Diagnostic accuracy of quantitative sensory testing for detecting small fiber impairment in polyneuropathy and diagnosing small fiber neuropathy

Eleonora Galosi; Daniel Litewczuk; Gianfranco De Stefano; Giuseppe Di Pietro; Giulia Di Stefano; Nicoletta Esposito; Enrico Evangelisti; Pietro Falco; Caterina Leone; Juliane Sachau; Ralf Baron; Nanna Brix Finnerup; Andrea Truini

doi:10.1097/j.pain.0000000000003685

Diagnostic accuracy of quantitative sensory testing for detecting small fiber impairment in polyneuropathy and diagnosing small fiber neuropathy

Eleonora Galosi
, Daniel Litewczuk
, Gianfranco De Stefano
, Giuseppe Di Pietro
, Giulia Di Stefano
, Nicoletta Esposito
, Enrico Evangelisti
, Pietro Falco
, Caterina Leone
, Juliane Sachau
, Ralf Baron
, Nanna Brix Finnerup
, Andrea Truini^*

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

1 Citation (Scopus)

Abstract

This cross-sectional retrospective study evaluated the diagnostic accuracy of cold detection thresholds (CDT) and warm detection thresholds (WDT), measured by quantitative sensory testing, for detecting small fiber impairment in polyneuropathy and diagnosing small fiber neuropathy (SFN). A total of 384 individuals with distally distributed sensory disturbances were included. Using ACTTION criteria, 138 patients with polyneuropathy were identified. Among them, 36 were diagnosed with SFN, 91 with mixed fiber polyneuropathy, and 11 with pure large fiber polyneuropathy. First, we assessed CDT and WDT accuracy, both individually and combined (ie, an abnormal value in either CDT or WDT), in detecting small fiber impairment in polyneuropathy. Next, we calculated CDT and WDT diagnostic accuracy for SFN, both alone and combined, and evaluated their accuracy when integrated with small fiber-related clinical abnormalities. Isolated abnormalities in CDT or WDT showed relatively low diagnostic accuracy. However, combined abnormalities achieved a sensitivity of 69% and specificity of 70% for detecting small fiber impairment in distal symmetric polyneuropathy. For SFN diagnosis, combining CDT and WDT yielded 78% sensitivity, 70% specificity, and a 94% negative predictive value. These metrics improved to 78% sensitivity and 100% specificity when CDT or WDT were integrated with small-fiber-related clinical abnormalities. Although individual CDT and WDT assessments offer limited diagnostic accuracy, their combination provides a practical, noninvasive approach for screening small fiber impairment in distal symmetric polyneuropathy and diagnosing SFN. This strategy may reduce the need for more invasive and less cost-effective procedures, like skin biopsy.

Original language	English
Journal	Pain
ISSN	0304-3959
DOIs	https://doi.org/10.1097/j.pain.0000000000003685
Publication status	E-pub / Early view - 2025

Keywords

Neuropathic pain
Quantitative sensory testing
Small fiber neuropathy

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Galosi, E., Litewczuk, D., De Stefano, G., Di Pietro, G., Di Stefano, G., Esposito, N., Evangelisti, E., Falco, P., Leone, C., Sachau, J., Baron, R., Finnerup, N. B., & Truini, A. (2025). Diagnostic accuracy of quantitative sensory testing for detecting small fiber impairment in polyneuropathy and diagnosing small fiber neuropathy. Pain. Advance online publication. https://doi.org/10.1097/j.pain.0000000000003685

@article{3d7eba1b19524e8cbdaef5736cde75d5,

title = "Diagnostic accuracy of quantitative sensory testing for detecting small fiber impairment in polyneuropathy and diagnosing small fiber neuropathy",

abstract = "This cross-sectional retrospective study evaluated the diagnostic accuracy of cold detection thresholds (CDT) and warm detection thresholds (WDT), measured by quantitative sensory testing, for detecting small fiber impairment in polyneuropathy and diagnosing small fiber neuropathy (SFN). A total of 384 individuals with distally distributed sensory disturbances were included. Using ACTTION criteria, 138 patients with polyneuropathy were identified. Among them, 36 were diagnosed with SFN, 91 with mixed fiber polyneuropathy, and 11 with pure large fiber polyneuropathy. First, we assessed CDT and WDT accuracy, both individually and combined (ie, an abnormal value in either CDT or WDT), in detecting small fiber impairment in polyneuropathy. Next, we calculated CDT and WDT diagnostic accuracy for SFN, both alone and combined, and evaluated their accuracy when integrated with small fiber-related clinical abnormalities. Isolated abnormalities in CDT or WDT showed relatively low diagnostic accuracy. However, combined abnormalities achieved a sensitivity of 69\% and specificity of 70\% for detecting small fiber impairment in distal symmetric polyneuropathy. For SFN diagnosis, combining CDT and WDT yielded 78\% sensitivity, 70\% specificity, and a 94\% negative predictive value. These metrics improved to 78\% sensitivity and 100\% specificity when CDT or WDT were integrated with small-fiber-related clinical abnormalities. Although individual CDT and WDT assessments offer limited diagnostic accuracy, their combination provides a practical, noninvasive approach for screening small fiber impairment in distal symmetric polyneuropathy and diagnosing SFN. This strategy may reduce the need for more invasive and less cost-effective procedures, like skin biopsy.",

keywords = "Neuropathic pain, Quantitative sensory testing, Small fiber neuropathy",

author = "Eleonora Galosi and Daniel Litewczuk and \{De Stefano\}, Gianfranco and \{Di Pietro\}, Giuseppe and \{Di Stefano\}, Giulia and Nicoletta Esposito and Enrico Evangelisti and Pietro Falco and Caterina Leone and Juliane Sachau and Ralf Baron and Finnerup, \{Nanna Brix\} and Andrea Truini",

