Additionally, it can contribute in the differentiation between pain of a peripheral nature vs. QST, when combined with other clinical and sub-clinical tests, can be extremely helpful in diagnosing the pain-mediating, neurosensory nerve pathway and nerve root involved in a patient’s pain condition. It is well documented that small-caliber C-fibers are responsible for pain transmission, which can mainly be evaluated with Quantitative Sensory Testing. In fact, spontaneous and stimulus-evoked positive sensory symptoms frequently dominate the clinical picture and can hide the signs of small fiber loss, namely thermal and pinprick hypoesthesia. Small fibers are invisible to routine nerve conduction studies and their damage most frequently causes a neuropathic pain syndrome, making the diagnosis of SFN often particularly difficult. Although small fibers encompass thermal and nociceptive sensation as well as autonomic functions, SFN commonly refers to somatic neuropathy alone and the overlap with the term ‘painful neuropathy’ is accepted. In the last decade, after the availability of new tools for investigating unmyelinated C and thinly myelinated A-delta fibers, Small Fiber Neuropathy (SFN) has been recognized as a distinct nosologic entity. Disorders of ‘sensation’ are very common in clinical medicine.
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