Small Fiber and Painful Neuropathy

  • Sanjeev Kelkar


Small fiber neuropathic abnormalities are somewhat different, finer, and little difficult to understand and hence have been treated in this chapter. Pain is the intimate sensation associated with these. A somewhat deeper understanding of pain-related issues will help the clinician to communicate the nature of painful neuropathies and the partial results obtained in its treatment. Pain and thermal sensations are injurious to the body if the acuteness of these is grossly reduced. These are also among the early neural fibers that are damaged before the larger nerve fibers are damaged. That is why its earliest possible diagnosis becomes important to prevent further damage to the tissue. Excellent laboratory support for this detection is available and is described in detail. The treatment of this is described separately in a later chapter.


  1. 1.
    Singer W, Spies JM, McArthur J, Low J, Griffin JW, Nickander KK, Gordon V, Low PA. Prospective evaluation of somatic and autonomic small fibers in selected autonomic neuropathies. Neurology. 2004;62:612–8. PubMed: 14981179.CrossRefGoogle Scholar
  2. 2.
    Dabby R, Vaknine H, Gilad R, Djaldetti R, Sadeh M. Evaluation of cutaneous autonomic innervation in idiopathic sensory small-fiber neuropathy. J Peripher Nerv Syst. 2007;12:98–101. [PubMed: 17565534].CrossRefGoogle Scholar
  3. 3.
    Russell JW, Sullivan KA, Windebank AJ, Herrmann DN, Feldman EL. Neurons undergo apoptosis in animal and cell culture models of diabetes. Neurobiol Dis. 1999;6:347–63. [PubMed: 10527803].CrossRefGoogle Scholar
  4. 4.
    Singleton JR, Smith AG, Bromberg MB. Increased prevalence of impaired glucose tolerance in patients with painful sensory neuropathy. Diabetes Care. 2001;24:1448–53. [PubMed: 11473085].CrossRefGoogle Scholar
  5. 5.
    Tesfaye S, Chaturvedi N, Eaton SE, Ward JD, Manes C, Ionescu-Tirgoviste C, Witte DR, Fuller JH. Vascular risk factors and diabetic neuropathy. N Engl J Med. 2005;352:341–50. [PubMed: 15673800].CrossRefGoogle Scholar
  6. 6.
    Costa LA, Canani LH, Lisboa HR, Tres GS, Gross JL. Aggregation of features of the metabolic syndrome is associated with increased prevalence of chronic complications in type 2 diabetes. Diabet Med. 2004;21:252–5. [PubMed: 15008835].CrossRefGoogle Scholar
  7. 7.
    Vincent AM, Hinder LM, Pop-Busui R, Feldman EL. Hyperlipidemia: a new therapeutic target for diabetic neuropathy. J Peripher Nerv Syst. 2009;14:257–67. [PubMed: 20021567].CrossRefGoogle Scholar
  8. 8.
    Wiggin TD, Sullivan KA, Pop-Busui R, Amato A, Sima AA, Feldman EL. Elevated triglycerides correlate with progression of diabetic neuropathy. Diabetes. 2009;58:1634–40. PubMed: 19411614.CrossRefGoogle Scholar
  9. 9.
    Gibbons CH, Freeman R. Treatment-induced diabetic neuropathy: a reversible painful autonomic neuropathy. Ann Neurol. 2010;67:534–41. [PubMed: 20437589].CrossRefGoogle Scholar
  10. 10.
    Guyton & Hall. Pennsylvania, USA. In: Textbook of Medical Physiology. 11th ed: Elsevier Inc.; 2006. International Edition ISBN 0-8089-2317-X.Google Scholar
  11. 11.
    Raputova J, Srotova I, Vlckova E, Sommer C, Üçeyler N, Birklein F, Rittner HL, Rebhorn C, Adamova B, Kovalova I, Kralickova Nekvapilova E, Forer L, Belobradkova J, Olsovsky J, Weber P, Dusek L, Jarkovsky J, Bednarik J. Sensory phenotype and risk factors for painful diabetic neuropathy: a cross-sectional observational study. Pain. 2017;158(12):2340–53.CrossRefGoogle Scholar
  12. 12.
    Sumner CJ, Sheth S, Griffin JW, Cornblath DR, Polydefkis M. The spectrum of neuropathy in diabetes and impaired glucose tolerance. Neurology. 2003;60:108–11.CrossRefGoogle Scholar
  13. 13.
