Unilateral peripheral neuropathic pain: The role of neurodiagnostic skin biopsy

Abstract

According to the current definition of neuropathic pain (“pain arising as a direct consequence of a lesion or disease affecting the somatosensory system”), the demonstration of a lesion or disease involving the somatosensory system is mandatory for the diagnosis of definite neuropathic pain. Although several methods are currently available for this aim, none is suitable for every type of disease (or lesion). Neurodiagnostic skin biopsy (NSB) is a relatively new technique for the diagnosis of peripheral nerve lesions. It is an objective method, completely independent from the patient’s complaining, based on immunohistochemical staining techniques that allow measurement of the density of the epidermal nerve fibers, currently considered the free nerve endings of small diameter (A-delta and C) afferent fibers. NSB has the important property of being used to investigate the skin, allowing obtaining a diagnosis of small fiber axonal neuropathy of peripheral nerves supplying every body part covered by skin. This feature appears to be very important, particularly in cases of unilateral nerve lesions, because it allows going beyond the possibilities of neurophysiological tests which are available only for a limited number of peripheral nerves. All these characteristics make NSB a precious instrument for the diagnosis of peripheral unilateral neuropathic pain.

Keywords: Skin biopsy; Neuropathic pain; Diagnosis; Peripheral nerve lesion; Innervation

Core tip: The demonstration of a lesion or disease involving the somatosensory system is mandatory for the diagnosis of definite neuropathic pain. Unfortunately, none of the currently available methods is suitable for every type of nerve lesion. Neurodiagnostic skin biopsy (NSB) is an objective method to measure the density of epidermal sensory small fibers. In case of unilateral nerve lesions, it goes beyond the diagnostic possibilities of neurophysiological tests, allowing the diagnosis of axonal neuropathies of peripheral nerves supplying every body part covered by skin. For these reasons, NSB represents a precious tool for the diagnosis of peripheral unilateral neuropathic pain.