Thanks Nancy, for the further information.
If the Neurophysiologic testing, principally nerve conduction studies and electromyography are unable to diagnose pain, you need to consult a neurologist for the following investigations;
a) Autonomic function testing; The value of autonomic testing with a localized neuropathic disorder, like small-fiber neuropathy has immense value. The most useful test would be the quantitative sudomotor axon reflex test (QSART), in your case.
b) skin biopsy; also provides good diagnosis for the small fiber neuropathy.
The treatment entails;
1) Medications like Tegretol, Pregabalin, Gabapentin
3) Alpha-lipoic acid; it has antioxidant properties
4) Trans cutaneous electrical stimulation
Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
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