The Central Sensitization Inventory (CSI): establishing clinically-significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample
Open accessAbstract
Unlabelled Central sensitization (CS) is a proposed physiological phenomenon in which central nervous system neurons become hyperexcitable, resulting in hypersensitivity to both noxious and non-noxious stimuli. The term central sensitivity syndrome (CSS) describes a group of medically indistinct (or nonspecific) disorders, such as fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome, for which CS may be a common etiology. In a previous study, the Central Sensitization Inventory (CSI) was introduced as a screening instrument for clinicians to help identify patients with a CSS. It was found to have high reliability and validity (test-retest reliability = .82; Cronbach's alpha = .88). The present study investigated a cohort of 121 patients who were referred to a multidisciplinary pain center, which specializes in the assessment and treatment of complex pain and psychophysiological disorders, including CSSs. A large percentage of patients (n = 89, 74%) met clinical criteria for one or more CSSs, and CSI scores were positively correlated with the number of diagnosed CSSs. A receiver operating characteristic analysis determined that a CSI score of 40 out of 100 best distinguished between the CSS patient group and a nonpatient comparison sample (N = 129) (area under the curve = .86, sensitivity = 81%, specificity = 75%).Perspective The CSI is a new self-report screening instrument to help identify patients with CSSs, including fibromyalgia. The present study investigated CSI scores in a heterogeneous pain population with a large percentage of CSSs, and a normative nonclinical sample to determine a clinically relevant cutoff value.
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The CSI scores were dichotomized using the validated cutoff ≥40, which indicates clinically relevant central sensitization.
“The scores were dichotomized using the validated cutoff ≥40, which indicates clinically relevant central sensitization.30”
From Acceptance and commitment therapy for prevention of chronic pain after total knee arthroplasty. (2026) · cites this paper as [30]
The Results (Identification of a Clinically Significant Cut-off Value) identify a CSI cutoff of 40 for distinguishing patients diagnosed with a central sensitivity syndrome (CSS) from non-patient controls. The Discussion calls it a clinically relevant guide to the *possibility* of a CSS, but says it is unknown whether the cutoff distinguishes CSS from non-CSS chronic pain patients. Thus, the cutoff is supported, but saying a score ≥40 indicates clinically relevant central sensitization overstates what this study established. Page numbers were not supplied. (LLM, conf=0.86)
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“Each response is scored from 0 to 4, yielding a total score of 0 to 100 [14, 17].”
BackgroundCentral sensitization inventory in endometriosis
Orr, N. L., Wahl, K., Lisonek, M., Joannou, A., Noga, H. L., Albert, A., Bedaiwy, M. A., Williams, C., Allaire, C., & Yong, P. J. (2021) · Pain · doi:10.1097/j.pain.0000000000002351 · Cited by 91 · see citing works
Cross-cultural adaptation and validity of the Italian version of the Central Sensitization Inventory
Chiarotto, A., Viti, C., Sulli, A., Cutolo, M., Testa, M., & Piscitelli, D. (2018) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2018.06.005 · Cited by 90 · see citing works
O’Leary, H., Smart, K. M., Moloney, N. A., Blake, C. M., & Doody, C. (2018) · Pain · doi:10.1097/j.pain.0000000000001288 · Cited by 87 · see citing works
Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management
Goom, T., Malliaras, P., Reiman, M. P., & Purdam, C. R. (2016) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2016.5986 · Cited by 86 · see citing works
Lluch, E., Dueñas, L., Falla, D., Baert, I. A. C., Meeus, M., Sánchez‐Frutos, J., & Nijs, J. (2017) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000511 · Cited by 82 · see citing works
Clark, J. R. (2017) · Pain Physician · doi:10.36076/ppj.2017.20.5.487 · Cited by 82 · see citing works
Association of Central Sensitization Inventory Scores With Pain Outcomes After Endometriosis Surgery
Orr, N. L., Huang, A. J., Liu, Y. D., Noga, H. L., Bedaiwy, M. A., Williams, C., Allaire, C., & Yong, P. J. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.0780 · Cited by 80 · see citing works
Schuttert, I., Timmerman, H., Petersen, K. K., McPhee, M. E., Arendt‐Nielsen, L., Reneman, M. F., & Wolff, A. P. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10245931 · Cited by 82 · see citing works
Headaches and myofascial temporomandibular disorders: overlapping entities, separate managements?
