Small fiber neuropathy is defined as a disorder of sensory nerves caused by abnormalities in thinly myelinated A delta fiber (Aδ) and unmyelinated C nerve fibers. It causes a painful neuropathy that can be difficult to diagnose. Recent electrophysiological and histological methods have been developed to help improve the diagnosis. Treatment of small fiber neuropathy is symptomatic unless an underlying cause is found. Medications currently available can reduced the pain between 20–40%. Patient should be made aware of this, so realistic goals and expectations can be set. Medications include anticonvulsants, tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, sodium channel blockers, opioids and others.