{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:05:13Z","timestamp":1791975913778,"version":"4.4.0"},"reference-count":57,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1 TR002345"],"award-info":[{"award-number":["UL1 TR002345"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R37CA267905"],"award-info":[{"award-number":["R37CA267905"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and Purpose<\/jats:title><jats:p>Small fiber neuropathy (SFN), resulting from dysfunction and loss of peripheral unmyelinated and thinly myelinated nerve fibers, is traditionally characterized by distal skin pain and sensory loss. Patients often report additional symptoms, including muscle cramps, myalgias, fatigue, subjective weakness, and neuropathic itch, but the prevalence and intensity of these symptoms remain poorly defined. Current treatments\u2014focused primarily on pain\u2014are often ineffective, possibly due to substantial between\u2010patient heterogeneity. This study aimed to characterize the symptomatic variability of SFN and determine whether patients can be stratified into clinically meaningful subgroups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Demographic, clinical, and laboratory data were analyzed from patients with skin biopsy\u2010confirmed SFN (<jats:italic>n<\/jats:italic>\u2009=\u2009203) and healthy controls (<jats:italic>n<\/jats:italic>\u2009=\u200930). SFN patients were clustered based on clinical features using unsupervised machine learning.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fatigue\u2014not neuropathic pain\u2014was the most prevalent and intense symptom among patients with SFN. Muscle symptoms were as common and severe as neuropathic pain, while neuropathic itch was rare. Three distinct phenotypic clusters were identified: (1) an \u201calgesic\u201d group (~20%) with severe neuropathic pain and co\u2010occurring intense symptoms; (2) a \u201cmyalgic\u201d group (~60%) with prominent fatigue, myalgias, and subjective weakness but milder neuropathic pain; and (3) a \u201cpauci\u2010symptomatic\u201d group with few, mild to moderate symptoms. Clusters differed by symptom profiles, disease duration, intraepidermal nerve fiber density, sex, and body mass index.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Fatigue and muscle symptoms are highly prevalent in SFN and may rival pain in clinical importance. Identifying patient subgroups provides a foundation for stratified treatment approaches and improved disease management.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.70321","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T07:29:08Z","timestamp":1756106948000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Uncovering Hidden Profiles: From Pain\u2010Centric to Multi\u2010Symptom Small Fiber Neuropathy"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0727-9565","authenticated-orcid":false,"given":"Peyton J.","family":"Murin","sequence":"first","affiliation":[{"name":"Department of Neurology Saint Louis University  Saint Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0132-7578","authenticated-orcid":false,"given":"Nicholas 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