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Symptoms

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 throughout your body (length-dependent or "stocking-glove" pattern). However, not all cases follow this pattern. Some people experience symptoms that are patchy, asymmetric, migratory, or involve the face, trunk, or proximal limbs (non–length-dependent, or NLD). These NLD symptoms are more common in immune-mediated causes like Sjögren syndrome or sarcoidosis. Recognizing both types of symptom patterns can help you and your doctor get the right diagnosis and treatment sooner.

Common Symptoms

SFN symptoms are often described as burning, stabbing, or electric-like sensations. Many people say it feels like walking on hot coals or being stuck with pins and needles. These feelings happen because your damaged nerves are sending wrong signals to your brain. While many people experience symptoms in a symmetric, length-dependent pattern, others may have symptoms that are patchy, intermittent, migratory, or affect areas like the face, trunk, or one side of the body. These non–length-dependent symptoms can change location and intensity throughout the day.
The most common symptoms include burning 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.
  • Stabbing or shooting pain - Sharp pains that come suddenly and can feel like electric shocks or being stabbed with needles.
  • Tingling or pins and needles - A prickly feeling similar to when your foot falls asleep, but it doesn't go away.
  • Numbness - Loss of feeling in your hands or feet. You might not notice cuts, burns, or other injuries.
  • Sensitivity to touch - Light touches that normally wouldn't bother you can feel painful or uncomfortable.
  • Temperature problems - Difficulty telling if something is hot or cold, or unusual sensitivity to temperature changes.
  • 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.
  • 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.
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 might include problems with sweating, digestion, or heart rate changes. You might sweat too much or not at all, 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.
In the early stages, you might only have mild tingling or burning in your toes or fingertips. These feelings might come and go, and you might not think much of them at first. As nerve damage progresses, the symptoms can become more constant and spread to larger areas.
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.
  1. Early stage - Mild tingling or burning, usually in toes or fingertips. Symptoms may come and go.
  2. Moderate stage - Pain becomes more constant. Symptoms spread up from toes to feet, from fingertips to hands.
  3. Advanced stage - Pain and numbness can affect larger areas. Walking and using your hands might become more difficult.
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.
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.
Join the SFN support group
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're having symptoms that might be SFN, it's important to see a healthcare provider. Early diagnosis and treatment can help manage your symptoms and might prevent them from getting worse. Don't wait if you're experiencing ongoing pain or unusual sensations.
You should see a doctor if you have persistent painful or unusual symptoms that lasts more than a few days. Even if the symptoms seem mild, it's better to check with a healthcare provider than to ignore them.
  • 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, try to describe your symptoms as clearly as possible. Keep a symptom diary for a week or two before your appointment. Write down when symptoms happen, how bad they are, and what makes them better or worse. This information will help your doctor understand your condition and plan the best tests and treatments.
Remember that SFN can be hard to diagnose, and you might need to see a specialist called a neurologist. Don't give up if the first doctor you see doesn't have answers right away. Keep advocating for yourself and seeking help until you find a healthcare provider who takes your symptoms seriously.
Written by the SFN Foundation
August 24, 2025
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