The main cause 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 punch biopsies should be routinely used to diagnose Fibromyalgia. Additional papers and studies also state that Small Fiber Neuropathy is the first finding for neurological sequel from diabetes.

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. There is currently a general feeling that all the patients on chronic opioids are opioid addicts and do not have a real diagnosis or problem warranting treatment. This test will allow you to screen for Small Fiber Neuropathy and diagnose up to 50% more patients.

Small Fiber Neuropathy testing (SFN)

We provide procedure kits and shipping at no charge. 

The biopsy kit includes:













  • Biopsy fixative

  • Skin puncture tool

  • Scissors and forceps

  • Alcohol swabs and band aids

  • Buffered Zamboni solution

  • Printed instructions for biopsy

  • Post biopsy patient instructions

  • Shipping container and ice pack for packaging return shipments

  • Shipping instructions, including a pre-paid shipping label for return shipments

The 3-mm punch biopsies are easy-to-learn, minimally invasive, reimbursable procedures that can be performed in an outpatient office setting. 


Our new specimen collection protocol allows you to request free kits in advance, keep them until needed (tests stored in your office at room temperature will stay stable for up to one year), and then ship specimens overnight directly to our lab.


This revised protocol will allow you to perform the biopsy during the same clinic visit, making it more convenient for you and your patients. 



We also provide in-office and staff training for biopsy procedure,packaging and shipping, if requested.

Our expert staff and board-certified pathologists will be available for consultation to answer all procedural and patient questions.


Small fibers are small narrow diameter myelinated (Aδ) and unmyelinated (C) nerve fibers of the peripheral nervous system (McGlone; 2010). Somatosensory Aδ-fibres and C-fibres innervating skin pass through the dermis where they innervate cutaneous structures; both groups of fibers end as free nerve endings in the epidermis (the Aδ-fibres lose their myelin sheath as they cross the dermo-epidermal junction).


Aδ-fibres are responsible for conveying cold input and nociceptive input. C-fibres convey innocuous warm sensations and possibly innocuous cold sensations (Hensel; 1960), and noxious input from a variety of high threshold mechanical, thermal and chemical stimuli.


Small fibers play an important role in the autonomic nervous system because thinly myelinated fibers contribute to preganglionic fibers and C-fibres contribute to postganglionic fibers, innervating structures such as sweat glands, blood vessels and the heart.