Uncovering Hidden Profiles: From Pain-Centric to Multi-Symptom Small Fiber Neuropathy.

This article appears to describe that small fiber neuropathy (SFN) is not just a "pain disease" but can present as a broad, multi‑symptom problem affecting autonomic, sensory, and sometimes immune functions. The authors likely highlight that many patients with POTS/dysautonomia, hypermobile EDS, MCAS, and other complex syndromes have SFN that is under‑recognized because clinicians often only think to test for SFN when severe burning or stabbing pain is present. By identifying “hidden profiles” of SFN—such as patients whose main complaints are dizziness, tachycardia, GI dysmotility, temperature dysregulation, fatigue, or cognitive problems—the paper emphasizes expanding diagnostic suspicion and using tools like skin biopsy and autonomic testing even when pain is not the dominant feature. For both patients and clinicians, the key takeaway is that SFN may be a common unifying mechanism underlying multi‑system symptoms, and that recognizing the non–pain‑centric presentations can improve diagnosis, allow more targeted evaluation for underlying causes (e.g., autoimmune, metabolic, or inflammatory), and open up additional management options rather than attributing symptoms solely to functional or psychiatric causes.