The small nerve fibres, terminating under the skin, are responsible for the sensation of pain and temperature. Patients with small fibre neuropathy often experience spontaneous pain without external cause, such as a trauma. Normal touch of the skin may be painful (allodynia). This may lead to intolerance for sheets or wearing shoes. The pain often is described as burning, sharp or shooting. Pain sensation in relation to painful stimuli on the other hand may be reduced.
Also, patients may have a reduced sensation in relation to temperature sensitivity (warm/cold), for example when taking a shower. Itch may also be a troublesome symptom of small nerve fibre impairment
The complaints often have a nerve length-dependent distribution meaning that the complaints start in the feet and hands, and may slowly spread to legs and arms. Occasionally the complaints have a more patchy distribution, and can occur in the face or trunk.