurotoxicity: results of EFFOX, a randomized, double-blind, placebo-controlled phase III trial. Ann Oncol. 2012;23(1):200–5. https://doi.org/10.1093/annonc/mdr045.

    Article  CAS  PubMed  Google Scholar 

  18. Aiyer R, Barkin RL, Bhatia A. Treatment of neuropathic pain with venlafaxine: a systematic review. Pain Med. 2017;18(10):1999–2012. https://doi.org/10.1093/pm/pnw261.

    Article  PubMed  Google Scholar 

  19. Goldstein DJ, Lu Y, Detke MJ, Lee TC, Iyengar S. Duloxetine vs. placebo in patients with painful diabetic neuropathy. Pain. 2005;116(1–2):109–18. https://doi.org/10.1016/j.pain.2005.03.029.

    Article  CAS  PubMed  Google Scholar 

  20. • Shimada Y, Inage K, Orita S, Koda M, Yamauchi K, Furuya T, et al. Effect of duloxetine on neuropathic pain in patients intolerant to continuous administration of pregabalin. Spine Surg Relat Res. 2017;1(1):40–3. https://doi.org/10.22603/ssrr.1.2016-0012A retrospective study that demonstrated effectiveness of the duloxetine treatment for neuropathic pain in patients who either experienced intolerable adverse effects or the treatment failure with the pregabalin treatment.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162–73. https://doi.org/10.1016/s1474-4422(14)70251-0.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Li CY, Zhang XL, Matthews EA, Li KW, Kurwa A, Boroujerdi A, et al. Calcium channel α2δ1 subunit mediates spinal hyperexcitability in pain modulation. Pain. 2006;125(1–2):20–34. https://doi.org/10.1016/j.pain.2006.04.022.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Chang E, Chen X, Kim M, Gong N, Bhatia S, Luo ZD. Differential effects of voltage-gated calcium channel blockers on calcium channel alpha-2-delta-1 subunit protein-mediated nociception. Eur J Pain. 2015;19(5):639–48. https://doi.org/10.1002/ejp.585.

    Article  CAS  PubMed  Google Scholar 

  24. Sills GJ. The mechanisms of action of gabapentin and pregabalin. Curr Opin Pharmacol. 2006;6(1):108–13. https://doi.org/10.1016/j.coph.2005.11.003.

    Article  CAS  PubMed  Google Scholar 

  25. Wiffen PJ, Derry S, Bell RF, Rice AS, Tolle TR, Phillips T, et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;6:CD007938. https://doi.org/10.1002/14651858.cd007938.pub4.

    Article  PubMed  Google Scholar 

  26. Onakpoya IJ, Thomas ET, Lee JJ, Goldacre B, Heneghan CJ. Benefits and harms of pregabalin in the management of neuropathic pain: a rapid review and meta-analysis of randomised clinical trials. BMJ Open. 2019;9(1):e023600. https://doi.org/10.1136/bmjopen-2018-023600.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Senderovich H, Jeyapragasan G. Is there a role for combined use of gabapentin and pregabalin in pain control? Too good to be true? Curr Med Res Opin. 2018;34(4):677–82. https://doi.org/10.1080/03007995.2017.1391756.

    Article  CAS  PubMed  Google Scholar 

  28. Dib-Hajj SD, Cummins TR, Black JA, Waxman SG. Sodium channels in normal and pathological pain. Annu Rev Neurosci. 2010;33:325–47. https://doi.org/10.1146/annurev-neuro-060909-153234.

    Article  CAS  PubMed  Google Scholar 

  29. Wiffen PJ, Derry S, Moore RA. Lamotrigine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2013;12:CD006044. https://doi.org/10.1002/14651858.cd006044.pub4.

    Article  Google Scholar 

  30. Rogawski MA, Tofighy A, White HS, Matagne A, Wolff C. Current understanding of the mechanism of action of the antiepileptic drug lacosamide. Epilepsy Res. 2015;110:189–205. https://doi.org/10.1016/j.eplepsyres.2014.11.021.

    Article  CAS  PubMed  Google Scholar 

  31. de Greef BTA, Hoeijmakers JGJ, Geerts M, Oakes M, Church TJE, Waxman SG, et al. Lacosamide in patients with Nav1.7 mutations-related small fibre neuropathy: a randomized controlled trial. Brain. 2019;142(2):263–75. https://doi.org/10.1093/brain/awy329.

