Good morning. I can’t comment on the pain, but I want to tell you how helpful your first sentence is! My small fiber polyneuropathy was not confirmed by the punch test either. The punch test showed no amyloid, and that the nerve fibers were normal, but I have horrible itching and tingling. My doctor also said that small fiber polyneuropathy is patchy and might not be able to be demonstrated on three small punches. But everything else was ruled out and clinically. He has determined it is Neuropathy. God knows why I have it! Good to know that somebody else clinically presents as small fiber neuropathy without a positive punch test!