Abstract body: Children, who are born without any perception of pain, tend to develop a severe phenotype of self-injury. Pain, despite being a dreadful experience, is an important warning signal that prevents us from cutting, biting, or burning ourselves. Neuropathic pain, on the other hand, constitutes an impactful health burden as well. We examined a cohort of 100 idiopathic small fiber neuropathy patients (70% female; mean age: 44.8 years), in whom neuropathic pain was the most abundant symptom (95%) and cause of daily life impairment (72%). As a potential risk factors, we found that metabolic syndrome leads to an increase in neurotoxic 1-deoxy-sphingolipids, which were significantly higher in the “sensory loss” patient cluster compared to ''thermal hyperalgesia'' (p
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