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Small-fiber neuropathy (SFN) is a subset of peripheral neuropathy that affects primarily thermal and pain fibers, autonomic function, or both. The condition may be particularly vexing because of difficulties in diagnosis and in managing neuropathic pain, a common feature.
This comprehensive review of SFN begins with the pertinent neurophysiology. The reviewers note that the most common presentation is "burning feet" and that most SFNs are length-dependent and evolve slowly, although multifocal presentations do occur. The degree of autonomic involvement varies. The most important known cause of SFN is diabetes mellitus. Other causes include impaired glucose tolerance, hyperlipidemia, amyloidosis, viral infections, alcoholism, vasculitis, and …