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Suggest Tests To Diagnose Small Fiber Neuropathy
Question: My mother has had fibromyalgia for over 25 years. She also has diabetes and arthritis. Her egfr reading has been 44 on her last test / she may also have moderate chronic kidney disease.
She has all the fibromyalgia symptoms including pain through out her body, joint pain, severe head pain / migraines, digestion problems, almost no sleep most nights, anxiety, and depression. She also has burning sensations in her sides, her chest, and her feet.
I have seen articles on the Internet recently that say that many people diagnoses with fibromyalgia really have small fiber neuropathy. Can you please advise on the following questions:
1- What tests should be done to definitively determine if she has small fiber neuropathy?
My mother will be seeing a neurologist late XXXXXXX - are all these tests generally ordered by a neurologist?
2- If she does have small fiber neuropathy, what are the best treatment options for someone of her age and condition? Are these treatment options proven and effective?
NOTE: Our primary goal would be to relieve pain.
3- How long does it take to see improvements, including reduction in pain, with these options?
Kind Regards
She has all the fibromyalgia symptoms including pain through out her body, joint pain, severe head pain / migraines, digestion problems, almost no sleep most nights, anxiety, and depression. She also has burning sensations in her sides, her chest, and her feet.
I have seen articles on the Internet recently that say that many people diagnoses with fibromyalgia really have small fiber neuropathy. Can you please advise on the following questions:
1- What tests should be done to definitively determine if she has small fiber neuropathy?
My mother will be seeing a neurologist late XXXXXXX - are all these tests generally ordered by a neurologist?
2- If she does have small fiber neuropathy, what are the best treatment options for someone of her age and condition? Are these treatment options proven and effective?
NOTE: Our primary goal would be to relieve pain.
3- How long does it take to see improvements, including reduction in pain, with these options?
Kind Regards
Brief Answer:
Details below.
Detailed Answer:
Hello,
Thanks for posting your query.
1. Diagnosis of small fiber neuropathy is determined primarily by the history and physical exam, but functional neurophysiologic testing and skin biopsy evaluation of intraepidermal nerve fiber density can provide diagnostic confirmation. These tests are not ordered routinely by a neurophysician. These are done only when there is a need for definitive diagnosis.
2. The various treatment options include antidepressants, anticonvulsants, opioids, topical therapies, and nonpharmacologic treatments for neuropathic pain. The efficacy of treatment depends on the severity of affection. There is no specific treatment available to reverse the disease process. Only symptomatic treatment is given to reduce the pain .
3. Usually the pain decreases in 4-5 weeks after choosing the best agent and most effective doses by trial and error method.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Details below.
Detailed Answer:
Hello,
Thanks for posting your query.
1. Diagnosis of small fiber neuropathy is determined primarily by the history and physical exam, but functional neurophysiologic testing and skin biopsy evaluation of intraepidermal nerve fiber density can provide diagnostic confirmation. These tests are not ordered routinely by a neurophysician. These are done only when there is a need for definitive diagnosis.
2. The various treatment options include antidepressants, anticonvulsants, opioids, topical therapies, and nonpharmacologic treatments for neuropathic pain. The efficacy of treatment depends on the severity of affection. There is no specific treatment available to reverse the disease process. Only symptomatic treatment is given to reduce the pain .
3. Usually the pain decreases in 4-5 weeks after choosing the best agent and most effective doses by trial and error method.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Above answer was peer-reviewed by :
Dr. Prasad
Thank-you for your response. Follow up questions are:
1A- The treatment options noted in the response sound to me pretty much the same as the ones used for fibromyalgia and they also sound similar to the type of medications my mother is taking today. Am I missing something - is there a difference?
The medications taken today are not very effective at managing pain and so this does not sound very hopeful. Will it make any difference for us to find out if she has fibromyalgia or small fiber neuropathy?
1B- Do have experience and/or knowledge of use of stem cells to treat small fiber neuropathy? If so, are the results good?
2- What are a few hallmark symptoms of small fiber neuropathy that we could check if my mother is experiencing, while we are waiting for a neurologist appontment?
EG. Which symptoms might enable a non-medical person to distinguish this from fibromyalgia?
Kind Regards,
1A- The treatment options noted in the response sound to me pretty much the same as the ones used for fibromyalgia and they also sound similar to the type of medications my mother is taking today. Am I missing something - is there a difference?
The medications taken today are not very effective at managing pain and so this does not sound very hopeful. Will it make any difference for us to find out if she has fibromyalgia or small fiber neuropathy?
1B- Do have experience and/or knowledge of use of stem cells to treat small fiber neuropathy? If so, are the results good?
2- What are a few hallmark symptoms of small fiber neuropathy that we could check if my mother is experiencing, while we are waiting for a neurologist appontment?
EG. Which symptoms might enable a non-medical person to distinguish this from fibromyalgia?
Kind Regards,
Brief Answer:
Details below.
Detailed Answer:
Hello.
Thanks for writing again.
1A. Yes. The treatment options are similar as there is no definitive treatment available. These are all used for symptomatic relief.
Diagnosis of small fiber neuropathy will not change the line of management much.
1B. Stem cell treatment for neuropathy is still under research and is not being clinically used. It needs more extensive studies to prove it's effectiveness.
2. The differentiation can only be done by skin biopsy and nerve conduction studies. This differentiation cannot be done on clinical basis specially by a non medical person. Further symptomatically there is considerable amount of overlap making it extremely difficult to distinguish.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards
Details below.
Detailed Answer:
Hello.
Thanks for writing again.
1A. Yes. The treatment options are similar as there is no definitive treatment available. These are all used for symptomatic relief.
Diagnosis of small fiber neuropathy will not change the line of management much.
1B. Stem cell treatment for neuropathy is still under research and is not being clinically used. It needs more extensive studies to prove it's effectiveness.
2. The differentiation can only be done by skin biopsy and nerve conduction studies. This differentiation cannot be done on clinical basis specially by a non medical person. Further symptomatically there is considerable amount of overlap making it extremely difficult to distinguish.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
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