Table 1.

Practical tips for the best treatment strategy for small fiber neuropathy in the elderly

Practical tips for the clinician
Always make the best choice considering safety and tolerability, strive for tailor-made therapy and individualization of care in clinical practice
Local treatment	In case of focal pain distribution or systemic contra-indications
Medication	Take a careful medication history Ask for previous adverse effects, inadequate effects, inadequate dose Check for comorbidity such as liver and kidney impairment Check potential interactions with other drugs, herbs, caffeine, smoking, grapefruit Adjust dose if necessary Consider genetic testing in patients with a history of many side effects Make patient also responsible for medication history by handing out a form for medication
Opioids	Avoid instant-release opioids Start strong opioids only as third-line treatment Be aware of the potential risks
Social context	Ask for impact on sleep, work, daily functioning, relationship, and anxiety, and treat when possible
Age	Avoid polypharmacy as much as possible Strive for treatment with the least side effects Always start low, go slow!
AND if nothing works consider multi-targeting!