Never heard of it? Let us know how it goes!! I am sure it will be OK!

I used to be a neurophysiology tech (before I was a nurse) and did many nerve conduction studies on patients. I've also had several of them preformed on me while I was a patient. It is NOT a painless procedure, and you need to prepare yourself for that.

There are two parts to a nerve conduction exam---you may be given one or both of them. The first part is the "electric shocks". They will tape electrodes to the skin on your arms in key places, depending on which nerves they're studying. They will then touch an instrument to your skin which will administer a series of electrical shocks---these will make your hand twitch. With fancy computer equipment they'll be able to tell how well your motor nerves are working. This part of the exam is mildly to moderately painful.

The second part of the exam is called the "needle exam," and it is very painful---I'm sorry, but that's the truth. You may not need this part of the exam, and you can also refuse to have it if it's too painful for you. Basically they stick an inch long needle into your muscle and jiggle it around---this makes the muscle generate electrial impulses, and they can measure how well your nerves transmit those impulses.

I had both the electrical shock and the needle exams done on my mid-back area and in both hands. The needle exam was agony---I got through it on my back but couldn't bear it on my hands. I've known many patients who did get through it though. Whomever told you it was painless was lying through their teeth (or is just plain ignorant).

Good luck and try not to worry, just be empowered by the truth.

Ms. Rigor,

I am not about to have this exam (thanks God!) but having read your response, I am dying to know why these tests are conducted without any type of anesthetic. They sound like sheer torture. Also, my understanding is that MRI is good enough to determine how well your nerves work. It is used extensively with people who have Multiple Sclerosis to determine how damaged their nerves are. Why would anyone offer a patient this connectivity test if MRI could provide the same or similar information and why would any patients be willing to take it? Finally, given that RA is NOT about damage to the nerves, why would anyone suggest such a test for someone with RA?

Please let me know! Thanks. Me

Oh yes I remember, ouch, had it done on both hands a couple of years back, they thought my carpel tunnel had returned.. duh, in the end it was coming from my spine, ( another problem) all that dam torture for nothing.

I had two of these done on separate dates by separate doctors in the last few months. Both on my wrist/hands. The first one was a somewhat painful because my wrist had been hurting more than normal due to carpal-tunnel syndrome symptoms. Come to find out that was actually due to my RA. The second time was not nearly as bad. I did not have to have the needles in either test. I also took some Ibuprofin before the test the second time around and that seemed to help. Just take some deep breaths. It may be a little uncomfortable but the test does not take long and it's tolerable. Good luck

I have had multi. nerve conduction studies done start with both hands due to carpal tunnel. how it feels is a little like have you ever pulled out a plug from the wal and get a little "sap" and when you feel that you tell them and then they judge when you feel it and measure normal and abnormal responce I have had them done from head to toe and thou not pleasent not extremly bad either it also depend which kind of test is done, sometimes they'll stick very tiny needle in skin to measure and others just like ekg patch!! its not the kind of pain that makes you go cross eyed but a little unconfortable no need for pain meds to have done, don't mean to scare you just telling you truth, not pleasent but not bad !!!!

Hey D, good questions! An MRI will only show "plaques." These plaques are actually erosions on a person's "myelin" (caused by MS). MS does not damage the nerve itself, it damages the myelin that surrounds every inch of your nerves (think of myelin as insulation). Without the insulation, electrical nerve impulses fizzle out and you lose motor function (meaning you can't move). I know---it's kinda complicated!

Nerve conduction studies are totally different---they measure the speed at which nerves are able to transmit electrical impulses---no MRI can do that.

They can't give people anesthetic for nerve conduction exams because those are depressants, which would slow your nerve's ability to process impulses (giving a false positive result). Sometimes they'll give you a light dose of valium, but mostly they just make you suffer through---and suffer you will!

Sometimes in RA joint swelling will compress your nerves---that's why RA can cause carpal tunnel and such. A nerve study will measure how much your nerves are impaired. Some options for treatment are 1. Reduce swelling by DMARDS if at all possible to free up the nerve, or 2. Surgically release the nerve, or 3. There may be no treatment if the nerve damage is permanent.

A "positive result" means there IS nerve damage or compression. A "negative result" means all is well with your nerves.

For fascinating reading on myelin and it's wonderful properties, see here:

http://en.wikipedia.org/wiki/Myelin

Ms. Rigor,

Thanks for the brilliant response. I knew I could rely on you!

To paraphrase what you said, if you have RA and your doctor recommends that you do this conduction test, it will be because your doctor is considering one of the following courses of action:

1. He or she are considering starting a DMARD - but, then, starting you on a DMARD is the best course of action for RA anyway irrespective of nerve damage;

2. He or she are considering cutting your nerve through an operation - but, then, if you intend to use the organ that you are suffering pain with, cutting the nerve is not a desirable option anyway;

3. There may be no treatment for your nerve damage because it is permanent but, then, there is no point in doing the test.