    Article  PubMed  Google Scholar 

  32. Sène D. Small fiber neuropathy: diagnosis, causes, and treatment. Joint Bone Spine. 2018;85(5):553–9. https://doi.org/10.1016/j.jbspin.2017.11.002.

    Article  PubMed  Google Scholar 

  33. IVIG in the treatment of autoimmune small fiber neuropathy with TS-HDS or FGFR-3 antibodies.” Case Medical Research, 6 Nov. 2019. Doi: https://doi.org/10.31525/ct1-nct04153422.This is a randomized double-blind trial designed to investigate the use of intravenous immunoglobulin Gammagard in the treatment of SFN.

  34. Liu X, Treister R, Lang M, Oaklander AL. IVIg for apparently autoimmune small-fiber polyneuropathy: first analysis of efficacy and safety. Ther Adv Neurol Disord. 2018;11. https://doi.org/10.1177/1756285617744484.

  35. Schofield JR, Chemali KR. How we treat autoimmune small fiber polyneuropathy with immunoglobulin therapy. Eur Neurol. 2018;80(5–6):304–10. https://doi.org/10.1159/000498858.

    Article  CAS  PubMed  Google Scholar 

  36. Brix Finnerup N, Hein Sindrup S, Staehelin JT. Management of painful neuropathies. Handb Clin Neurol. 2013;115:279–90. https://doi.org/10.1016/B978-0-444-52902-2.00017-5.

    Article  PubMed  Google Scholar 

  37. Gaskell H, Derry S, Stannard C, Moore RA. Oxycodone for neuropathic pain in adults. Cochrane Database Syst Rev. 2016;7:CD010692. https://doi.org/10.1002/14651858.cd010692.pub3.

    Article  PubMed  Google Scholar 

  38. Zin CS, Nissen LM, O’Callaghan JP, Duffull SB, Smith MT, Moore BJ. A randomized, controlled trial of oxycodone versus placebo in patients with postherpetic neuralgia and painful diabetic neuropathy treated with pregabalin. J Pain. 2010;11(5):462–71. https://doi.org/10.1016/j.jpain.2009.09.003.

    Article  CAS  PubMed  Google Scholar 

  39. • Kim BS, Jin JY, Kwon JH, Woo IS, Ko YH, Park SY, et al. Efficacy and safety of oxycodone/naloxone as add-on therapy to gabapentin or pregabalin for the management of chemotherapy-induced peripheral neuropathy in Korea. Asia Pac J Clin Oncol. 2018;14(5):e448–e54. https://doi.org/10.1111/ajco.12822The efficacy and safety of the therapy combining oxycodone/naloxone and pregabalin or gabapentin was investigated in 72 patients with chemotherapy-induced peripheral neuropathy.

    Article  PubMed  Google Scholar 

  40. Duehmke RM, Derry S, Wiffen PJ, Bell RF, Aldington D, Moore RA. Tramadol for neuropathic pain in adults. Cochrane Database Syst Rev. 2017;6:CD003726. https://doi.org/10.1002/14651858.cd003726.pub4.

    Article  PubMed  Google Scholar 

  41. Ho TW, Backonja M, Ma J, Leibensperger H, Froman S, Polydefkis M. Efficient assessment of neuropathic pain drugs in patients with small fiber sensory neuropathies. Pain. 2009;141(1–2):19–24. https://doi.org/10.1016/j.pain.2008.07.013.

    Article  CAS  PubMed  Google Scholar 

  42. Hassamal S, Miotto K, Dale W, Danovitch I. Tramadol: understanding the risk of serotonin syndrome and seizures. Am J Med. 2018;131(11):1382e1–6. https://doi.org/10.1016/j.amjmed.2018.04.025.

    Article  CAS  Google Scholar 

  43. “Overview | Neuropathic Pain in Adults: Pharmacological Management in Non-Specialist Settings | Guidance | NICE.” Nice.Org.Uk, NICE, 20 Nov. 2013.

  44. Khdour MR. Treatment of diabetic peripheral neuropathy: a review. J Pharm Pharmacol. 2020;72(7):863–72. https://doi.org/10.1111/jphp.13241.

    Article  CAS  PubMed  Google Scholar 

  45. Dworkin RH, O’Connor AB, Audette J, Baron R, Gourlay GK, Haanpaa ML, et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc. 2010;85(3 Suppl):S3–14. https://doi.org/10.4065/mcp.2009.0649.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Clifford DB, Simpson DM, Brown S, Moyle G, Brew BJ, Conway B, et al. A randomized, double-blind, controlled study of NGX-4010, a capsaicin 8% dermal patch, for the treatment of painful HIV-associated distal sensory polyneuropathy. J Acquir Immune Defic Syndr. 2012;59(2):126–33. https://doi.org/10.1097/qai.0b013e31823e31f7.

