In patients with crest, do they often complain of episodes of very sharp pains in toes and fingertips, as if being stuck with a needle? if not, do some crest patients have an autoimmune neuropathy?

Raynaud's syndrome: This is part of the crest syndrome, a form of an autoimmune disease called scleroderma. Raynaud's symptoms could certainly consist of sharp pains, or other abnormal nerve sensations. Best to see a rheumatologist.

See below: Besides raynaud's, there could neuropathy from other reasons such as pinched nerves from your back or you could have calcinosis depositions causing you pain.