Disease patterns · Core

Small-fiber disease with normal NCS

Small-fiber neuropathy

Know the scope of routine testing before interpreting a negative result.

3 learning sectionsCompiled 2026-09-08English edition · Traditional Chinese available

01Different fibers

  • Routine NCS predominantly assesses larger myelinated fibers and does not directly evaluate all Aδ and C fibers.
  • Burning pain, altered pain/temperature sensation and autonomic symptoms may prompt assessment for small-fiber dysfunction.

02Selecting investigations

  • Depending on the question, consider skin nerve-fiber density, autonomic testing or other specialized assessments.
  • These methods also require appropriate technique- and population-matched references.

03Explain a normal result

  • State that tested large-fiber responses show no abnormality, while acknowledging the small-fiber limitation.
  • Use the clinical hypothesis to guide persistent symptoms; normal NCS does not mean the symptoms are absent.

Pause and explain

Explain in your own words: “A normal test answers only for the system it actually measures.” Then think of a situation in which it could be misinterpreted.

Show a review prompt

Burning pain is not automatically small-fiber neuropathy; other causes remain in the differential.

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References and further reading

Educational synthesis; independent neuromuscular specialist review is pending. Publication dates and compilation dates are distinct. This is an original teaching synthesis; consult the source for complete methods and criteria.