Hi Ea1, I don’t know if I agree, I’ve had SFN for 3 yrs., had all the usual tests minus the skin punch test, had no underlying health issues, no diabetes, no accidental nerve damage, no drugs, drinking, exercised and ate healthy so my neuro said “idiopathic”. She thought the end result would be the same: managing the symptoms and trying to control the progression. I would get a punch test tomorrow if I knew it could make a difference, what is your reason if I may ask? I hope you get some answers that you can share with us. Helen