Look, I'm not a doctor and don't have a crystal ball, so I can't say for sure what's going on with Alan.

All I know is, after I was diagnosed with small-fiber PN, I later discovered that my pain could be aggravated by pressure at certain places in my neck. That does not in any way fit the picture of small-fiber PN.

SFPN is not in itself positional. Only compressive neuropathies are positional.

I, too, was told that my neck is fine, my spine is fine, and so on. However, I recovered through PT, manipulation, trigger-point treatment and other stuff--all of which work only on compressive neuropathies.

So what gives? When I was hanging out on TOS sites, I heard about a doctor in PA who has a theory about TOS and SFPN. He thinks early TOS sufferers get small fiber pain, because their compressions are technically mild enough that only the long, thin axons of the small fibers are affected. So they'll get burning, tingling, or whatever weird sensation their nerves are prone too--but they won't get total numbness or motor loss they way somebody with full-blown TOS might.

Personally, I think the same thing can happen in other compressive neuropathies besides TOS, where a bulge, tight discs or some other problem chokes and aggravates the tiny small nerve fibers. In these cases, the irritant is almost never visible on MRIs. It's too minor, or it may be muscle-related, or not obvious when the patient is lying on the table in a certain position (much like the way TOS itself is invisible on MRIs).

Doctors don't recognize this syndrome. But my PT people had seen it multiple times.

Anyway, something like that happened to me. Maybe it happens to Alan, too.