    Rolke R, Baron R, Maier C, Tolle TR, Treede RD, Beyer A, Binder A, Birbaumer N, Birklein F, Botefur IC, Braune S, Flor H, Huge V, Klug R, Landwehrmeyer GB, Magerl W, Maihofner C, Rolko C, Schaub C, Scherens A, Sprenger T, Valet M, Wasserka B. Quantitative sensory testing in the German research network on neuropathic pain (DFNS): standardized protocol and reference values. Pain. 2006;123:231–43.CrossRefGoogle Scholar
  14. 14.
    Paisley AN, Abbott CA, van Schie CH, Boulton AJ. A comparison of the Neuropen against standard quantitative sensory-threshold measures for assessing peripheral nerve function. Diabet Med. 2002;19:400–5.CrossRefGoogle Scholar
  15. 15.
    Baumgartner U, Magerl W, Klein T, Hopf HC, Treede R-D. Neurogenic hyperalgesia versus painful hypoalgesia: two distinct mechanisms of neuropathic pain. Pain. 2002;96:141–51.CrossRefGoogle Scholar
  16. 16.
    Chan AW, MacFarlane IA, Bowsher D, Campbell JA. Weighted needle pinprick sensory thresholds: a simple test of sensory function in diabetic peripheral neuropathy. J Neurol Neurosurg Psychiatry. 1992;55:56–9.CrossRefGoogle Scholar
  17. 17.
    Magerl W, Wilk SH, Treede R-D. Secondary hyperalgesia and perceptual wind-up following intradermal injection of capsaicin in humans. Pain. 1998;74:257–68.CrossRefGoogle Scholar
  18. 18.
    Nguyen M, Henniges W, Lobisch M, Reifert S, Larbig M, Pfützner A, and Forst T, Evaluation of SET–A New Device for the Measurement of Pain Perception in Comparison to Standard Measures of Diabetic Neuropathy. Diabetes Technol Ther. 2004;6(5):601–606. Published Online:12 October 2004.CrossRefGoogle Scholar
  19. 19.
    Ponirakis G, Odriozola MN, Odriozola S, et al. NerveCheck: an inexpensive quantitative sensory testing device for patients with diabetic neuropathy. Diabetes Res Clin Pract. 2016;113:101–7.CrossRefGoogle Scholar
  20. 20.
    Haanpaa M, Attal N, Backonja M, et al. NeuPSIG guidelines on neuropathic pain assessment. Pain. 2011;152:14–27.CrossRefGoogle Scholar
  21. 21.
    Greenspan JD. Quantitative assessment of neuropathic pain. Curr Pain Headache Rep. 2001;5:107–13.CrossRefGoogle Scholar
  22. 22.
    Dworkin RH, Backonja M, Rowbotham MC, Allen RR, Argoff CR, Bennett GJ, et al. Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Arch Neurol. 2003;60:1524–34.CrossRefGoogle Scholar
  23. 23.
    Bendtsen L, Jensen R, Olesen J. Qualitatively altered nociception in chronic myofascial pain. Pain. 1996;65:259–64.CrossRefGoogle Scholar
  24. 24.
    Brennum J, Kjeldsen M, Jensen K, Jensen TS. Measurements of human pressure–pain thresholds on fingers and toes. Pain. 1989;38:211–7.CrossRefGoogle Scholar
  25. 25.
    Treede R-D, Rolke R, Andrews K, Magerl W. Pain elicited by blunt pressure: neurobiological basis and clinical relevance. Pain. 2002;98:235–40.CrossRefGoogle Scholar
  26. 26.
    Fischer AA. Pressure algometry over normal muscles. Standard values, validity, and reproducibility of pressure thresholds. Pain. 1987;30:115–26.CrossRefGoogle Scholar
  27. 27.
    Kosek E, Ekholm J, Hansson P. Pressure pain thresholds in different tissues in one body region. The influence of skin sensitivity in pressure algometry. Scand J Rehabil Med. 1999;31:89–93.CrossRefGoogle Scholar
  28. 28.
    Dhansai Laboratory, Mumbai, India (2019) Manual Of Operation for Heat and Cold Sensitometer.Google Scholar

Further Reading

  1. American Association of Electrodiagnostic Medicine Review: Quantitative Sensory Testing Equipment and Reproducibility Studies; A literature review of QST can be found in Muscle & Nerve, in the May 2004 issue, volume 29, pages 734–747 or on the Muscle & Nerve website at:
  2. Rolke R, Magerl W, Campbell KA, Schalber C, Caspari S, Birklein F, Treede RD. Quantitative sensory testing: a comprehensive protocol for clinical trials. Eur J Pain. 2006;10:77–88.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Sanjeev Kelkar
    • 1
  1. 1.Independent Health ResearcherPuneIndia

Personalised recommendations