alex3619
Senior Member
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Hi everyone,
It has recently come to my attention that many of us have small fiber neuropathy, as posted on CO-CURE:
CLINICAL PAIN MEDICINE
ISSUE: 9/2010 | VOLUME: 9:09
Small Fiber Neuropathy Demonstrated in Pain Syndromes
Andrew Wilner, MD
Toronto—Nearly half of patients with a painful condition had evidence
of small fiber neuropathy on skin biopsy, according to research
presented at the 2010 annual meeting of the American Academy of
Neurology meeting (poster P05.231).
Devanshi Gupta, MD, and John Harney, MD, neurologists at Dallas
Neurological Associates, Richardson, Texas, and co-authors of the
paper, reviewed 48 patients who underwent skin biopsy for evaluation
of small fiber neuropathy. Of the patients, 30 had a painful
condition, such as fibromyalgia, chronic fatigue syndrome, chronic
pain syndrome or some combination of the above. Of these, 13 (43%) had
evidence of small fiber peripheral neuropathy determined by reduced
epidermal nerve fiber densities on punch biopsy of the skin. Although
some of these patients had positive electromyography and nerve
conduction velocity tests for neuropathy, others did not.
“We have found an overlap between small fiber neuropathy and chronic
pain in many patients,” observed Dr. Gupta.
Punch biopsies were taken 10 cm proximal to the lateral malleolus
(abnormal <5.4 fibers/mm) and 20 cm from the anterior iliac crest on
the thigh (abnormal <6.8 fibers/mm). Specimens were sent to Therapath
Lab for interpretation.
Dr. Gupta advised that physicians consider a skin biopsy for
evaluation of small fiber neuropathy in patients who present with
sharp, shooting pains, orthostatic hypotension, autonomic symptoms,
trophic skin changes, incontinence, sexual dysfunction or other
neuropathic symptoms. One should consider a small fiber neuropathy
particularly in patients with comorbidities such as diabetes,
Sjogren’s syndrome or vitamin deficiency, according to Dr. Gupta.
“There are other ways to diagnose a small fiber neuropathy,” Dr. Gupta
observed, “but skin biopsy is the easiest way and provides an
objective number, which can be followed. The technique takes a little
practice, but it is straightforward to learn.”
“Small fiber neuropathy should be suspected if there is distal limb
(lower extremity greater than upper extremity) pain or decreased pain
sensation,” W. King Engel, MD, director and professor of neurology and
pathology, Neuromuscular Center, Good Samaritan Hospital, University
of Southern California, Keck School of Medicine, Los Angeles. “I do
not do skin biopsy exams. I am concerned about false-negatives. Skin
biopsy abnormalities must not be the sine qua non of diagnosing small
fiber neuropathy. A careful clinical sensory exam for hypo- and/or
hypersensitivity, along with the history, is the best way to diagnose
a small fiber neuropathy. However, a punch biopsy of skin can support
the diagnosis of small fiber neuropathy.”
Dr. Engel cautioned that the reproducibility of results of different
biopsies taken at the same time in the same region probably is not
consistent enough for following improvement or worsening
determinations.
“When you see chronic pain overlapping with symptoms of small fiber
neuropathy, it is very correct to pursue a thorough investigation,”
Dr. Gupta concluded. “If you diagnose a small fiber neuropathy,
patients may respond to specific treatment for neuropathic pain.”
---------------------------------------------
Send posts to CO-CURE@listserv.nodak.edu
Unsubscribe at http://www.co-cure.org/unsub.htm
Co-Cure Archives: http://listserv.nodak.edu/archives/co-cure.html
---------------------------------------------
Co-Cure's purpose is to provide information from across the spectrum of
opinion concerning medical, research and political aspects of ME/CFS and/or
FMS. We take no position on the validity of any specific scientific or
political opinion expressed in Co-Cure posts, and we urge readers to
research the various opinions available before assuming any one
interpretation is definitive. The Co-Cure website <www.co-cure.org> has a
link to our complete archive of posts as well as articles of central
importance to the issues of our community.