Conti, P. C. R., Costa, Y. M., Gonçalves, D. A. D. G., & Svensson, P. J. (2016) · Journal of Oral Rehabilitation · doi:10.1111/joor.12410 · Cited by 77 · see citing works
Validity and reliability of the Turkish version of the central sensitization inventory
Keleş, E. D., Birtane, M., Ekuklu, G., Kılınçer, C., Çalıyurt, O., Taştekin, N., Is, E. E., Ketenci, A., & Neblett, R. (2021) · Archives of Rheumatology · doi:10.46497/archrheumatol.2022.8665 · Cited by 77 · see citing works
Tu, T. T. H., Takenoshita, M., Matsuoka, H., Watanabe, T., Suga, T., Aota, Y., Abiko, Y., & Toyofuku, A. (2019) · BioPsychoSocial Medicine · doi:10.1186/s13030-019-0142-7 · Cited by 76 · see citing works
“It is probably true that some central sensitization might be related to BMS, as are other functional somatic syndromes [28, 29], however, recent evi-”
BackgroundHuysmans, E., Ickmans, K., Dyck, D. V., Nijs, J., Gidron, Y., Roussel, N. A., Polli, A., Moens, M., Goudman, L., & Kooning, M. D. (2018) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2017.08.007 · Cited by 73 · see citing works
Part of pain labelled neuropathic in rheumatic disease might be rather nociplastic
Bailly, F., Cantagrel, A., Bertin, P., Perrot, S., Thomas, T., Lansaman, T., Grange, L., Wendling, D., Dovico, C., & Trouvin, A.-P. (2020) · RMD Open · doi:10.1136/rmdopen-2020-001326 · Cited by 73 · see citing works
“…severity score, whereas they are not usually present in NP. 29 The Central Sensitisation Inventory is a questionnaire that has been developed to identify the presence of pain of the central sensitisation type, regardless of a specific aetiology, 30 31 with good psychometric characteristics.”
The Impact of Psychological Factors and Their Treatment on the Results of Total Knee Arthroplasty
Kazarian, G. S., Anthony, C. A., Lawrie, C. M., & Barrack, R. L. (2021) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.20.01479 · Cited by 74 · see citing works
Chronic Pain in Breast Cancer Survivors: Nociceptive, Neuropathic, or Central Sensitization Pain?
Leysen, L., Adriaenssens, N., Nijs, J., Pas, R., Bilterys, T., Vermeir, S., Lahousse, A., & Beckwée, D. (2018) · Pain Practice · doi:10.1111/papr.12732 · Cited by 72 · see citing works
Bennett, E., Walsh, K. M., Thompson, N. R., & Krishnaney, A. A. (2017) · World Neurosurgery · doi:10.1016/j.wneu.2017.04.166 · Cited by 72 · see citing works
Shigetoh, H., Tanaka, Y., Koga, M., Osumi, M., & Morioka, S. (2019) · Pain Research and Management · doi:10.1155/2019/3916135 · Cited by 69 · see citing works
“Patients who were referred to a multidisciplinary pain center, which specializes in the assessment and treatment of complex pain and psychophysiological disorders, including CSSs reported high CSI scores (>40) [15].”
BackgroundKoh, I. J., Kang, B. M., Kim, M. S., Choi, K. Y., Sohn, S., & In, Y. (2020) · The Journal of Arthroplasty · doi:10.1016/j.arth.2020.04.004 · Cited by 68 · see citing works
Aguila, M. E. R., Rebbeck, T. J., Leaver, A. M., Lagopoulos, J., Brennan, P., Hübscher, M., & Refshauge, K. M. (2016) · Journal of Pain · doi:10.1016/j.jpain.2016.06.008 · Cited by 66 · see citing works
“The CSI is a highly reliable and valid screening tool for central sensitivity syndromes, that is, diseases that have central sensitization as a common feature.(33) Scores of $40 indicate possible central sensitivity syndromes, with higher CSI scores reflecting a higher degree of sensitization.”
MethodLow back pain – a diagnostic approach
Almeida, D. C., & Kraychete, D. C. (2017) · Revista Dor · doi:10.5935/1806-0013.20170034 · Cited by 66 · see citing works
Monaco, A., Cattaneo, R., Marci, M. C., Pietropaoli, D., & Ortu, E. (2017) · Pain Research and Management · doi:10.1155/2017/5957076 · Cited by 66 · see citing works
“Headache/Migraine, FM, IBS, Chronic Fatigue Syndrome, Multiple Chemical Sensitivity, and posttraumatic stress disorder with childhood onset [34].”
