Normal EMG and Normal Skin Biopsy means...
 

Hi there

If the one's EMG is normal and the Skin biopsy that one's gonna do is also normal (negative for small neuropathic pain), can one infer that the prolonging of his pain is psicossomatic? Maybe due to anxiety?

Or on the other hand, if a skin biopsy is positive for small fiber neuropathies and a year later is negative can can one infer his pain is going to be over?

Thank you

PS:(does a idiopathic small fibers neuropathic pain can be seen during a skin biopsy?)

IF both are normal that wouldn't indicated Neuropathy. There are a few other things that are needed to determine if the Neuropathy could be from your spinal column. An SSEP is a test that will check for damage from the Spinal Column and a Brain MRI would check for damange there. I'm pretty sure you've stated to have had an MRI of the brain and it was normal, also a cervical MRI?

IF all is negative, than it is possible that "Tingling, Needles and Numbness" could be an attribute of anxiety. Anxiety does cause symptoms that mimic a nerve illness MINUS the pain! NOW as the pain is concerned, there is something called "Somatoform Disorder", which is a mental disorder or disease that MIMICS a PHYSICAL disease! It could cause pain and a host of other problems!

Back to the other causes, you need to have your Thyroid checked, have a full run of T3, Free T4 and TSH, that could cause neuropathies that wouldn't be found by EMG or Biopsies. Also, have your blood glucose checked, 2 Hr. fast and if you re-take the 12 hour fast it may show up something the second EVEN third time around!

There are many causes for your pains, don't you let the doctor label it as a "Mental' disorder, if he does, get another opinion until you're satisfied!

Keep me updated :)
Josh

BTW, it isn't the "pain" that they can see in the biopsy, what it will show is a smaller amount of the "small fiber" nerves/nerve endings in the skin, OR deadened nerves.

I have Idiopathic Small Fiber Neuropathy, it was a journey, but FINALLY they found it! Good luck :)

Thank you Josh for your kind Reply.

I don't have any desease that may be the cause for my neuropathic pain (I did all kind of exams). My pain was dued to a stupid exercice with dumbells. However I do have small neuropathic symptoms, that are decreasing from day-to-day, that is why I'm gonna do the biopsy. Now I'm affraid I'm the one who is prolonging that pain (with my mind, stress, etc...)

Anyway, what I wanted to know is that: reenervation of small fibers on the skin after a nerve lesion, means that the pain should stops.

By the way how did they find your idiopathic pain?

Regeneration means the pain COULD stop! Even tho the problem is fixed your body could still send the pain signals to your brain.

My Neuropathy was found by an EMG and my Quantitative Sensory Testing (QST) was all kinds of abnormal! They've not found the cause as of yet, (which we're working on), so I'm still labled *IDIOPATHIC* ! :)

How do you know that the dumbbells are what caused your pain for sure?

Have you had a SSEP test yet?

Sorry Joshua, but what is a SSEP test?

By the way, have you heard about Neurotrophin NT 3? And that sea coral? Do you know why is taking so long for them to be approved by the FDA and available to us?

Wouldn't that basically be like fibromialgia?
They don't know what causes the pain in that disorder either do they? And yet the people who suffer from it are in a load of pain.

However, there are mental disorders that cause "pain" when there is no pain AKA psychosomatic pain.

But, if you have a negative EMG (no large fiber damage) and negative skin biopsy (no small fiber damage), I think we can rule out peripheral neuropathy at least.

A MRI of brain and spine would be good, to see if its a central nervous disorder.

Fibromyalgia is debated as a somatoform disorder, some say it is, some say it isn't! It all depends on the person I think, some could be diagnosed with Fibro and it really be a phyc. disorder.

Peripheral would show up in either a Biopsy of some kind or/and an EMG, then we'll move to disease of the central nervous systems nerves or an injury to the spinal column.

An SSEP is a test where the test the amount of time it takes for your spinal cord to transfer electrical impulses to your brain. It will determine if there is a lesion in your spinal column that A. they couldn't see with an MRI or B. that area wasn't tested.

Also, blood work, do you have results that you could show us? Especially TSH? Your thyroid? Hypothyroid could mimic Neuropathy.

And--
 

--I will chime in that negative NCV/EMG studies and/or negative skin biopsies does not necessarily mean that there is no nerve damage--just that it is not gross enough yet, or is not gross enough now (it may have been once), to fall outside the test norms.

EMG/NCV studies tend not to go into abnormal ranges until at least 6-8 weeks after an initial damage, and the damage has to be fairly extensive to be picked up.

With skin biopsy, the MacArthur protocols "norm" intraepidermal nerve fiber density at the 5th and 95th percentiles of a control group--those are what is defined on most reports as pathology. But since there are individual differeneces, a person who started in, say, the 70th percentile but had damage that took him/her to the 25th percentile might be undergoing a nerve damage process, yet be considered "normal" for purposes of the report, and be considerably symptomatic.

Sometime this can be qualified by noticing the condition of the small-fiber nerves from a skin biopsy--excessive branching and swelling tends to point to a neuropathic process whatever the numbers are.

Fibro used to be a diagnosis of exclusion....when all tests are negative, you have Fibro. Now it is the first stop for the train. They diagnose it in people PRIOR to having any testing, that makes me nervous. They put people on Lyrica and SSRIs without checking to see what is the problem. I am not on the Fibro bandwagon.

Hmmmm!
 

Unfortunately for the moment, through no fault of my own, I seem to be on the Fibromyalgia 'bandwagon'. Mine though has come after much testing and persistence to get to the bottom of the twenty-five, mostly ongoing symptoms, that I've experienced over the past 2 years 4 months.

