First, it is a fairly uninvasive and quick procedure--a few shots of topical pain killer (Lidocaine of Xylocane), some 3mm diameter/1mm thickness skin punches, and a few band aids finishes you up.

Second, as much of the preliminary work on standardizing the procedure and interpreting the results was done at Hopkins, it's one of the best places to get the test interpreted. The pathologists will be looking at your intraepidermal nerve density and the fiber condition, as Brian says, and comparing that to "normals" with no symptoms. It's unlikely that it will show a cause for all this, but it can document that damage to small fiber axons is occurring or has occurred.

I had this test done at Cornell Weill, and it was the first test that unequivocally showed ANYTHING. Before that, I'd had MRI's, CT scan, X-rays, evoked potential testing, spinal tap, NCV/EMG, EEG, blood and urine tests up the wazoo--and not a one of those showed anything abnormal. (That often happens with small-fiber syndromes.) And, of course, since all those other tests were "normal", the doctors were starting to doubt me and looking at me in that "psychiatric" way. I KNEW I was feeling body-wide burning pain and I KNEW something was wrong that has nothing to do with my mood (which was getting incresaingly ****** by then). I was fortunate that at Cornell Weill the neuropathy experts were familiar with the possibilty that the skin biopsy confirmed.