Overview
Sensory neuropathy involves dysfunction of peripheral nerves leading to sensory disturbances such as pain, numbness, and tingling, often seen in conditions like HIV infection and congenital syndromes 125.Diagnosis
Clinical assessment focusing on sensory deficits (pain, temperature, vibration perception) 15.
Electromyography (EMG) and nerve conduction studies to evaluate peripheral nerve function 1.
Skin biopsy for small nerve fiber assessment in complex cases 1.
Blood group antigen-related glycoepitope expression in DRG neurons may indicate specific pathophysiological mechanisms 4.Management
First-line treatments:
- Amitriptyline: Titrated to median 50 mg (IQR 25-50 mg) for moderate to severe pain in HIV-associated neuropathy 2.
- Smoked cannabis (3.56% THC): Three times daily for 5 days, showing significant pain reduction 3.
Adjunctive treatments:
- Consider adjunctive therapies based on individual patient response and comorbidities 23.Special Populations
Pediatrics: Congenital sensory neuropathy with anhidrosis (CSNA) requires multidisciplinary care addressing self-mutilation and orthopedic complications 5.
Comorbidities: Management in HIV-infected patients should consider antiretroviral therapy interactions and efficacy 23.Key Recommendations
Use amitriptyline as a first-line analgesic for moderate to severe painful HIV-associated sensory neuropathy, titrated to 50 mg (IQR 25-50 mg) daily (Evidence: Moderate 2).
Consider smoked cannabis as an adjunctive treatment option for significant pain relief in HIV-associated sensory neuropathy, with careful monitoring (Evidence: Moderate 3).
In congenital sensory neuropathy with anhidrosis, prioritize comprehensive care addressing sensory deficits, anhidrosis, and behavioral issues (Evidence: Expert opinion 5).References
1 Roberts RC. Removing the idiopathic from the chronic sensory neuropathies. Brain : a journal of neurology 2021. link
2 Dinat N, Marinda E, Moch S, Rice AS, Kamerman PR. Randomized, Double-Blind, Crossover Trial of Amitriptyline for Analgesia in Painful HIV-Associated Sensory Neuropathy. PloS one 2015. link
3 Abrams DI, Jay CA, Shade SB, Vizoso H, Reda H, Press S et al.. Cannabis in painful HIV-associated sensory neuropathy: a randomized placebo-controlled trial. Neurology 2007. link
4 Yamada M, Yuki N, Kamata T, Itoh Y, Miyatake T. Expression of a blood group B antigen-related glycoepitope in human dorsal root ganglion cells. Journal of the neurological sciences 1994. link90270-4)
5 Ishii N, Kawaguchi H, Miyakawa K, Nakajima H. Congenital sensory neuropathy with anhidrosis. Archives of dermatology 1988. link