Practice Parameter: Evaluation of distal symmetric polyneuropathy: Role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review) [RETIRED]

Abstract

Background: Distal symmetric polyneuropathy (DSP) is the most common variety of neuropathy.

Healthcare Utilization in People with Postherpetic Neuralgia and Painful Diabetic Peripheral Neuropathy

“…31,32 The significant excess utilization of sural nerve biopsy in younger but not older patients with painful DPN might reflect greater diagnostic uncertainty in younger patients or, perhaps more likely, greater concern in older patients regarding the complications of this procedure, which can include wound infection and persisting dysesthesias, numbness, and sensory loss in the distribution of the sural nerve. For the seven classes of medications, it was found that excess utilization varied depending on patient age, as well as on the specific neuropathic pain condition.…”

Peripheral neuropathy: pattern recognition for the pragmatist

“…The use of nerve biopsy should be restricted to these two specific clinical scenarios outwith specialist centres. Its value depends on the expertise of the neuropathologist interpreting the biopsy, and when used in a less selective way nerve biopsy usually merely confirms the diagnosis of axonal neuropathy rather than revealing its cause 15. In patients with suspected amyloid related neuropathy, abdominal fat or skin biopsy may yield the diagnosis more readily and with less chance of complications.…”

Neuroimaging overuse is more common in Medicare compared with the VA

“…2,3 Guideline discordant neuroimaging overuse appears to be common for headache 4,5 and peripheral neuropathy. [6][7][8] At the same time, underuse of neuroimaging in some highrisk headache patients 9 and diagnostic laboratory testing 10 in neuropathy patients likely exists. 6 The Veterans Affairs (VA) health system is a single-payer health system that is largely separate from the private sector health care system.…”