This word is misleading when it comes to small fiber damage.

The only real treatment is removing the offending substance, and creating
an environment where the nerves may heal.

http://neuroskinbiopsy.mgh.harvard.edu/smallfiber.htm

1) if a toxin or drug is causing this...removing it has to be done.

2) if an autoimmune process is going on (gluten) or other, then that should
be measured. Some immune suppressing drugs may help (or may not).
Going gluten free for those reacting to gliadin, often helps. We had several people in the past for whom this worked wonders.

3) Prediabetes, insulin resistance, and frank diabetes must be handled appropriately. The sorbitol pathway is what damages the nerves.

4) nutritional challenges, such as low B12, MTFHR folate genetic errors ID'd,
thiamine deficiency, low iron, EFA deficiency all can be remedied and healing
may occur and damage ended. Some patients find mitochondrial supports very effective. (l-carnitine and CoQ-10)

Therapy for small fiber as it stands today involves typically symptom relief.
There is a list of treatments in the stickies. They are called "treatments" but they are only symptom relief...they do not change the course of PN.

The only REAL treatment is IVIG.

This sticky has some good posts on it:
http://neurotalk.psychcentral.com/thread177-2.html
post #13 is an old list I used to have up a couple of years ago.

I'd add to it, but we have an edit time of 24 hrs.
(I would add r-lipoic acid instead of alpha lipoic, and benfotiamine to the thiamine entry). R-lipoic acid is very effective for insulin resistance.

Many people over 40 (some experts say all people over 40) have some degree of insulin resistance. While it is not diabetes yet, it has potential for causing the beginnings of sensory PN. It will show up with a fasting INSULIN level being taken--which will be elevated. Often changes in diet, tending to less carbs and more protein and 10% more good fats will keep it in check. Some people use oral antidiabetic drugs for this..like metformin, or Actos. Females with polycystic ovary disease
often have insulin resistance.

So I think it is a good idea to have the skin biopsy if you have significant issues. It will tell you if damage is present. And then you go from there.