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Review
Peer-Review Record

Management of Chronic Pain Associated with Small Fiber Neuropathy Secondary to SARS-CoV-2

Int. J. Transl. Med. 2025, 5(2), 24; https://doi.org/10.3390/ijtm5020024
by Anirudh Bhimavarapu 1, Hana Mucevic 1, Sadiq Rahman 2,* and Amruta Desai 2
Reviewer 1: Anonymous
Reviewer 2: Anonymous
Int. J. Transl. Med. 2025, 5(2), 24; https://doi.org/10.3390/ijtm5020024
Submission received: 18 March 2025 / Revised: 30 May 2025 / Accepted: 11 June 2025 / Published: 13 June 2025

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The review may be accepted in its present form.

Author Response

Thank you kindly for reviewing our article.

Reviewer 2 Report

Comments and Suggestions for Authors

General Comments:
This narrative review addresses an increasingly relevant topic—small fiber neuropathy (SFN) as a potential neurological complication of COVID-19. It attempts to synthesize the proposed mechanisms and summarize available treatment options. While the topic is timely and the structure is logical, the manuscript requires refinement in multiple areas to reach publishable quality.

Scientific Quality and Content:

  1. Lack of Methodological Rigor:
    A major limitation is the absence of a clearly defined methodology. Even for narrative reviews, authors should outline how literature was selected (databases searched, inclusion/exclusion criteria, years covered, etc.).

  2. Heterogeneous Use of Evidence:
    The review relies heavily on case reports and small series, but it does not consistently distinguish levels of evidence. Consider adding a short comment on the strength of evidence when citing a source (e.g., case report vs. systematic review).

  3. Redundancy:
    Several points are repeated across sections (e.g., SFN symptoms and diagnostic methods appear in the introduction, diagnosis, and discussion). Streamlining the text would improve readability.

  4. Discussion Needs Expansion:
    The discussion could benefit from a more critical analysis of current gaps in knowledge, such as diagnostic criteria for COVID-associated SFN and the lack of consensus on IVIG treatment effectiveness.

  5. Figures or Tables Recommended:
    Including a table summarizing treatments and their reported efficacy in post-COVID SFN would greatly enhance the practical value of the review. A visual diagram of the hypothesized mechanisms would be helpful for readers.

Comments on the Quality of English Language
  • The manuscript is readable but requires polishing.

  • Issues such as verb tense inconsistencies, awkward phrasing, and typographical errors (e.g., "biops" instead of "biopsy") detract from the professional tone.

  • I suggest a full grammar and style check before resubmission.

Author Response

Thank you for your comments. We have included a methodology section now and expanded our discussion. 

Reviewer 3 Report

Comments and Suggestions for Authors

In the article titled “Management of Chronic Pain associated with Small Fiber Neuropathy Secondary to SARS-CoV-2”, the authors review small fiber neuropathy (SFN) as a potential sequela of COVID-19.

There are several points that need to be addressed.

It is important to include a more thoughtful discussion that compares and prioritizes mechanisms and treatments based on available evidence.

The discussion on vaccination is limited; post-vaccination SFN is mentioned, but this aspect could be better developed with emphasis on its prevalence and differentiation from the post-infection presentation.

The final section is more of a recap than a strong conclusion with clear clinical or future research proposals.

Scientific Writing and Style: There are some typographical errors (such as "biops" instead of "biopsy") and redundant or unpolished phrases that may hinder smooth reading.

Minor Points:
Please verify the following:

On page 2, line 56, there is a number “4” after “damaged”.

On page 2, line 72, there is a number “9” after “SFN”.

On page 2, line 73, there is a number “6” after “SFN”.

On page 2, line 92, there is a number “218” after “interleukin”.

Suggestions:

Add a comparative table: Include a chart summarizing the main reported treatments for post-COVID SFN, with doses, outcomes, and levels of evidence.

Strengthen the conclusion: Clearly state clinical implications (e.g., when to suspect post-COVID SFN) and priority areas for research.

Review the writing: Correct minor errors and improve the fluency of some sections to enhance academic rigor and clarity.

Include a multidisciplinary approach: Discuss how specialists in neurology, immunology, and rehabilitation should be involved in managing these cases.

Explore the Social/Health Impact: Include a brief reflection on the burden of this condition on post-pandemic healthcare systems and its functional impact on patients.

Author Response

Thank you for your comments. We have worked to address your points and streamline our discussion section and add figures / tables.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

I have no further comments

Reviewer 3 Report

Comments and Suggestions for Authors

Thanks to the authors for their replies, with the changes done to the manuscript, it was substantially improved.

 

 

 

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