    Article  CAS  PubMed  Google Scholar 

  47. • Blair HA. Capsaicin 8% Dermal Patch: A Review in Peripheral Neuropathic Pain. Drugs. 2018;78(14):1489–500. https://doi.org/10.1007/s40265-018-0982-7The article discussed the efficacy of capsaicin 8% dermal patch in painful diabetic peripheral neuropathy, non-diabetic peripheral neuropathic pain, postherpetic neuralgia, and HIV-associated neuropathy and compared it with the other drugs commonly used in treatment of neuropathic pain.

    Article  CAS  PubMed  Google Scholar 

  48. Zilliox L, Russell JW. Treatment of diabetic sensory polyneuropathy. Curr Treat Options Neurol. 2011;13(2):143–59. https://doi.org/10.1007/s11940-011-0113-1.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Barbano RL, Herrmann DN, Hart-Gouleau S, Pennella-Vaughan J, Lodewick PA, Dworkin RH. Effectiveness, tolerability, and impact on quality of life of the 5% lidocaine patch in diabetic polyneuropathy. Arch Neurol. 2004;61(6):914–8. https://doi.org/10.1001/archneur.61.6.914.

    Article  PubMed  Google Scholar 

  50. Fulas OA, Laferriere A, Stein RS, Bohle DS, Coderre TJ. Topical combination of meldonium and N-acetyl cysteine relieves allodynia in rat models of CRPS-1 and peripheral neuropathic pain by enhancing NO-mediated tissue oxygenation. J Neurochem. 2020;152(5):570–84. https://doi.org/10.1111/jnc.14943.

    Article  CAS  PubMed  Google Scholar 

  51. Boyaji S, Merkow J, Elman RNM, Kaye AD, Yong RJ, Urman RD. The role of cannabidiol (CBD) in chronic pain management: an assessment of current evidence. Curr Pain Headache Rep. 2020;24(2):4. https://doi.org/10.1007/s11916-020-0835-4.

    Article  PubMed  Google Scholar 

  52. • Xu DH, Cullen BD, Tang M, Fang Y. The effectiveness of topical cannabidiol oil in symptomatic relief of peripheral neuropathy of the lower extremities. Curr pharm. Biotechnol. 2020;21(5):390–402. https://doi.org/10.2174/1389201020666191202111534The efficacy of transdermal CBD oil in patients with symptomatic peripheral neuropathy was investigated. The evidence suggested that CBD oil ameliorated the pain and other sensations in these patients.

    Article  CAS  Google Scholar 

  53. Mu A, Weinberg E, Moulin DE, Clarke H. Pharmacologic management of chronic neuropathic pain: review of the Canadian Pain Society consensus statement. Can Fam Physician. 2017;63(11):844–52.

    PubMed  PubMed Central  Google Scholar 

  54. Dore K, Stein IS, Brock JA, Castillo PE, Zito K, Sjostrom PJ. Unconventional NMDA receptor signaling. J Neurosci. 2017;37(45):10800–7. https://doi.org/10.1523/jneurosci.1825-17.2017.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Zhou HY, Chen SR, Chen H, Pan HL. Opioid-induced long-term potentiation in the spinal cord is a presynaptic event. J Neurosci. 2010;30(12):4460–6. https://doi.org/10.1523/jneurosci.5857-09.2010.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Liu H, Mantyh PW, Basbaum AI. NMDA-receptor regulation of substance P release from primary afferent nociceptors. Nature. 1997;386(6626):721–4. https://doi.org/10.1038/386721a0.

    Article  CAS  PubMed  Google Scholar 

  57. Aiyer R, Mehta N, Gungor S, Gulati A. A systematic review of NMDA receptor antagonists for treatment of neuropathic pain in clinical practice. Clin J Pain. 2018;34(5):450–67. https://doi.org/10.1097/ajp.0000000000000547.

    Article  PubMed  Google Scholar 

  58. Cvrcek P. Side effects of ketamine in the long-term treatment of neuropathic pain. Pain Med. 2008;9(2):253–7. https://doi.org/10.1111/j.1526-4637.2007.00314.x.

    Article  PubMed  Google Scholar 

  59. Farber NB, Jiang XP, Heinkel C, Nemmers B. Antiepileptic drugs and agents that inhibit voltage-gated sodium channels prevent NMDA antagonist neurotoxicity. Mol Psychiatry. 2002;7(7):726–33. https://doi.org/10.1038/sj.mp.4001087.

