Living with small fibre neuropathy often means being believed less than you should be, because standard nerve tests come back normal. Practical management targets burning pain, touch sensitivity, sleep, and any autonomic symptoms. Autonomic symptoms including dry eyes, altered sweating and light-headedness on standing may accompany it, and each is treatable rather than something to tolerate.
Living with small fibre neuropathy often means being believed less than you should be, because standard nerve tests come back normal. Practical management targets burning pain, touch sensitivity, sleep, and any autonomic symptoms. Autonomic symptoms including dry eyes, altered sweating and light-headedness on standing may accompany it, and each is treatable rather than something to tolerate.
Standard nerve conduction studies assess large fibres and are normal in small fibre neuropathy, so many people are told their tests are fine while experiencing severe burning pain. That leads to being doubted, sometimes by clinicians, and to doubting yourself. Understanding why the test is normal helps: it examines a different set of fibres entirely. Carrying a copy of any confirmatory skin biopsy result is practically useful when seeing new clinicians who may not know the condition well.
Allodynia, where light touch becomes painful, drives many of the practical adaptations. Loose clothing and soft seamless socks, a bed cradle or loose bedding to keep sheets off the feet, and a cooler room all help. Some people find cool water or a fan soothing; others find cold makes it worse, and both are legitimate. Medications used for nerve pain help substantially for many; ordinary painkillers do not. Topical agents are worth discussing for localised areas.
Small fibres also carry autonomic signals, so dry eyes and mouth, altered sweating, light-headedness on standing, and bowel or bladder changes may accompany the pain. Each is treatable and worth reporting rather than tolerating. Keep pursuing a cause: glucose tolerance testing matters because impaired tolerance short of diabetes is a recognised cause, along with B12, excess vitamin B6, thyroid function, autoimmune conditions and medications. A proportion remain idiopathic.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: peripheral nerve disorders; National Institute of Neurological Disorders and Stroke; MedlinePlus, National Library of Medicine.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.