---------------------------------------------
The Cleveland Clinic Journal of Medicine has this to say:
http://www.ccjm.org/content/76/5/297.full
Small fiber neuropathy: A burning problem
JINNY TAVEE, MD
+ Author Affiliations
Neuromuscular Disease Center, Neurological Institute, Cleveland Clinic
LAN ZHOU, MD, PhD
+ Author Affiliations
Director, Cleveland Clinic Cutaneous Nerve Laboratory, Neuromuscular Disease Center, Neurological Institute, Cleveland Clinic
ADDRESS: Lan Zhou, MD, PhD, Neuromuscular Disease Center, Neurological Institute, S90, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; e-mail zhoul2@ccf.org.
Next Section
Abstract
Small fiber neuropathy is increasingly being recognized as a major cause of painful burning sensations in the feet, especially in the elderly. Although strength remains preserved throughout the course of the disease, the pain and paresthesias are often disabling. Diabetes mellitus is the most common identifiable cause of small fiber neuropathy, and impaired oral glucose tolerance and individual components of the metabolic syndrome are often associated with it. Some cases, however, are idiopathic. Skin biopsy (with an evaluation of the density of intraepidermal nerve fibers) and tests of autonomic nerve function are useful for the diagnosis. Management involves controlling pain and identifying and aggressively treating the underlying cause.
Previous Section
Next Section
Key points Symptoms of small fiber neuropathy typically start with burning feet and numb toes.
Key points Causes and associated conditions can be found in over 50% of cases. These include glucose dysmetabolism, connective tissue diseases, sarcoidosis, dysthyroidism, vitamin B12 deficiency, paraproteinemia, human immunodeficiency virus infection, celiac disease, neurotoxic drug exposure, and paraneoplastic syndrome.
Key points Findings on routine nerve conduction studies and electromyography are typically normal in this disease.
Key points Management includes aggressively identifying and treating the underlying cause, advising lifestyle modifications, and alleviating pain.
Alex again: given that B12 problems, glucose and connective tissues diseases, neurotoxins and HIV can probably cause this, what's the bet that XMRV is another cause?
Bye
Alex
It has recently come to my attention that many of us have small fiber neuropathy, as posted on CO-CURE:
CLINICAL PAIN MEDICINE
ISSUE: 9/2010 | VOLUME: 9:09
Small Fiber Neuropathy Demonstrated in Pain Syndromes
Andrew Wilner, MD
Toronto—Nearly half of patients with a painful condition had evidence
of small fiber neuropathy on skin biopsy, according to research
presented at the 2010 annual meeting of the American Academy of
Neurology meeting (poster P05.231).
Devanshi Gupta, MD, and John Harney, MD, neurologists at Dallas
Neurological Associates, Richardson, Texas, and co-authors of the
paper, reviewed 48 patients who underwent skin biopsy for evaluation
of small fiber neuropathy. Of the patients, 30 had a painful
condition, such as fibromyalgia, chronic fatigue syndrome, chronic
pain syndrome or some combination of the above. Of these, 13 (43%) had
evidence of small fiber peripheral neuropathy determined by reduced
epidermal nerve fiber densities on punch biopsy of the skin. Although
some of these patients had positive electromyography and nerve
conduction velocity tests for neuropathy, others did not.
“We have found an overlap between small fiber neuropathy and chronic
pain in many patients,” observed Dr. Gupta.
Punch biopsies were taken 10 cm proximal to the lateral malleolus
(abnormal <5.4 fibers/mm) and 20 cm from the anterior iliac crest on
the thigh (abnormal <6.8 fibers/mm). Specimens were sent to Therapath
Lab for interpretation.
Dr. Gupta advised that physicians consider a skin biopsy for
evaluation of small fiber neuropathy in patients who present with
sharp, shooting pains, orthostatic hypotension, autonomic symptoms,
trophic skin changes, incontinence, sexual dysfunction or other
neuropathic symptoms. One should consider a small fiber neuropathy
particularly in patients with comorbidities such as diabetes,
Sjogren’s syndrome or vitamin deficiency, according to Dr. Gupta.
