26 Figure 3 Inclusion results of systematic literature search. Articles excluded with a wrong study design, included review articles, animal models or case reports. If review articles did publish data about sensitivity (sens) and/or specificity (spec), the original papers were looked up. As a result, 29 extra articles were included. 19 articles did publish the test results from all participants, which made it possible to calculate sens & spec. 57 articles did calculate sens & spec based on QST and/or IENFD. Results Questionnaires Studies focusing on SFN use numerous questionnaires to assess or screen for neuropathic pain symptoms.58,59 Neuropathic pain can be caused by small fibers, mixed fibers or large fibers. The last two causes are classified as polyneuropathy. In order to give a clear overview of the questionnaires, they are categorized into screening questionnaires and assessment questionnaires 58, specific small fiber questionnaires and pain intensity questionnaires, Figure 4. Screening questionnaires are helpful for easy identification of neuropathic pain, which especially applies for patients with complex medical conditions (e.g., spinal cord injury). Assessment questionnaires are helpful for quantification of neuropathic symptoms.58 Some questionnaires are listed in two categories, due to multiple types of questions. Which questionnaire will be most suitable depends on the patient population and their symptoms. A good overview of sensitivity and specificity for the screening and assessment questionnaires in polyneuropathies is presented elsewhere.60 For SFN questionnaires a distinction can be made between autonomic symptoms (survey of autonomic symptoms (SAS), autonomic symptom profile (ASP)),61 validation based on Chemotherapy Induced Polyneuropathy (CIPN) (Total Neuropathy Scale (TNS)),62 validation based on diabetes (modified Toronto Clinical Neuropathy Score (mTCNS),63 Utah Early Neuropathy Scale (UENS)),64 pure SFN with the focus on frequency of symptoms (SFNSymptom Inventory Questionnaire (SFN-SIQ)),65 isolated SFN with the focus on activity and participation restrictions due to SFN (SFN-RODS)66 and isolated SFN validated in sarcoidosis patients with the focus on both frequency and intensity of symptoms (Small Fiber Neuropathy Screening List (SFNSL)).67 2 28 2
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