What is the role of skin biopsy for evaluating small fiber neuropathy in patients with rheumatic disease who have treatment recalcitrant pain?  

I have a shared decision-making discussion with the patient, especially alluding to the fact that the result would not change my therapy (i.e., use neuropathic analgesics for treatment) for small fiber neuropathy (SFN). Where I find it especially useful is in a patient with systemic lupus (SLE) or ...

This is a great topic for discussion, and I want to thank all experts who made very valuable comments.As a Neurologist, I tend to side more towards Dr. @Lewis’s opinion. What I would encourage everybody to read is a review article by 3 international experts in SFN (Drs. Lauria, Faber and Cornb...

I greatly appreciate the thoughtful perspectives shared by Drs. @Manousakis and @Lewis on the nuances of interpreting skin biopsy results. While I agree that small fiber neuropathy (SFN) is ultimately a clinical diagnosis that should not rest solely on a single abnormal ENFD number, I believe dismis...

There are a lot of aspects to this question. But they all fall under the umbrella of: "What will the biopsy tell me that will change treatment decisions or change diagnostic thinking?"I rarely order skin biopsy for IENFD as the symptoms are usually pain, and the treatment for this pain will not be i...