BackgroundInfluentialO’Leary, H., Smart, K. M., Moloney, N. A., & Doody, C. (2016) · Pain Practice · doi:10.1111/papr.12484 · Cited by 66 · see citing works
Caumo, W., Alves, R. L., Serrano, P. V., Alves, C. F. D. S., Ramalho, L., Sanches, P. R. S., Silva, D. P., Torres, I. L. D. S., & Fregni, F. (2021) · Journal of Pain · doi:10.1016/j.jpain.2021.11.002 · Cited by 62 · see citing works
Coppieters, I., Pauw, R. D., Kregel, J., Malfliet, A., Goubert, D., Lenoir, D., Cagnie, B. J., & Meeus, M. (2017) · PubMed · doi:10.2522/ptj.20160259 · Cited by 62 · see citing works
Kieskamp, S. C., Paap, D., Carbo, M., Wink, F. R., Bos, R., Bootsma, H., Arends, S., & Spoorenberg, A. J. P. L. (2021) · Rheumatology · doi:10.1093/rheumatology/keab019 · Cited by 60 · see citing works
Phenotyping Post-COVID Pain as a Nociceptive, Neuropathic, or Nociplastic Pain Condition
Fernández‐de‐las‐Peñas, C., Nijs, J., Neblett, R., Polli, A., Moens, M., Goudman, L., Patil, M. S., Knaggs, R., Pickering, G. P., & Arendt‐Nielsen, L. (2022) · Biomedicines · doi:10.3390/biomedicines10102562 · Cited by 62 · see citing works
Mibu, A., Nishigami, T., Tanaka, K., Manfuku, M., & Yono, S. (2019) · Journal of Pain Research · doi:10.2147/jpr.s200723 · Cited by 60 · see citing works
“In addition, previous studies have evaluated the sensitivity (Sn) and specificity (Sp) of the CSI in identifying people with signs of CS using the pressure pain threshold (PPT) and temporal summation (TS)(30) and diagnosed CSS.(22,23) In clinical practice, in patients with chronic musculoskeletal pain, the goal of tre…”
BackgroundMethodResultInfluentialAssessment of pain associated with chronic pancreatitis: An international consensus guideline
Drewes, A. M., van Veldhuisen, C. L., Bellin, M. D., Besselink, M. G., Bouwense, S. A. W., Olesen, S. S., van Santvoort, H. C., Vase, L., & Windsor, J. A. (2021) · Pancreatology · doi:10.1016/j.pan.2021.07.004 · Cited by 61 · see citing works
Pelvic organ prolapse: The lived experience
Carroll, L., Sullivan, C. O., Doody, C., Perrotta, C., & Fullen, B. M. (2022) · PLoS ONE · doi:10.1371/journal.pone.0276788 · Cited by 63 · see citing works
“The Central Sensitization Inventory This is a self-report outcome measure [10, 18] designed to identify people who have symptoms related to CS or central sensitivity syndromes (CSS).”
BackgroundDahmani, D., Taik, F. Z., Berrichi, I., Fourtassı, M., & Abourazzak, F. E. (2023) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-023-07019-z · Cited by 63 · see citing works
“A 40-points score out of 100 was described as the cut off value, indicative for CS [38].”
BackgroundImpulsivity and risk for prescription opioid misuse in a chronic pain patient sample
Vest, N. A., Reynolds, J., & Tragesser, S. L. (2016) · Addictive Behaviors · doi:10.1016/j.addbeh.2016.04.015 · Cited by 58 · see citing works
Deitos, A., Dussán‐Sarria, J. A., de Souza, A., Medeiros, L. F., Tarragó, M. D. G. L., Sehn, F. C., Chassot, M., Zanette, S. D. A., Schwertner, A., Fregni, F., et al. (2014) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000194 · Cited by 57 · see citing works
Siqveland, J., Nygaard, E., Hussain, A., Tedeschi, R. G., & Heir, T. (2015) · Health and Quality of Life Outcomes · doi:10.1186/s12955-014-0202-4 · Cited by 58 · see citing works
von Piekartz, H., Schwiddessen, J., Reineke, L., Armijo‐Olivio, S., Bevilaqua‐Grossi, D., Biasotto‐Gonzalez, D. A., Carvalho, G. F., Chaput, E., Cox, E., Fernández‐de‐las‐Peñas, C., et al. (2020) · Journal of Oral Rehabilitation · doi:10.1111/joor.12959 · Cited by 54 · see citing works
Fernández‐de‐las‐Peñas, C., & von Piekartz, H. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9113686 · Cited by 55 · see citing works
“The Central Sensitization Inventory (CSI) is a self-reported questionnaire developed for identifying central sensitization-related symptoms [14].”
