Hi Ed @njed, It is a head scratcher indeed. I think I heard or read that 20% of people with neuropathy don't have the pain, just numbness. Another quirk to throw into the equation is that each of us have our own pain scale and what it feels like so that may play a part in the no pain equation.

The term idiopathic gives me cause to laugh a little as I remember listening to 3 different neurologist at a Minnesota Neuropathy Association meeting each sharing their perspective and what they know about neuropathy, symptoms, facts, treatments and more. The last one to speak was an 80 year old neurologist who mentioned if you live long enough you will get neuropathy. He closed by telling describing in colorful terms how the term idiopathic came about for a neuropathy diagnosis. It was named after the idiot neurologist who came up with the term. 🙂 I think everyone had a good laugh which is what we needed at the time.

I've often wondered about the possibility of different causes of my idiopathic small fiber PN especially since I know diabetes can be one of the causes and I've been in the prediabetic category most of my adult life. Last year I ran across some interesting information on the metabolic syndrome which is a cluster of conditions. I fall into that diagnosis. Mayo has some info on the metabolic syndrome here - https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916.

Here are a couple of articles that got me started if you want to learn more...
-- The Metabolic Syndrome and Neuropathy: Therapeutic Challenges and Opportunities: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3881591/
-- Metabolic syndrome as a risk factor for neurological disorders
https://pubmed.ncbi.nlm.nih.gov/21997383/

Hoping we all can stay healthy and find some relief for the symptoms.