Our nerves are made up of fibers of varying sizes, ranging from small fibers which sense pain and temperature sensations to large fibers which assist in our sense of balance. Some patients develop injury to small nerve fibers, a condition called small fiber neuropathy. Conventional tests such as EMG cannot detect problems limited to small nerve fibers. However, at our health clinic Phoenix Neurological Associates we can diagnose small fiber neuropathy by means of skin biopsy. A small circular piece of skin (smaller than the diameter of a pencil eraser) is pinched from the surface of the skin. Lidocaine, a local anesthetic, is used to numb the skin first. This involves just a small needle poke. A simple band-aid is placed over the biopsy site which heals by simply scabbing over. The whole procedure takes only a few minutes. The skin specimen is processed in a special way so that the small nerve fibers in the skin can be visualized and counted.