Unifying Concepts

Diagnostic Criteria for Small Fibre Neuropathy (SFN)

Small fiber neuropathy manifests in a variety of different diseases and often results in symptoms of burning pain, shooting pain, allodynia, and hyperesthesia.

Patients are diagnosed with small fibre neuropathy (SFN) when at least two of the following examinations are abnormal:

  1. Clinical signs of small fibre impairment (pinprick and thermal sensory loss and/or allodynia and/or hyperalgesia), which distribution is consistent with peripheral neuropathy (length or non-length dependent neuropathy);
  2. Abnormal warm and/or cooling threshold at the foot assessed by quantitative sensory testing (QST);
  3. Reduced intraepidermal nerve fibres (IENF) density at the distal leg.

SFN are ruled out in the presence of:

  1. any sign of large fibre impairment (light touch and/or vibratory and/or proprioceptive sensory loss and/or absent deep tendon reflexes);
  2. any sign of motor fibre impairment (muscle waste and/or weakness);
  3. any abnormality on sensorimotor nerve conduction study (NCS).




  1. Devigili G, Tugnoli V, Penza P, Camozzi F, Lombardi R, Melli G, Broglio L, Granieri E, Lauria G. The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology. Brain. 2008 Jul;131(Pt 7):1912-25. [Medline]


Created: Sep 15, 2009

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