Small-fibre and pain studies

Abstract This chapter outlines the expanding role of small-fibre studies in the clinical neurophysiological evaluation of small-fibre neuropathy and pain syndromes, where conventional nerve conduction studies often fall short. Standard techniques predominantly assess large, myelinated fibres, leaving small unmyelinated and thinly myelinated fibres underrepresented in routine testing. This chapter reviews key modalities for assessing small-fibre function, including quantitative sensory testing, cutaneous silent period and nociceptive evoked potentials such as laser-evoked potentials and contact-heat evoked potentials. Reference ranges and methodological considerations are provided with emphasis on standardised protocols, patient preparation and stimulus parameters. Limitations, technical challenges and artefact recognition are also addressed. By combining objective electrophysiological methods with clinical context, small-fibre studies provide a critical complement to traditional neurophysiological testing in the comprehensive assessment of neuropathic pain and autonomic sensory dysfunction.