Early detection of small-fiber neuropathy in diabetes: a laser-induced pain somatosensory-evoked potentials and pupillometric study

Over the last 15 years, many authors have pointed out that small nerve fibers may be selectively damaged in the early stages of diabetes, leading to an early impairment of pain and temperature sensations and to a decline in autonomic nervous function (1,2). The CO2 pain-induced laser somatosensory- evoked potential (pSEP) evaluation may represent a new quantitative and objective approach to evaluate pain and temperature sensation functions (3– 8). Recently, Agostino et al. (9) reported small-fiber dysfunction assessed by pSEPs in diabetic patients with different degrees of peripheral nerve damage.