Cognitive behavioral therapy in patients with small fiber neuropathy

Small fiber neuropathy (SFN) is a condition that is dominated by invalidating
neuropathic pain. Pharmacological neuropathic pain treatment is often
disappointing, since pain reduction is mostly slight and side effects can be
debilitating. Although neuropathic pain is caused by a lesion of the
somatosensory system, also psychological factors, such as fear and
catastrophizing, appear to play a role in the origin and maintenance of
disability in chronic pain. Rehabilitation based on pain education and
cognitive behavioral treatment including elements of acceptance and commitment
therapy, exposure in vivo or graded activity can be performed to influence
these factors. To date no specific rehabilitation programs are available for
patients diagnosed with SFN.

The main objective is that a cognitive behavioral intervention for patients
with SFN will have a positive effect on disability and quality of life.

Sequential replicated randomized single-case experimental ABCD-design

Every patient will receive a personalized treatment containing education and a
set of sessions improving physical functioning based on a cognitive behavioral
approach. All participants start with an educational session. In addition, a
personalized treatment based on a cognitive behavioral approach will follow
including one or more of the following elements (depending on a patient*s
profile):
1. Exposure in vivo (to change catastrophic (mis)interpretations). 2.
Acceptance and commitment therapy (to increase the psychosocial flexibility,
and to accept events, but not to change the events). 3. Graded activity (aims
to gradually increase the amount of activity with the operant conditioning
principle). The total length of treatment for all participants will be 8-10
weeks (with two sessions each week)

All participants will receive one of the rehabilitation treatments. It is
expected that the risks associated with participation in the study are
negligible and that the burden will be minimal. The measurements that will be
conducted during the study consist of diaries and questionnaires and are not
invasive or risky full.
SFN is a chronic neuropathic pain condition, with autonomic dysfunction.
Adverse events are rarely seen in patients with small fiber neuropathy. Pain
will not be recorded as AE. It is known that patients will experience more pain
from practical experience since they are stimulated to increase their activity
level during therapy and will be actively engaged with their pain. This
temporary increase in pain is not harmful