Small fibre neuropathy (SFN) is characterized primarily by neuropathic pain and quantitatively and qualitatively altered sensory perception. The current gold standard for diagnosis is measurement of intraepidermal nerve fibre density (IENFD), while quantitative sensory testing (QST) provides insight into the functional state of the thermo-nociceptive system. We conducted a study including 37 patients with SFN. Thermal testing was used to determine perception thresholds for cold and warm stimuli, as well as pain thresholds for cold and heat, at the thenar eminence, dorsum of the foot, shin, and thigh. Participants also completed the EQ-5D questionnaire and rated their perceived pain using a visual analogue scale (VAS). Statistically significant differences were observed between measured and normative values, and comparisons were made across measurement types and test locations (p < 0.001). Significant correlations were identified between several parameters: deviation of IENFD from normative values and perception threshold on the dorsum of the foot (ρ = 0.417, p = 0.010); VAS pain rating and EQ-5D index values (ρ = -0.458, p = 0.004); VAS pain rating and perception threshold at the thenar eminence (ρ = 0.359, p = 0.029); and EQ-5D index and perception threshold on the thigh (ρ = -0.445, p = 0.006). QST sensitivity was determined to be 92%. Our findings support the clinical and research utility of thermal testing. To enhance diagnostic accuracy, thermal testing should be applied in conjunction with other available diagnostic methods.
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