Small Fiber Neuropathy (SFN) is a type of neuropathy that predominately affects small-caliber sensory nerve fibers, which
control the perception of pain (pinprick), and cold and heat stimuli. Patients with SFN usually present with numbness, tingling (pins and needles sensation), and pain. Although the symptoms may involve any part of the body, it often affects feet the most. The pain is usually described as burning, stabbing or electric-like. It is a common neuromuscular disorder associated with many medical conditions, including diabetes, mellitus, amyloidosis, HIV infection, connective tissue diseases, pharmacological neurotoxicity, and alcohol abuse. It is caused by damage to the small nerves that supply feeling to the body, assist in breathing, regulate heart rate, control perspiration and aid with digestion.

The main cause of SFN is diabetes, pre-diabetes, and metabolic syndrome. Studies have shown that up to 50% of patients with Fibromyalgia suffer from Small Fiber Neuropathy. There are a multitude of clinical papers stating that biopsies should be routinely used to diagnose Fibromyalgia. Another chronic pain clinic that treats patients not only for Fibromyalgia, but also chronic back and neck pain, found that 50% of their patients are suffering from Small Fiber Neuropathy as well. The implications from this are stunning.

Some patients may present with pain as the primary or the only symptom, but pain is inherently subjective and difficult to measure or quantify. A sensitive and specific diagnostic tool is thus essential for making a correct diagnosis and providing appropriate subsequent management. SFN Biopsies are a safe procedure with minimal discomfort that allows somatic fibers, carrying temperature and pain sensation, to be differentiated from autonomic fibers.

Prior to the availability of the epidermal biopsy technique, the diagnosis of SFN was largely one of exclusion. In many cases, it may be unclear whether a patient has a SFN versus some other pain syndrome, such as fibromyalgia. Admittedly, symptomatic treatment strategies would be largely the same regardless of diagnosis. For this reason, a number of clinicians may argue against the utility of performing a skin biopsy. In some cases, this is a valid argument. However, there are situations in which it is unclear whether a patient has a SFN as opposed to non-neurological process or even a somatization disorder. 

RX2Live works with the premier labs in the country that provide the tools and medically trained personnel to offer neuropathy biopsies to a practice or senior care center. The revenue can be significant, and the benefits to the practice are many.

All training, equipment, biopsy kits and return shipping to the lab are provided at no charge to the practitioner. A technician can be provided at no charge when the practice does a minimum of 100 biopsies per month. The biopsy report is usually generated and sent back in 1–2 weeks.

Commercial and government payers are desperately trying to get their arms around patient issues caused by neuropathy. This is an $11 billion-a-year item that is getting worse year-by-year. Now that there are focused treatment plans available, the medical professionals just need to be educated and compensated for these procedures. Centers for Medicare and Medicaid Services (CMS) was the first to step up and provide support for the reimbursement of the procedures.