note = "Publisher Copyright: {\textcopyright} 2025 International Association for the Study of Pain.",

year = "2025",

doi = "10.1097/j.pain.0000000000003685",

language = "English",

journal = "Pain",

issn = "0304-3959",

publisher = "Lippincott Williams and Wilkins",

}

Galosi, E, Litewczuk, D, De Stefano, G, Di Pietro, G, Di Stefano, G, Esposito, N, Evangelisti, E, Falco, P, Leone, C, Sachau, J, Baron, R, Finnerup, NB & Truini, A 2025, 'Diagnostic accuracy of quantitative sensory testing for detecting small fiber impairment in polyneuropathy and diagnosing small fiber neuropathy', Pain. https://doi.org/10.1097/j.pain.0000000000003685

Diagnostic accuracy of quantitative sensory testing for detecting small fiber impairment in polyneuropathy and diagnosing small fiber neuropathy. / Galosi, Eleonora; Litewczuk, Daniel; De Stefano, Gianfranco et al.
In: Pain, 2025.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Diagnostic accuracy of quantitative sensory testing for detecting small fiber impairment in polyneuropathy and diagnosing small fiber neuropathy

AU - Galosi, Eleonora

AU - Litewczuk, Daniel

AU - De Stefano, Gianfranco

AU - Di Pietro, Giuseppe

AU - Di Stefano, Giulia

AU - Esposito, Nicoletta

AU - Evangelisti, Enrico

AU - Falco, Pietro

AU - Leone, Caterina

AU - Sachau, Juliane

AU - Baron, Ralf

AU - Finnerup, Nanna Brix

AU - Truini, Andrea

PY - 2025

Y1 - 2025

N2 - This cross-sectional retrospective study evaluated the diagnostic accuracy of cold detection thresholds (CDT) and warm detection thresholds (WDT), measured by quantitative sensory testing, for detecting small fiber impairment in polyneuropathy and diagnosing small fiber neuropathy (SFN). A total of 384 individuals with distally distributed sensory disturbances were included. Using ACTTION criteria, 138 patients with polyneuropathy were identified. Among them, 36 were diagnosed with SFN, 91 with mixed fiber polyneuropathy, and 11 with pure large fiber polyneuropathy. First, we assessed CDT and WDT accuracy, both individually and combined (ie, an abnormal value in either CDT or WDT), in detecting small fiber impairment in polyneuropathy. Next, we calculated CDT and WDT diagnostic accuracy for SFN, both alone and combined, and evaluated their accuracy when integrated with small fiber-related clinical abnormalities. Isolated abnormalities in CDT or WDT showed relatively low diagnostic accuracy. However, combined abnormalities achieved a sensitivity of 69% and specificity of 70% for detecting small fiber impairment in distal symmetric polyneuropathy. For SFN diagnosis, combining CDT and WDT yielded 78% sensitivity, 70% specificity, and a 94% negative predictive value. These metrics improved to 78% sensitivity and 100% specificity when CDT or WDT were integrated with small-fiber-related clinical abnormalities. Although individual CDT and WDT assessments offer limited diagnostic accuracy, their combination provides a practical, noninvasive approach for screening small fiber impairment in distal symmetric polyneuropathy and diagnosing SFN. This strategy may reduce the need for more invasive and less cost-effective procedures, like skin biopsy.

AB - This cross-sectional retrospective study evaluated the diagnostic accuracy of cold detection thresholds (CDT) and warm detection thresholds (WDT), measured by quantitative sensory testing, for detecting small fiber impairment in polyneuropathy and diagnosing small fiber neuropathy (SFN). A total of 384 individuals with distally distributed sensory disturbances were included. Using ACTTION criteria, 138 patients with polyneuropathy were identified. Among them, 36 were diagnosed with SFN, 91 with mixed fiber polyneuropathy, and 11 with pure large fiber polyneuropathy. First, we assessed CDT and WDT accuracy, both individually and combined (ie, an abnormal value in either CDT or WDT), in detecting small fiber impairment in polyneuropathy. Next, we calculated CDT and WDT diagnostic accuracy for SFN, both alone and combined, and evaluated their accuracy when integrated with small fiber-related clinical abnormalities. Isolated abnormalities in CDT or WDT showed relatively low diagnostic accuracy. However, combined abnormalities achieved a sensitivity of 69% and specificity of 70% for detecting small fiber impairment in distal symmetric polyneuropathy. For SFN diagnosis, combining CDT and WDT yielded 78% sensitivity, 70% specificity, and a 94% negative predictive value. These metrics improved to 78% sensitivity and 100% specificity when CDT or WDT were integrated with small-fiber-related clinical abnormalities. Although individual CDT and WDT assessments offer limited diagnostic accuracy, their combination provides a practical, noninvasive approach for screening small fiber impairment in distal symmetric polyneuropathy and diagnosing SFN. This strategy may reduce the need for more invasive and less cost-effective procedures, like skin biopsy.

KW - Neuropathic pain

KW - Quantitative sensory testing

KW - Small fiber neuropathy

UR - https://www.scopus.com/pages/publications/105009043302

U2 - 10.1097/j.pain.0000000000003685

DO - 10.1097/j.pain.0000000000003685

M3 - Journal article

C2 - 40539482

AN - SCOPUS:105009043302

SN - 0304-3959

JO - Pain

JF - Pain

ER -

Diagnostic accuracy of quantitative sensory testing for detecting small fiber impairment in polyneuropathy and diagnosing small fiber neuropathy

Abstract

Keywords

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