“There are other ways to diagnose a small fiber neuropathy,” Dr. Gupta
observed, “but skin biopsy is the easiest way and provides an
objective number, which can be followed. The technique takes a little
practice, but it is straightforward to learn.”
“Small fiber neuropathy should be suspected if there is distal limb
(lower extremity greater than upper extremity) pain or decreased pain
sensation,” W. King Engel, MD, director and professor of neurology and
pathology, Neuromuscular Center, Good Samaritan Hospital, University
of Southern California, Keck School of Medicine, Los Angeles. “I do
not do skin biopsy exams. I am concerned about false-negatives. Skin
biopsy abnormalities must not be the sine qua non of diagnosing small
fiber neuropathy. A careful clinical sensory exam for hypo- and/or
hypersensitivity, along with the history, is the best way to diagnose
a small fiber neuropathy. However, a punch biopsy of skin can support
the diagnosis of small fiber neuropathy.”
Dr. Engel cautioned that the reproducibility of results of different
biopsies taken at the same time in the same region probably is not
consistent enough for following improvement or worsening
determinations.
“When you see chronic pain overlapping with symptoms of small fiber
neuropathy, it is very correct to pursue a thorough investigation,”
Dr. Gupta concluded. “If you diagnose a small fiber neuropathy,
patients may respond to specific treatment for neuropathic pain.”
---------------------------------------------
Send posts to CO-CURE@listserv.nodak.edu
Unsubscribe at http://www.co-cure.org/unsub.htm
Co-Cure Archives: http://listserv.nodak.edu/archives/co-cure.html
---------------------------------------------
Co-Cure's purpose is to provide information from across the spectrum of
opinion concerning medical, research and political aspects of ME/CFS and/or
FMS. We take no position on the validity of any specific scientific or
political opinion expressed in Co-Cure posts, and we urge readers to
research the various opinions available before assuming any one
interpretation is definitive. The Co-Cure website <www.co-cure.org> has a
link to our complete archive of posts as well as articles of central
importance to the issues of our community.
---------------------------------------------
The Cleveland Clinic Journal of Medicine has this to say:
http://www.ccjm.org/content/76/5/297.full
Small fiber neuropathy: A burning problem
JINNY TAVEE, MD
+ Author Affiliations
Neuromuscular Disease Center, Neurological Institute, Cleveland Clinic
LAN ZHOU, MD, PhD
+ Author Affiliations
Director, Cleveland Clinic Cutaneous Nerve Laboratory, Neuromuscular Disease Center, Neurological Institute, Cleveland Clinic
ADDRESS: Lan Zhou, MD, PhD, Neuromuscular Disease Center, Neurological Institute, S90, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195; e-mail zhoul2@ccf.org.
Next Section
Abstract
Small fiber neuropathy is increasingly being recognized as a major cause of painful burning sensations in the feet, especially in the elderly. Although strength remains preserved throughout the course of the disease, the pain and paresthesias are often disabling. Diabetes mellitus is the most common identifiable cause of small fiber neuropathy, and impaired oral glucose tolerance and individual components of the metabolic syndrome are often associated with it. Some cases, however, are idiopathic. Skin biopsy (with an evaluation of the density of intraepidermal nerve fibers) and tests of autonomic nerve function are useful for the diagnosis. Management involves controlling pain and identifying and aggressively treating the underlying cause.
Previous Section
Next Section
Key points Symptoms of small fiber neuropathy typically start with burning feet and numb toes.
Key points Causes and associated conditions can be found in over 50% of cases. These include glucose dysmetabolism, connective tissue diseases, sarcoidosis, dysthyroidism, vitamin B12 deficiency, paraproteinemia, human immunodeficiency virus infection, celiac disease, neurotoxic drug exposure, and paraneoplastic syndrome.
Key points Findings on routine nerve conduction studies and electromyography are typically normal in this disease.
Key points Management includes aggressively identifying and treating the underlying cause, advising lifestyle modifications, and alleviating pain.
Alex again: given that B12 problems, glucose and connective tissues diseases, neurotoxins and HIV can probably cause this, what's the bet that XMRV is another cause?
Bye
Alex