Originally Posted by bernadettemarie

Hello, I have had burning, tingling, stabbing shooting pains in hands and feet for over ten years. It has, at times, gone into remission or was mild. In 2009 had EMG, nerve conduction and skin biopsy..all normal. Symptoms came back strong this July. Rhemo, pain doctor and neuro all said symptoms of small fiber so I had another skin biopsy. Came back negative so neuro (a new one) said I don't have neuropathy and told me to go to the Mayo clinic (which denied me last go around with this). My hands and feet are getting increasining numb. neuro confirmed that my vibration was decreased. Tips of fingers and heals cannot detect hot or cold.
My question is...I'm on Cymbalta, neurontin and 150 MG prednisone 1 week for four weeks. Can the medications alter the testing results? Particulary wondering about past EMGs and nerve conduction. one said totally normal, one said radiculapathy. Was on meds during that time also.
PS offical diag. Undifferentiated Tissue Disease (last ten years) ANA only blood test to come out high. ten years ago complements also came out low..
Any input would be appreciated.

Originally Posted by glenntaj

here's what my first skin biopsy report said (without the extraneous stuff about how the sample was collected):

Epidermal nerve fibers per millimeter:

Thigh Mean 4.7
Range 3.0-7.7
Reference Values: 21.1 +/- 10.4; range 2.9--57.5
Fifth percentile value 5.2

Leg Mean 3.2
Range 1.3-4.3
Reference Values: 13.8 +/- 5.6; range 0.6--32.2
Fifth percentile value 3.8

The reference values indicate the mean in the tested reference group, which presumably included normals and people suffering from small-fiber syndromes normals (first number), then the standard deviation in that group (the +/- number), then the total range across everyone. These are known as the McArthur protocols. The fifth percentile values are then given, and as you can see, my means are both below that value, so by protocol definition, I have "abnormal intraepidermal nerve fiber density, consistent with a small fiber neuropathy". The report also states "the nerve fibers within the thigh suggest excessive branching, also consistent with a small-fiber neuropathy".

In my most recent skin biopsy, my thigh mean comes back at 9.5, and my leg mean comes back 5.8, which they tell me averages out at about the 18th percentile. This was almost two years ago--it's possible I would show even more re-enervation now, but who knows at what figures I "began".

Originally Posted by bernadettemarie

Hello, I have had burning, tingling, stabbing shooting pains in hands and feet for over ten years. It has, at times, gone into remission or was mild. In 2009 had EMG, nerve conduction and skin biopsy..all normal. Symptoms came back strong this July. Rhemo, pain doctor and neuro all said symptoms of small fiber so I had another skin biopsy. Came back negative so neuro (a new one) said I don't have neuropathy and told me to go to the Mayo clinic (which denied me last go around with this). My hands and feet are getting increasining numb. neuro confirmed that my vibration was decreased. Tips of fingers and heals cannot detect hot or cold.
My question is...I'm on Cymbalta, neurontin and 150 MG prednisone 1 week for four weeks. Can the medications alter the testing results? Particulary wondering about past EMGs and nerve conduction. one said totally normal, one said radiculapathy. Was on meds during that time also.
PS offical diag. Undifferentiated Tissue Disease (last ten years) ANA only blood test to come out high. ten years ago complements also came out low..
Any input would be appreciated.

Originally Posted by dac122

With regards to the biopsy, I must caution you and others about the results. I am seeing Dr. James Berry at Mass General who specializes in SFN and he explained the difficulties of biopsy. He said at one time he did them frequently but discovered in too many cases the nerve counts were normal or near normal when there was clearly a problem. He also saw cases where the nerve counts were abnormally low and there was no associated problems. He definitely uses them when the neuropathy appears to be advancing rapidly. But in general, when the neuropathy is not advancing, it does not take him in any new diagnostic direction.

Originally Posted by Idiopathic PN

dAC122: Does it mean that there are cases when nerve counts are normal or near normal but patients are symptomatic while on the other hand, there are nerve counts that are abnormally low and yet patients are asymptomatic?

For t hose asymptomatic patients, how can they subject themselves to skin biopsy when they dont have symptoms of discomforts in the first place? I'd like to understnd what the doctor meant about his precaution of getting a skin biopsy. My skin biopsy last year showed normal result but my pain is getting worse than when it started.