BackgroundRoldán‐Jiménez, C., Pérez‐Cruzado, D., Neblett, R., Gatchel, R. J., & Cuesta‐Vargas, A. (2020) · Pain Medicine · doi:10.1093/pm/pnaa069 · Cited by 54 · see citing works
Neblett, R., Sanabria‐Mazo, J. P., Luciano, J. V., Mirčić, M., Čolović, P., Bojanić, M., Jeremić-Knežević, M., Aleksandrić, T., & Knežević, A. (2024) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105612 · Cited by 53 · see citing works
Kim, M. S., Koh, I. J., Sohn, S., Kang, B. M., Kwak, D., & In, Y. (2019) · The Journal of Arthroplasty · doi:10.1016/j.arth.2019.03.042 · Cited by 54 · see citing works
Leemans, L., Elma, Ö., Nijs, J., Wideman, T. H., Siffain, C. N., den Bandt, H. L., Laere, S. V., & Beckwée, D. (2020) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2020.04.001 · Cited by 54 · see citing works
“A mean score of 40 is the cut off value for central sensitization.(68,69) Next to excellent measurement properties, the CSI is found to be a responsive treatment outcome measure as well.”
BackgroundCurrent Challenges in the Management of Chronic Pelvic Pain in Women: From Bench to Bedside
Siqueira-Campos, V. M., de Deus, M. S. C., Poli-Neto, O. B., Silva, J. C. R. E., de Deus, J. M., & Conde, D. M. (2022) · International Journal of Women s Health · doi:10.2147/ijwh.s224891 · Cited by 53 · see citing works
Clark, J. R., Nijs, J., Yeowell, G., Holmes, P. S., & Goodwin, P. C. (2019) · Pain Practice · doi:10.1111/papr.12809 · Cited by 53 · see citing works
“88, sensitivity of 81% ,and specificity of 75%.(6) CSI scores are classified into symptom severity levels of clinical rele-”
BackgroundTraits associated with central pain augmentation in the Knee Pain In the Community (KPIC) cohort
Akin-Akinyosoye, K., Frowd, N., Marshall, L., Stocks, J., Fernandes, G., Valdes, A. M., McWilliams, D. F., Zhang, W., Doherty, M., Ferguson, E., et al. (2018) · Pain · doi:10.1097/j.pain.0000000000001183 · Cited by 50 · see citing works
“75 for predicting PPT gain-of-function.(54) Unless otherwise stated, results are reported in the main text for primary analyses using PPTs (after log-transformation) at the proximal tibia distal to the participant’s worst affected knee, taken to be an index for centrally augmented pain.”
BackgroundTanaka, K., Murata, S., Nishigami, T., Mibu, A., Manfuku, M., Shinohara, Y., Tanabe, A., & Ono, R. (2019) · European Journal of Pain · doi:10.1002/ejp.1443 · Cited by 51 · see citing works
“A cut‐off score of 40 was not described to be diagnostic, but with this score, the CSI was able to best distinguish subjects with CSS from the non‐patient population (Neblett et al., 2013).”
MethodHendriks, E., Voogt, L., Lenoir, D., Coppieters, I., & Ickmans, K. (2020) · Pain medicine (Malden, Mass.) · doi:10.1093/pm/pnaa276 · Cited by 43 · see citing works
Midenfjord, I., Grinsvall, C., Koj, P., Carnerup, I., Törnblom, H., & Simrén, M. (2021) · Neurogastroenterology & Motility · doi:10.1111/nmo.14156 · Cited by 52 · see citing works
Knežević, A., Neblett, R., Jeremić-Knežević, M., Tomašević-Todorović, S., Bošković, K., Čolović, P., & Vargas, A. I. C. (2017) · Pain Practice · doi:10.1111/papr.12618 · Cited by 50 · see citing works
“As recommended by Neblett et al.,16 the sample was classified into 5 CSI severity subgroups for further analysis.”