The neuropathic pain is only one symptom and this too is ongoing, although helped somewhat now by Lyrica and TDS Tramadol (Ultram)/Panadol (Tylenol) combos. The Gastroparesis - diagnosed earlier this year has pulled me down even further and I've lost 20+kgs (44+ lbs) while being only able to eat liquids and pureed food. This is also another horrible symptom.

I still wait to see what will unfold and whether a more 'acceptable' diagnosis will be made in the days to come but meanwhile I have to advocate for myself as best I can. Thankfully much is being 'discovered' now about Fibro. Thankfully, it may turn out that some people actually fit into different diagnostic 'camps' but in the meantime while relative ignorance abounds as to its causation/existance all we who have it can do is, to support each other.

To label difficult to decipher medical conditions as psychosomatic/somatoform is hugely ignorant in my book, especially when there is still sooooo much we don't yet know about the minutiae of workings of the human body. New research findings tell us this everyday.

Megan, have you been tested for autonomic neuropathy? Have you have skin biopsy done? 44lb weight loss should not occur with Fibro. They told me I had Fibro for years, until I got the skin biopsy....now I am on IVIG.

I talk to a DR that told me that the amount of fibers lost on skin is proportional to the neuropathic pain you have.

So I guess that when I do the test in one year from now maybe everything is normal and the pain is gonne. Maybe people feel pain because there is less nerve fibers on skin and not because your brain continoing to receive signals of pain from the nervous system. What do you think? After all skin biopsys are a very new procedure

I had my skin biopsy back in 2004. I don't know if pain is equal to nerve fibers lost. I have 2 fibers per mm in my calf.....yet my pain is like 'bone pain'...no burning.

Hope you recover and have no lasting effects.

The pain of small-fiber neuropathy--
 

--is not necessarily proportional to the amount of nerve fiber loss. It seems to have more to do with the presence of acidic inflammatory substances, such as the mysterious Substance P. that appear partly as the result of the breakdown of nerve components, and with the brain's difficulty in interpreting garbled signals from damaged pathways.

Pain is often most severe during an ongoin damage process, before the nerves have completely died. Dead nerves tend to leave patches of numbness. Of course, as many have reported, it is possible to have both pain and numbness at the same time from the same area, likely representing different stages of a damaging process at slightly different dermal levels.

Also, regenerating nerves are known to be qite painful in certain circumstances, as the growth cones fight through tissue to link up with their targets; the brain also has difficulty interpreting those incomplete signals.

Hi,

There is one thing I don't understand. Everytime you damage your nerve you are sure you gonna have a chronic neuropathic pain? Aren't the possibility of nerves regenerate and the pain is gonne forever? How long does it takes for a nerve to regenerate anyway?

I don't understand why people say that your nervous system is sending pain signals to your brain, when we can see through skin biopsies that the problem is there. You've got pain because you have a less nerves then a regular person on the area that is causing you pain. Why is this misterious explanation for neuropathic pain. This could be the explanation before 2006, but after this year they proved that the pain is due to a loss of nerve fibers on your skin. Isn't so? Or Do Cientist verify through nerve biopsys that the nerve is fine and despite this fact people still feel pain?

http://www.neuropathy.org/site/DocSe...pdf?docID=1661

By the way. My pain is intermitent (it is not constant) and I had my hands sometimes stiff. Any explanation for this? They feel swallowed but they aren't. And everything is fine on the X-Ray and blood exams.

Thank you,

PS: Sorry about my English

Autonomic tests!
 

Cyclelops, I did have some autonomic tests done back at the end of 2007 within a couple of months of getting the neuropathic pain but BEFORE Gastroparesis.

They did the QSART and a cardiac test which were normal at the time. I didn't have the tilt table test. I haven't had a skin biopsy done as it is only available here for research purposes and rarely at that. As yet to my knowledge it has not been approved for general diagnostic use by the Australia Gov't protocols.

Damaged nerves--
 

--are not even necessarily painful--they can experience numbness, phantom vibration, sensations of things that aren't there (parastheses), and a whole host of erroneous sensations or lack of sensations.

Much depends on which nerves are damaged--there are numerous types of both small and large sensory fibers, designed to detect different types of sensations--and to what extent (and where).

Yes, it is possible for nerves to regenerate. But they grow back more slowly than almost any other body tissue. One commonly cited figure that is commonly cited is under ooptimal conditions, they can grow 1mm a day. If you think about that, if you'er talking about a fiber to the distal part of a limb, you may be talking years before the full path is traversed--assuming the damage process has stopped, assuming it can reconnect with the original target (and it's likely to take a different path than it originally did, which may re-wire the body in a very different way than previously, if the damage was widespread).

I am more numb from the knees down, with a bone like pain in my tibia and foot area. Filipe, in my presentation, I had no pain below the knees! I didn't even realize when I hurt myself! I felt like a tight stocking was on. At first I thought I had a compartment syndrome. I was running on these feet and legs and ended up with a bad stress fracture which would not heal. Still no one thought neuropathy. It was not until my autonomic system failed that I got the neuropathy evaluation. Neuropathy is complex.

Megan, my QSARTS were abnormal....my thermoregulatory sweat test showed global anhidrosis. Can they do a tilt? After I flunked the autonomic battery, then they did a skin biopsy. I am cared for at a research center. You pretty much have to be at a research center here too, altho research centers are widely available. I did have to wait 3 months originally, and they wanted me to wait 6 months to get in!

Glenn, so if I read what you posted, +ANA=vasculitic in general? I am thinking it is vasculitic myself. Ugh.

Thanks for sharing.