Peripheral Neuropathy or Fibromyalgia? Making the Right Diagnosis

Peripheral Neuropathy or Fibromyalgia? Making the Right Diagnosis

Fatigue. Brain fog. Widespread pain. Burning feet. Pins and needles. If these symptoms sound familiar, they should—fibromyalgia and peripheral neuropathy share more clinical overlap than most realize.

Unfortunately, this overlap often leads to misdiagnosis. Patients are frequently told they have fibromyalgia when in fact, they have treatable small fiber neuropathy. In a traditional system, these patients get labeled, medicated, and sent on their way. In your private practice, you can offer something better: clarity, validation, and a plan.

Where the Overlap Occurs

Many patients diagnosed with fibromyalgia actually meet criteria for neuropathy, including:

• Burning or tingling in feet or hands

• Allodynia (pain from light touch)

• Restless legs or cramping

• Symptoms worse at night or in heat

• “Weird” sensations that come and go

Recent studies show a significant percentage of fibromyalgia patients have confirmed small fiber neuropathy upon skin biopsy or detailed neurologic evaluation.

Fibromyalgia or SFN? How to Tell

As a direct-pay physician, you have time to listen and examine thoroughly, something most patients with these symptoms never experience.

What to Evaluate:

• Symptom localization: fibromyalgia tends to be diffuse; neuropathy more distal

• Neurologic testing: vibration, pinprick, temperature, and monofilament

• Autonomic symptoms (e.g., sweating changes, GI irregularities) that suggest SFN

• Labs: B12, B6, ANA, thyroid panel, glucose, CRP

• Family or medication history for neuropathic risk factors

Why It Matters

Fibromyalgia is a diagnosis of exclusion. If you catch small fiber neuropathy early, you can intervene before chronic central pain patterns develop. That means better outcomes—and more hope for your patients.

Want to Help Patients Misdiagnosed and Misunderstood?

Book a Strategy Session with John Hayes Jr., MD to see what protocols help independent physicians diagnose small fiber neuropathy early and differentiate it from syndromes that patients have been told to “just live with.”