Well, if these are the only three reasons for doing the test, I still don't understand why anybody would be inclined to have it...:)

It just shows you that when it comes to tests, we may need to be much more suspicious of doctors than we tend to be.

And, yes, thanks for the explanation on MS and MRI and for the reference too. Me

I totally agree with you D----as an informed patient I'll not be having these tests ever again. Really the only time it's useful is if you're considering having surgery to free a nerve (like in carpel tunnel or ulnar tunnel). After all, you really want to make sure a nerve is being significantly compressed before you cut yourself open. Also MDs like to "just see" about a lot of things. They may just want to know if there really is nerve damage, even if there's nothing to be done about it. A waste of medical resources if you ask me. But then, I suppose there's a reason people never ask me.... ;)

Ms. Rigor,

Thanks for the additional clarification. But, to continue the discussion, if your doctor is considering surgery on your nerves because you are suffering horrendous pain, then, I would be inclined to undergo the operation irrespective of what damage can or cannot be seen through this test. In fact, if I was suffering horrendous pain that could be cured by surgery (and didn't care about losing that nerve), I would be insisting on the surgery but still would refuse this test...:)

It's an honor for me that you agree with me on this point...:)

I recently had my hands and arms done as RD wanted to see if I had carpel tunnel in addition to my RA and OA. I ws scared too. But it was a piece of cake. The needle pricks are no worse than what it feels like to administer yourself an injection. The electrode part is also a piece of cake. It feels like little stings momentarily. They will instruct you prior to the test to mention if it hurts and they will tune things down. It took an entire hour but I was no worse for the wear.

After reading the replies of D and Ms I have to disagree on having this test conducted. It can verify for your doctor exactly what is going on and if the nerves are involved. I personally feel the more info my doctor has based on real facts about me is a good thing when discussing and recommending treatment. Again, don't be scared. Either I had one great doctor or it just wasn't that bad! Good luck.

Ultimately there is no right or wrong here---every person has to undergo what tests they feel appropriate. I personally feel that sometimes more "knowledge" is not more helpful if there's nothing that can be done about it, but others do prefer to know the details. I just wish MDs would explain it to patients that having this test doesn't mean your course of treatment will change. PATIENTS should be the one deciding how to spend their healthcare dollar, not MDs (though MDs can be a wonderful guide).

Yes D---we are in total agreement. :)

PS The pain experienced in this test happens to be worse for younger people---their nerves are younger and more sensitive than those who are older. Disease like diabetes and MS will damage nerves and also make them less prone to sensation. Also the skill of the tech will matter greatly.

Not to belabor this point much, but there are viable reasons for this test that don't have to do with nerve ablation (cutting your nerve through an operation). For instance, I have pretty severe problems because of a low back surgery that damaged my spinal cord. Six years later, my nerve pains suddenly got worse. For me, the point of this test was to determine if the damage was arising in my nerves themselves (like from MS or diabetic neuropathy) or if it was from the nerve root in my back. It can also help differentiate between a problem with muscle weakness and a true nerve problem. My experience was like Bizemomm's- not pleasant, but not excruciating, and the whole procedure was done in 15 minutes.

Well, I think this was a fantastic discussion because it highlighted a point that I have been preaching about for years - be very careful what tests you agree to do and make sure that before having any tests you ask your doctor how the results of the test will affect his/her decision-making process regarding your treatment.

I learnt this lesson when my grandmother was dying of cancer. She was over eighty years old and her doctors insisted that she should have a test that involved swallowing a camera-line device that was to determine whether the growth in her stomach was cancer.

She had severe stomach pain for months and it got worse over time. She already had x-rays that indicated that there was a big mass in her stomach. And, as I said, she was over eighty years old.

The doctors insisted that she had to take the test because it was the only way to determine if she had cancer.

I was a teen-ager at the time and I decided to check on this issue with some books. I found out that simply taking two x-rays, several weeks apart would determine if the tumor was growing (and, hence, was cancer) or not. There was absolutely no reason to torture my grandmother by having her undergo the invasive test that the doctors were insisting on.

I passed this information to my father and asked him to insist that she should not have the test. He refused, saying that the doctors knew best.

My grandma had the test. It was terrible for her. She had horrible pain, kept throwing up, could not swallow the device, had to try again and again and again. At the end, after hours of torture they did get the result that they wanted (she did have cancer, of course) but she was so distressed by the test that she had a heart attack that same night while still in hospital, and died from it. She never had heart problems before.

My conclusion from the story was never to trust a doctor on any test (or any procedure for this matter), unless he/she can convince you of why it is necessary and how it will affect the course of your treatment.

Also, another lesson that I learnt from my grandma's story was that psychological distress is just as bad as a physical one. Under the best of circumstances, a particularly painful experience can lead to trauma that can last for years. Under the worst of circumstances it can make you physically sick or even kill you.