To quote you from another thread Glenn

Might this be true of Neuronopathy? for example, I have no numbness. Well, apart from waking with numb little fingers at night (I mean the 5th finger on each hand) which I take it means, due to what ever process has occurred, I am now more susceptible to compression numbness mostly of my ulnar nerve it seems? What I mean is, because I have dermal 'pain' (skin burning) and not numbness, does that potentially indicate that neurons are 'damaged' not 'dead' ? Does this 'pain is better than numbness' theory apply to small fiber damage? ie: If many of my neurons were 'dead' then my skin would not 'burn' it would simply be 'numb' ? or do dead neurons just transmit confused/painful signals to the brain

Second question if I may, Can one neuropathic 'process' cause these two 'types' of pain. I have the burning skin type of pain (that we've discussed) and additionally pain that feels like it's deeper within my hands and feet, a 'shooting' or 'aching' pain. It feels like it's *in* my hands. This pain is becoming increasingly worrying to me. If I could describe my hand pain like this, that someone (probably Satan) has inserted an I.V. into my wrists and pumped warm acid into my hands , and my feet just feel achy, like I have been on them all day, even if I have not. The only numbness I get, as I mentioned above, is in either of my little fingers at night, but it goes when I shake my hand and straighten my arm/arms

Does this distal hand/feet pain sound like 'small fiber' (or is that only the skin) or demyelinated axons or some other process? and how does the 'die back' process work? does it continue even following discontinuation of toxic exposure (assuming that is the cause) I assume the two kinds of pain are linked as they started within days of each other? I have not had any Nerve Conduction Studies as yet, because, of course, according to the Neurologist, this is all in my head. (yeah, cause I just love spending money on neurologists for my pretend-make-believe pain - like I don't have hobbies that are cheaper and more fun !?)

Any light shed on this would be much appreciated as always

--all other things being equal, in general, damaged nerves, or nerves undergoing repair from damage, tend to produce more odd sensations (parasthesas) and out of proportion pain (allodynia) than nerves that are dead, which are more likely to result in numbness in the area that is dead.

But--and it's a big but--nerve damage can be very patchy and incomplete. Many have reported having pain and numbness in the same area at the same time, and been mystified (probably for much the same reasons you're mentioning). It's no logical, but if one considers there are a number of different types of afferent fibers--those in myelinated nerves, those in thinly myelinated nerves, and those that are unmyelinated, and that these all have different overall structures, it's possible for one subtype of nerve in an area to be damaged to greater or lesser degree than another (or for them all to be globally damaged). This can get quite specific--there've been reports of people with only cold allodynia, meaning only the nerves that sense cold were damaged, people with only light touch allodynia, etc.

And it's not necessarily unusual to have somewhat different pain sensations at different "skin levels"--or to have pain at one "level" and numbness at another. With all of the weird sensations that damaged nerves result in, it can be very hard, merely by subjective experience of symptoms, to know exactly which nerves are involved. And I haven't even yet mentioned the possibility of "crosstalk"--damaged nerves often release chemicals that inflame their previously undamaged neighbors, and start them firing nastily--reflex sympathetic dystrophy/complex regional pain symdrome is thought to possibly start this way--or of pain signals being referred to points beyond the site of the original damage, which is common, especially in inflammatory or compressive situations--my right thumb/forefinger/third finger symptoms are certainly traceable to pressure on my right C6/C7 nerve root in the cervical spine, but I have no neck pain there.

Sometimes the symptoms of two different process are distinguishable, but sometimes not. One of the big problems with neuropathy is that symptoms that stem from brain/spine issues can be exactly mimicked by issues with more peripheral nerves--part of the reason our work-ups for cause are long, expensive, process of elimination, and not always fruitful.

Distal extremity pain is most commonly attributed to die-back, meaning that due to vascular insufficiency, such as is found in many autoimmune conditions, diabetes, and some toxic episodes, the fibers most distant from the heart of circulation are damaged/die first--the mechanism here is lack of oxygen/nutrients to the nerve and lack of removal of toxic wastes from it. But not all inflammatory processes work this way--some target specific areas (I can think of Sjogren's, Bechet's, polyarteritis nodosa, diabetic amytrophy, just off the top of my head), some are more global, and many toxic neuropathies are more body-wide.

That numbness you describe does sound like a vascular insufficiency--but it may just be a temporary compressive one, such as what happens when a limb "falls asleep". Of course, those of us with compressive nerve effects often find it easier to put parts to sleep, and fine it harder to "wake" them up.

The sad fact is there's a lot we don't know yet--until we can image down to the individual nerve fiber level, or individual capillary level, a lot of this is speculative.