Role of skin biopsy in the diagnosis of peripheral neuropathic pain

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Curr Pain Headache Rep. 2009 Jun;13(3):191-6.

Role of skin biopsy in the diagnosis of peripheral neuropathic pain.

Walk D.

University of Minnesota, 420 Delaware Street SE, MMC 295, Minneapolis, MN 55455,

USA.

Evaluation of epidermal nerve fiber density (ENFD) allows objective, pathologic,

and minimally invasive assessment of small myelinated and unmyelinated cutaneous

axons. In addition to providing diagnostic confirmation of neuropathies

affecting these " small fibers, " this procedure has advanced clinical care by

dramatically increasing awareness of the role of small myelinated and

unmyelinated axons in disorders of peripheral nerve and in neuropathic pain.

This review highlights the technical aspects of skin biopsy for ENFD

determination, the role of skin biopsy in the diagnosis of small-fiber

neuropathy and ganglionopathy, and the diagnostic approach to the patient with

peripheral neuropathic pain.