Should I be concerned...Although my neuro has diagnosed me with small fiber polyneuropathy I have not had an EMG nor a Skin biopsy, only the NVS. I asked why he had not done a skin biopsy and he said they didn't do that test at his practice.

Don't I need those for a definite diagnosis?

While a skin biopsy that shows reduced intraepidermal nerve fiber density and/or damage is the current gold standard for confirming a small-fiber syndrome, there are other tests that can point to it--most notably, abnormal quantitative sensory testing (which can reveal abnormal rsponses to changes in temperature), and several different autonomic tests (such as sudomotor axon reflex testing that can reveal abnormalities in sweat response, which is controlled by the autonomic small fibers).

The good reason for the skin biopsy is it actually looks at the condition of the fibers themselves. While the other tests can reveal abnormalities, they can often be normal in someone who will show up with an abnormal skin biopsy, as autonomic damage does not happen in all small-fiber neuropathies, and sometimes the fibers that subsume temperature sensation can be basically intact while the small nerve fibers that subsume pain are selectively damaged (which would render qualitative sensory testing equivocal at best). Moreover, the damage can be spotty or patchy.

The first neuro i seen done a nerve conduction test and going by him it showed nothing abnormal with me, so i went to another neuro that did an emg that did show some large nerve involvement even though i was not showing any large nerve problems at that time, and quanitive sensory testing showed mostly small fiber damage, the skin punch technology isn't used in OZ as far as I know, which is disappointing for some as Glentaj explained so well.

Brian

I probably have a minority opinion. I knew I had peripheral neurapathy before I went to the neuro. He ran a test which measures the time if takes an electrical puls to travel down my leg. He then confirmed I had neurapathy. He ran the same test a year or two later and said there was little change. I have little interest in finding what type of neurapatrhy I have until there is a cure for it. I do take all the supplements amd home procedures suggrested to help slow down the progress of the neuropathy.

Many on this board post messages about the tests they have had, but still have the same pain.

and the same meds.regardless of tests and results, same meds

My neuro did not mention emg or skin biopsy.only nct. He dxd axonal small fiber pn. Did I need more than that?

If a skin punch is not done at the practice,
it probably is because they have no lab for sending the samples to.
(& they may not have anyone qualified to interpret the results)

Johns Hopkins has a mail-out kit for skin punch tests,
with instructions for the doc or tech.
JHH Neuro dept is at 410-955-2227. they will probably refer you,
to call the testing lab number (sorry, I don't have it).

to help determine what all is going on....

These issues about PN were brought up by NewsBot here a few days ago:
http://www.neurology.org/cgi/rapidpd...51010.a1v1.pdf
and: http://www.neurology.org/cgi/rapidpd...70511.0fv1.pdf

For immune related neuropathies here is a good site to explore:
http://www.cidpinfo.com/ Check out all the tabs/sub-sites here and read up.

I myself would have a skin biopsy done, and I can guess easily what the results would be. I would only allow a full sural biopsy IF and only IF it was the only way to prove things [no need to risk infection when...]. My immune work-ups from blood and spinal fluids, To the various nerve condction studies have always shown - yep! somthing is wrong here! So, so far there has been no need for the biopsies. Of course, with insurance companies etc... that could change any minit?

OK to back up a bit? Nerve conduction studies and blood tests are the START of possible further testings. Put in context? It's an IF this? Then That! sort of thing. Plus how diligent your docs are in seeking the best info to ease things a bit. Still all in all....treatments are usually limited to pain meds, anti-seizure meds, steroids, and very few other things that can help.
Key to all this is to change then maintain a good lifestyle that helps stop the pain progressions and aid the nerve regrowth as best as WE can. It can take a long time. Sometimes a very long time.
Sure hope this helps - j