Glenn is it quantitative or qualitative. IM not being picky but i have seen it referred to as qualitative and when i discuss these tests at my soon to be visit i want to ask for the right name for obvious reasons. Thanks.

--but in most of the clinical application papers I've read that describe the procedure, it's referred to as quantitative, inasmuch as what is being looked at are thresholds for noticing pain as temperatures are increased/decreased, and also the JND--the just noticable difference at which one can discern that the temperature has actually changed.

A fairly consistent finding in this testing (probably the most consistent finding) is that people with small-fiber damage have to have the temperature increased/decreased by a greater amount than do "normals" to say they've noticed an actual change.

Hi Glentaj

Thanks for your comments -- yes, it is indeed called quantitative sensory testing, as this is the title at the top of my test results.

I was un-aware that a skin biopsy can also be used to verify smalll fibre neuropathy - next time I see the neuro I'll raise this with him. Thanks!

I agree with your comments about variability in test results from patient perception. I tried pretty hard to be consistent, but it was always difficult. I know that the computer controlling the test would re-test, and re-test until I was consistent in my responses.

Best wishes,
Steve

Did your Neuro tell you why it took 10 yrs. to decide to do this..I
would ask if he would update,but check your insurance..Are you sure he's
up to date on PN??? If you really like him just ignore me..What more has
he told you about your PN,and do your meds help?? Hugs to all Sue

Ok that answers that and Steve so right.
Glenn or anybody was the resulths of Steve's test normal,or good be better
can you tell from what he has written down or Steve have you seen
the Dr. yet,and please keep all your paper work and continue to do that,
there yours. Look up LJ sheets if you haven't done that yet..Sue

Hi Steve, Thermal threshold testing did show up my small fibre damage, & an EMG showed some damage to the large nerves as well, but thermal threshold testing doesn't always show the small fibre damage as Glentaj said, if i remember right it didn't work for him, but a skin punch biopsy did, the only trouble is finding a lab in Melbourne that does it, i do not know of any myself, but if you have the symptoms of small fibre damage and that thermal test showed abnormal reactions why bother, the important thing is to find the cause, which isn't always easy.
good luck
Brian

--I did have this testing and it came up "normal", but the skin biopsy did show rather definite small-fiber de-enervation and damage.

Part of the reason skin biopsy has replaced quantitative sensory testing, at least at facilities at which the former is available, is that the former is far less subject to individual reporting variation. (It's far more objective to count nerve fibers.)

I think the Neuromuscular Lab at Johns Hopkins will send a test kit and spend about 5 minutes on the phone giving instructions to whoever is to do the punch.

I know they will do this for people out of their area in the U.S., so I assume that the punch could also be done in Australia, then sent to JH for their evaluation...

Cathie

I'm with Glenn on this one, that temperature threshold test is not even being used much anymore. I do believe folks in Australia are at a disadvantage as there is no place doing skin biopsies. I do remember that post that soon a laser procedure that sounds similar to a pulse ox will be available to check for small fiber neuropathy. I do not remember who posted that, was it Dahlek??? I don't think it will be available for a few years.

I believe in the US, the procedure that was used, prior to skin biopsy was sural nerve biopsy. I don't see many folks from Australia having that procedure done either. ???

I would check into the suggestion Cathie made. The only definite way to get a diagnosis of SFN right now is skin biopsy or sural nerve biopsy. I do not know the logistics of sending the tissue to a lab elsewhere to be read, especially across borders. You can make a trip here, hey the dollar has never been lower, we are a cheap 'vacation' destination.

Some other testing in the autonomic realm, imply small fiber neuropathy, but, even with those being abnormal on me, they still did skin biopsies....and eventually that muscle biopsy.

Perhaps you can start putting pressure on your health care system to offer this test?

by a neuro who wanted me as his patient [but didn't believe I had what I'd been diagnosed with] to have the sural biopsy... He referred me to his mentor, a neuro dept head [not the neuro #3 I'd first seen and had diagnosed me]
This second neuro head was pretty much sceptical that I an an autoimmune neuropathy, saying that: patient he sees who have this are in wheelchairs. I replied: Maybe because I got treatment IN TIME I'm not in a wheelchair? He ultimately agreed with me and my conclusions [and my docs''] that I'd met essentially 9 out of 12 evaluation criteria for diagnosis and treatment. AND that a sural biopsy wasn't necessary. BTW Most insurances do NOT cover this procedure as it's now considered too risky anymore-except in the most confounding of situations. Punch biopsies are going to become more common soon, trials are almost done about this, And I've read that somewhere in AU they are doing tests/trials for this procedure [can't remember where tho! Durn].
One thing to keep in mind about any nerve tests is IF you are comfy! Too hot or too cold can skew your test #'s...Here is a site:
http://www.onecallmedical.com/PDFs/E...0ISSUE%205.pdf
I'd had one Nerve conduction test early in the Am...The room was very cold...my feet were rapidly turning blue...The doc gently 'rubbed' my feet. I alternately ahhed at the warmth of his hands and almost squirmed/screamed from the rubbing of those hands. He had a space heater put into the room, but I suggested that a hairdryer on lo might be safer and easier to use in the long run..Not had a test since then...But at least my feet were tepid for the test? Now that is for regular nerve tests. I've not had the temp.threshold test either. I 'passed' good or bad all the key ones for diagnosis. AND I think I'm grateful I didn't have to do the more well 'unique' ones! Good thoughts and pain-free moments! - j