Who Diagnoses and Treats SFN?
Neurologist (General/Neuromuscular)
Primary specialist for neuropathies. Can evaluate symptoms, order testing (e.g., skin biopsy), and coordinate treatment.
Autonomic Specialist
Focuses on dysautonomia (e.g., POTS, sweating abnormalities). Helpful when autonomic symptoms are prominent.
Pain Medicine
Helps with symptom control, procedures, and medication optimization in collaboration with neurology.
Endocrinology/Rheumatology
Assesses underlying causes like diabetes, thyroid disease, or autoimmune conditions when suspected.
How to Find the Right Provider
Start with your network
- Ask your primary care provider for a referral to neurology (mention suspected small fiber neuropathy).
- Contact major academic medical centers or teaching hospitals near you.
- Call neurology clinics and ask if they perform skin biopsies or autonomic testing for SFN.
What to ask when calling
- Do you evaluate and treat small fiber neuropathy?
- Do you perform or refer for skin biopsy (IENFD) and autonomic tests (QSART, tilt, etc.)?
- Do you review outside records and prior testing?
- What is the wait time for a new patient appointment?
Finding specialty clinics
- Search academic centers’ neuromuscular or autonomic clinics.
- Use your insurance directory to filter by neurology and pain specialists.
- Check regional medical societies for member directories.
What to Bring to Your Appointment
Documents
- Symptom timeline and top 3 concerns
- Medication and supplement list (doses)
- Prior test results (labs, EMG/NCS, imaging)
- Relevant medical history and family history
Practical items
- Photo ID and insurance card
- Comfortable clothing for exam and temperature control
- Questions about next steps, testing, and follow‑up
Tests You May Hear About
Skin Biopsy (IENFD)
Measures small nerve fiber density. Outpatient procedure with local anesthetic—brief and generally well‑tolerated.
Autonomic Testing
Includes QSART, tilt‑table testing, heart‑rate variability, and sweat testing when autonomic symptoms are present.
Laboratory Work‑up
Screens for common causes (glucose/A1c, B‑12, thyroid, autoimmune markers, paraproteins, celiac, infections as indicated).
Red Flags and When to Seek Urgent Care
- New or rapidly worsening weakness, falls, or difficulty walking
- Loss of bladder/bowel control or severe back pain with weakness
- Chest pain, significant shortness of breath, or fainting
Call emergency services for symptoms that may represent an emergency.
Insurance and Access Tips
Coverage basics
Specialist referrals and testing coverage vary. Ask about prior authorization requirements for skin biopsy or autonomic tests.
Practical steps
- Confirm in‑network providers and request referrals early.
- Bring supporting documentation for appeals if needed.
- Ask clinics about self‑pay options or financial counseling.
Appointment preparation
- Photo ID and insurance card
- Complete medical history and symptom diary
- Current medication list and previous test results
Educational content only—please consult your healthcare provider for personal medical advice.