Fibromyalgia as a Localized Non-Length-Dependent Small Fiber Neuropathy, Responding to Topical Phenytoin

A number of fibromyalgia patients were treated by prescribing a topical analgesic treatment based on phenytoin cream. This often resulted in clinical relevant pain reduction and increased quality of life. One explanation of this phenomenon could be that these patients are not suffering from fibromyalgia in a classic sense. In reality they might suffer from localized non-length-dependent small fiber neuropathy (NLDSFN). Recent studies suggest a prevalence of small fiber pathology in around 50% of all fibromyalgia patients. This would imply that half of all patients suffering from fibromyalgia might profit from a topical treatment based on the broad acting sodium channel blocker phenytoin