Overview

Small Fiber Neuropathy affects the smallest nerves in your body. These tiny nerves control how you feel pain, temperature, and touch. When they don't work properly, you might feel strange or painful sensations that can be hard to describe to others.
The symptoms of SFN can be different for each person. Some people have mild symptoms that come and go. Others have constant pain that affects their daily life. Understanding your symptoms is the first step toward getting the help you need.
SFN symptoms often start in your feet and hands and can slowly spread up your limbs. This is called a stocking-glove pattern. Not everyone follows this pattern. Some people have patchy or changing symptoms that may affect the face, trunk, or other areas. These patterns are more common when the cause is immune-related, such as Sjögren syndrome or sarcoidosis. Knowing the pattern can help your doctor make the right diagnosis and plan treatment.

Common Symptoms

The most common symptoms include burning pain, stabbing pain, tingling, and numbness. You might also notice that your skin becomes very sensitive to light touch. Something as simple as bed sheets touching your feet can feel uncomfortable or painful.
  • Burning pain - Often described as feeling like your feet are on fire. This is usually the most common and troubling symptom.
  • Gastrointestinal symptoms - Some people have problems with digestion, like bloating, constipation, or diarrhea.
  • Itching - Some people experience intense itching without any visible skin problems.
  • Muscle weakness - Your hands or feet might feel weak, making it hard to grip things or walk normally.
  • Numbness - Loss of feeling in your hands or feet. You might not notice cuts, burns, or other injuries.
  • Patchy, migratory, or asymmetric symptoms - Pain, tingling, or numbness that moves around, affects one side, or involves the face, trunk, or other areas. These patterns are more common in immune-related SFN.
  • Sensitivity to touch - Light touches that normally wouldn't bother you can feel painful or uncomfortable.
  • Sexual dysfunction - Some people experience changes in sexual function, including erectile dysfunction or vaginal dryness.
  • Stabbing or shooting pain - Sharp pains that come suddenly and can feel like electric shocks or being stabbed with needles.
  • Temperature problems - Difficulty telling if something is hot or cold, or unusual sensitivity to temperature changes.
  • Tingling or pins and needles - A prickly feeling similar to when your foot falls asleep, but it doesn't go away.
Illustration showing areas where SFN symptoms commonly occur on feet and hands
SFN symptoms typically start in the feet and hands, often beginning at the tips of fingers and toes.
Some people also have autonomic symptoms because small fibers control automatic body functions. These may cause problems with sweating, digestion, or heart rate. You might sweat too much or too little, have stomach problems, or feel dizzy when you stand up. Symptoms can be worse at certain times. Many people notice their pain gets worse at night, making it hard to sleep. Heat, stress, or being on your feet for long periods can also make symptoms worse.

Symptoms Changing Over Time

SFN symptoms can change as time goes on. For some people, symptoms stay about the same. For others, they might get slowly worse or sometimes even improve. Understanding how your symptoms might change can help you plan and work with your healthcare team.
The progression of SFN depends on what's causing it. If you have diabetes and can control your blood sugar well, your symptoms might not get worse. If the cause is something that can be treated, your symptoms might even improve over time.
Symptoms often follow stages. Early on you might have mild tingling or burning in your toes or fingertips that comes and goes. Over time pain can become more constant and spread from toes to feet or from fingertips to hands. In advanced cases, pain and numbness can affect larger areas and make walking or using your hands harder.
Not everyone follows this pattern. Some people have symptoms that stay mild for years. Others might have severe symptoms from the beginning that don't get worse. Working with your doctor to treat the cause and manage symptoms can help slow down progression.

Impact on Daily Life

Living with SFN symptoms can affect many parts of your daily life. The pain and discomfort can make simple tasks harder. Understanding these challenges can help you find ways to cope and maintain your quality of life.
Sleep problems are very common with SFN. The burning pain often gets worse at night, making it hard to fall asleep or stay asleep. Poor sleep can make pain feel worse during the day, creating a difficult cycle.
  • Walking and mobility - Foot pain and numbness can make walking uncomfortable or unsafe. You might worry about falls.
  • Work and activities - It can be harder to stand for long periods, type, or do tasks that require fine motor skills.
  • Sleep quality - Pain and discomfort can keep you awake or wake you up during the night.
  • Emotional health - Chronic pain can lead to feelings of sadness, frustration, or anxiety about the future.
  • Social activities - You might avoid activities you used to enjoy because of pain or fear of making symptoms worse.
  • Exercise - Pain might make you want to avoid physical activity, even though gentle exercise can help.
  • Sexual health - Some people experience changes in sexual function, including erectile dysfunction or vaginal dryness.
Person sitting on bed at night, depicting sleep difficulties from neuropathy pain
Many people with SFN find that symptoms worsen at night, affecting sleep quality and daily functioning.
The emotional impact of SFN is real and important. It's normal to feel frustrated, scared, or sad about having chronic symptoms. Support groups and counseling can help you cope with these feelings. Remember that you're not alone, and there are people who understand what you're going through.
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Many people with SFN find ways to adapt and continue doing the things they love. This might mean using tools to help with daily tasks, changing how you do certain activities, or finding new hobbies that work better with your symptoms.

When to See a Doctor

If you have symptoms that might be SFN, see a healthcare provider. Early diagnosis and treatment can help manage symptoms and may keep them from getting worse. Do not wait if you have ongoing pain or unusual sensations.
  • Burning pain in your hands or feet that doesn't go away
  • Numbness that makes it hard to feel cuts, burns, or injuries
  • Tingling or pins and needles that lasts for weeks
  • Pain that gets worse at night and affects your sleep
  • Sensitivity to touch that makes wearing shoes or clothes uncomfortable
  • Weakness in your hands or feet
  • Changes in sweating, digestion, or other automatic body functions
When you see your doctor, describe your symptoms clearly. Keep a symptom diary for a week or two before your visit. Note when symptoms happen, how bad they are, and what makes them better or worse. This helps your doctor plan tests and treatments.
SFN can be hard to diagnose. You may need to see a neurologist. If your first doctor does not have answers, keep looking for care and support. Find a SFN specialist
Written by the SFN Foundation
September 27, 2025
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