    Article  CAS  PubMed  Google Scholar 

  60. Lampe H, Bigalke H. Carbamazepine blocks NMDA-activated currents in cultured spinal cord neurons. Neuroreport. 1990;1(1):26–8. https://doi.org/10.1097/00001756-199009000-00008.

    Article  CAS  PubMed  Google Scholar 

  61. Delcker A, Wilhelm H, Timmann D, Diener HC. Side effects from increased doses of carbamazepine on neuropsychological and posturographic parameters of humans. Eur Neuropsychopharmacol. 1997;7(3):213–8. https://doi.org/10.1016/s0924-977x(97)00406-9.

    Article  CAS  PubMed  Google Scholar 

  62. Al-Quliti KW. Update on neuropathic pain treatment for trigeminal neuralgia. The pharmacological and surgical options. Neurosciences (Riyadh). 2015;20(2):107–14. https://doi.org/10.17712/nsj.2015.2.20140501.

    Article  Google Scholar 

  63. Bouhassira D, Lantéri-Minet M, Attal N, Laurent B. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain. 2008;136(3):380–7. https://doi.org/10.1016/j.pain.2007.08.013.

    Article  PubMed  Google Scholar 

  64. Bakkers M, Faber CG, Hoeijmakers JG, Lauria G, Merkies IS. Small fibers, large impact: quality of life in small-fiber neuropathy. Muscle Nerve. 2014;49(3):329–36. https://doi.org/10.1002/mus.23910.

    Article  PubMed  Google Scholar 

  65. Khoshnoodi MA, Truelove S, Burakgazi A, Hoke A, Mammen AL, Polydefkis M. Longitudinal assessment of small fiber neuropathy: evidence of a non-length-dependent distal axonopathy. JAMA Neurol. 2016;73(6):684–90. https://doi.org/10.1001/jamaneurol.2016.0057.

    Article  PubMed  Google Scholar 

  66. Flossdorf P, Haupt WF, Brunn A, Deckert M, Fink GR, Lehmann HC, et al. Long-time course of idiopathic small fiber neuropathy. Eur Neurol. 2018;79(3–4):161–5. https://doi.org/10.1159/000487717.

    Article  CAS  PubMed  Google Scholar 

  67. MacDonald S, Sharma TL, Li J, Polston D, Li Y. Longitudinal follow-up of biopsy-proven small fiber neuropathy. Muscle Nerve. 2019;60(4):376–81. https://doi.org/10.1002/mus.26648.

    Article  CAS  PubMed  Google Scholar 

  68. Moulin D, Boulanger A, Clark AJ, Clarke H, Dao T, Finley GA, et al. Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society. Pain Res Manag. 2014;19(6):328–35. https://doi.org/10.1155/2014/754693.

    Article  PubMed  PubMed Central  Google Scholar 

  69. O’Connor AB, Dworkin RH. Treatment of neuropathic pain: an overview of recent guidelines. Am J Med. 2009;122(10 Suppl):S22–32. https://doi.org/10.1016/j.amjmed.2009.04.007.

    Article  PubMed  Google Scholar 

  70. Trouvin AP, Perrot S, Lloret-Linares C. Efficacy of venlafaxine in neuropathic pain: a narrative review of optimized treatment. Clin Ther. 2017;39(6):1104–22. https://doi.org/10.1016/j.clinthera.2017.05.347.

    Article  CAS  PubMed  Google Scholar 

  71. Thakral G, Kim PJ, LaFontaine J, Menzies R, Najafi B, Lavery LA. Electrical stimulation as an adjunctive treatment of painful and sensory diabetic neuropathy. J Diabetes Sci Technol. 2013;7(5):1202–9. https://doi.org/10.1177/193229681300700510.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Saint Louis University, St. Louis, MO, USA

    Tikku George MD, Jafar Kafaie MD, PhD & Zi Ling Huang BS

  2. Department of Pharmaceutical and Administrative Sciences, Saint Louis College of Pharmacy, 4588 Parkview Pl., Saint Louis, MO, 63110, USA

    Jasmina Profirovic BPharm, PhD

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  1. Tikku George MD
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Correspondence to Jasmina Profirovic BPharm, PhD.

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George, T., Kafaie, J., Huang, Z.L. et al. Pharmacotherapy for Small Fiber Neuropathy. Curr Treat Options Neurol 22, 41 (2020). https://doi.org/10.1007/s11940-020-00652-2

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