MethodExplaining pain following cancer: a practical guide for clinicians
Nijs, J., Wijma, A. J., Leysen, L., Pas, R., Willaert, W., Hoelen, W., Ickmans, K., & van Wilgen, C. P. (2018) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2018.12.003 · Cited by 50 · see citing works
Cervigni, M., Onesti, E., Ceccanti, M., Gori, M. C., Tartaglia, G., Campagna, G., Panico, G., Vacca, L., Cambieri, C., Libonati, L., et al. (2018) · Neurourology and Urodynamics · doi:10.1002/nau.23718 · Cited by 49 · see citing works
Assessment of Pain in Osteoarthritis of the Knee
Thirumaran, A. J., Deveza, L. A., Atukorala, I. G., & Hunter, D. J. (2023) · Journal of Personalized Medicine · doi:10.3390/jpm13071139 · Cited by 52 · see citing works
Polli, A., Ghosh, M., Bakusic, J., Ickmans, K., Monteyne, D., Velkeniers, B., Bekaert, B., Godderis, L., & Nijs, J. (2020) · Arthritis & Rheumatology · doi:10.1002/art.41405 · Cited by 51 · see citing works
“(35) to measure physical activity, and the CFS symptoms list (36) and Central Sensitization Inventory (CSI) (37,38) to measure the different symptoms associated with CFS (fatigue, sleep distur-”
MethodInfluentialCentral sensitization has major impact on quality of life in patients with axial spondyloarthritis
Kieskamp, S. C., Paap, D., Carbo, M., Wink, F. R., Bos, R., Bootsma, H., Arends, S., & Spoorenberg, A. J. P. L. (2021) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2021.11.006 · Cited by 46 · see citing works
Guideline No. 449: Diagnosis and Impact of Endometriosis – A Canadian Guideline
Singh, S. S., Allaire, C., Al‐Nourhji, O., Bougie, O., Bridge-Cook, P., Duigenan, S., Kroft, J., Lemyre, M., Leonardi, M., Leyland, N. A., et al. (2024) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2024.102450 · Cited by 51 · see citing works
Malfliet, A., Kregel, J., Meeus, M., Danneels, L. A., Cagnie, B. J., Roussel, N. A., & Nijs, J. (2018) · PM&R · doi:10.1016/j.pmrj.2018.04.010 · Cited by 45 · see citing works
“Several studies found support for the reliability and validity of the CSI, including the Dutch CSI as used here [37-40].”
BackgroundResultIs Central Sensitisation the Missing Link of Persisting Symptoms after COVID-19 Infection?
Goudman, L., Smedt, A. D., Noppen, M. M. P., & Moens, M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10235594 · Cited by 45 · see citing works
“Despite the lack of a solid outcome measurement, the Central Sensitization Inventory (CSI) was previously introduced as a screening instrument for clinicians to help identify patients with central sensitisation [15].”
InfluentialKim, M. S., Kim, J. J., Kang, K. H., Kim, M. J., & In, Y. (2022) · Diagnostics · doi:10.3390/diagnostics12051248 · Cited by 44 · see citing works
Dizner-Golab, A., Lisowska, B., & Kosson, D. (2023) · Reumatologia/Rheumatology · doi:10.5114/reum/163094 · Cited by 50 · see citing works
“Another promising screening device is the central sensitization inventory (CSI) [75, 76].”
Background
- Authors
- Neblett, R., Cohen, H., Choi, Y., Hartzell, M. M., Williams, M., Mayer, T. G., & Gatchel, R. J.
- Affiliations
- Productive Rehabilitation Institute of Dallas for Ergonomics (US)
- The University of Texas at Arlington (US)
- The University of Texas Southwestern Medical Center (US)
- Corresponding author
- Mayer, Tom G.
- Venue
- The Journal of Pain
- Publisher
- Elsevier BV
- Published
- 2013-05
- Volume
- 14
- Issue
- 5
- Pages
- 438-445
- ISSN
- 1526-5900 (ISSN-L)
- PMC
- PMC3644381
- OpenAlex
- W1976214008
- Cited by
- 757
- References
- 45
- Citations by year
- 2026: 90 · 2025: 88 · 2024: 82 · 2023: 99 · 2022: 87 · 2021: 83 · 2020: 58 · 2019: 49 · 2018: 39 · 2017: 31 · 2016: 23 · 2015: 17 · 2014: 7 · 2013: 3
- FWCI
- 11.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Public Health Service (1UO1 DEO10713-12A2)
- National Institute of Dental and Craniofacial Research (U01DE010713)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- Central Sensitization Inventory, central sensitization, central sensitivity syndromes, fibromyalgia, chronic pain, screening tool, cut-off values, receiver operating characteristic, reference values, multidisciplinary pain center, complex pain
- MeSH terms
- Adolescent, Adult, Female, Fibromyalgia, Humans, Male, Middle Aged, Outpatients, ROC Curve, Sensitivity and Specificity, Cohort Studies, Young Adult, Central Nervous System Sensitization, Chronic Pain
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