Fig. 2.

Treatment algorithm for SFN in the elderly. In addition to physical factors, psychological, neurophysiological, socio-economic and cultural aspects may influence the experience and maintain pain; a multidisciplinary approach in line with the biopsychosocial model is required in optimizing treatment for the individual patient [41]. Asterisks see also Fig. 3 (contra-indication algorithm for drugs prescription) and Table 1 (Practical tips for the best treatment strategy for SFN in the elderly). Hash in contrast with first-line neuropathic pain treatment in adults <65 years, TCAs should be avoided in older adults, because of the risk of adverse events, such as cardiac arrhythmia, somnolence, hypotension with increased risk of falls and injury, cognitive impairment, and anticholinergic side effects [62]. SFN small fiber neuropathy, SNRI serotonin-noradrenalin reuptake inhibitor, TCA tricyclic antidepressant