The doctor said something about looking for a pattern to try to find out the cause?

Would an EMG show nerve damage to the small nerves that are the ones with the issues? Thank you.

Small fiber nerve damage will not show up on an EMG. A skin biopsy is the gold standard for determining if you have small fiber neuropathy.

Cliffman

I second Cliffman.

My neuro stated insurance requirements mandated an EMG before small fiber biopsies. EMG tests primarily address long fiber (motor) impairment. I knew it would be a waste of time....and it's painful! I tested negative, as I knew I would, and ultimately had positive small fiber biopsies. I have autonomic and sensory SFN.

Took months.....and because of this odd logic, I'm comparison shopping for a new neurologist. I now have two appointments scheduled with new docs....hopefully one will be very good.

You might also wish to seek a second opinion if you can.

Good luck with this. It's hard to trust your instincts and easy to have high hopes for a physician when you're ill....but it's so important to have a smart and empathetic neurologist with this baffling disorder.

S

It didn't show up on my EMG. Yet i have it. So, I would say nothing. Pretty sure you can diagnose yourself on this one just by the type of pain. If extreme cold bothers you, if you experience burning, etc.

Its allinsurance stuff, liek stated above. they make you do it even though it doesn't show anything unless you also have length dependent issues as well.

--may show damage to the myelinated sensory nerve if there is sufficient damage to disrupt the transmission of signals in some way. (It is not precise enough to reveal problems with small, thin, unmyelinated sensory nerves that subsume the sensations of pain and temperature).

The patterns being referred to--generally, is there slowing of nerve impulses (latency of F waves, etc.) as opposed to a complete conduction block--can be helpful in determining the type of damage; generally, whether the damage is demyelinating (loss of insulation on the fibers) versus axonal (breaks or tears in the fibers themselves).

But it's perfectly possible to have neuropathy with a "normal" EMG/nerve conduction study, if your syndrome involves damage mostly to those small fibers. I certainly fell into that category--the skin biopsy did reveal small fiber damage though I had normal nerve conduction studies on several occasions.