Therapath Neuropathology

Research finds nerve damage in patients with fibromyalgia

December 16, 2014

Objective skin test for small fiber neuropathy

NEW YORK, Dec. 16, 2014 /PRNewswire/ — Therapath, LLC (, a leader in neuropathology laboratory services, reports that new findings have revealed that patients diagnosed with fibromyalgia may also have a diagnosable small fiber neuropathy. Recently, several studies have examined fibromyalgia patients for small fiber neuropathy using a skin biopsy test to determine Epidermal Nerve Fiber Density (ENFD). The studies reported a decrease in ENFD in a subset of patients with fibromyalgia (Oaklander et al., Pain 2013; Caro & Winter, Arthritis Rheumatology 2014; Giannoccaro et al., Muscle Nerve 2014). These studies conclude that ENFD testing should be considered in the diagnostic work-up of fibromyalgia to search for small fiber neuropathy.

Patients diagnosed with small fiber neuropathy exhibit similar symptoms to those with fibromyalgia, including:

  • Chronic pain
  • Increased sensitivity to pressure and touch
  • Numbness and tingling

Epidermal Nerve Fiber Density (ENFD) is an objective measure of the small nerve fibers. To perform the test, a doctor performs a biopsy in the office to obtain a small piece of skin. That skin sample is then sent to a neuropathology laboratory for analysis. Patients with small fiber neuropathy exhibit a significant reduction in the ENFD.

About Therapath Neuropathology:

Therapath Neuropathology, founded in 2004, is a College of American Pathology accredited (CAP) and CLIA licensed specialized laboratory. The medical team are board certified in neuropathology, academically trained and extensively published. Therapath’s focus is on research and development in the testing services for muscle biopsy, nerve biopsy with teased fiber analysis, ocular (including optic neuritis), skin epidermal nerve fiber density, sweat gland nerve fiber density, skin biopsy for CADASIL and other storage disorders as well as brain/spinal cord specimens. Therapath serves hospitals, private practitioners, reference laboratories, the pharmaceutical industry, and researchers throughout the United States and internationally.


Therapath Neuropathology
Geoff Whitehouse, 800-681-4338