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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 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]
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“The Central Sensitization Inventory (CSI; Neblett et al., 2013) was developed for the expressed purpose of assessing CS-related symptoms and has been mentioned frequently throughout this special issue.”
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“CS is often associated not only with severe pain but also with various other symptoms like sleep disturbances and stress intolerance [28,29].”
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“As many of the participants in this study might experience mild symptoms, more participants showed 40-point or less in CSI, and lesser participants presented previous history of CSSs compared to previous studies.”
InfluentialGirbés, E. L., Dueñas, L., Barbero, M., Falla, D., Baert, I. A. C., Meeus, M., Sánchez‐Frutos, J., Aguilella, L., & Nijs, J. (2016) · Physical Therapy · doi:10.2522/ptj.20150492 · Cited by 133
Vargas, A. I. C., Neblett, R., Chiarotto, A., Kregel, J., Nijs, J., van Wilgen, C. P., Pitance, L., Knežević, A., Gatchel, R. J., Mayer, T. G., et al. (2017) · Journal of Pain · doi:10.1016/j.jpain.2017.11.006 · Cited by 130
Franco, K. F. M., Lenoir, D., Franco, Y. R. D. S., dos Reis, F. J. J., Cabral, C. M. N., & Meeus, M. (2020) · European Journal of Pain · doi:10.1002/ejp.1666 · Cited by 134
“Current evidence suggests that the qualitative tests and the Central Sensitization Inventory (Mayer et al., 2012; Neblett et al., 2013) are the main clinical criteria for the classification of central sensitization pain (Nijs et al., 2014).”
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“Psychometric properties of neuropathic and central sensitisation questionnaires vary widely within and between questionnaires, and results range from poor to excellent (Table 8).(10,18,19,24,25,35,44,55,66,68,71,88,106,122,127,138,139,146) ,(156,158,163,167,181,206,211,212,217,239,245)”
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Neblett, R. (2018) · Journal of Applied Biobehavioral Research · doi:10.1111/jabr.12123 · Cited by 131
“Agreement between physician- diagnosed CSSs and self- reported CSSs, in a group of general chronic pain subjects, was relatively high with fibromyalgia, headache, irritable bowel syndrome and moderate with restless leg syndrome and temporomandibular joint disorder (Neblett et al., 2013).”
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The clinical application of teaching people about pain
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“inventory (Neblett et al., 2013) can be used as helpful launching points to pose a question, followed by indepth pain neuroscience education of the particular”
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“The cutoff of 40 on the CSI allows correct identification of over 82% of central sensitization pain patients, but the chances of false-positives are relatively high, which supports our approach of combining this measure with a more comprehensive examination for identification of predominant central sensitization pain…”
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Does central sensitization help explain idiopathic overactive bladder?
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The Molecular Basis and Pathophysiology of Trigeminal Neuralgia
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“Sensitization in some of these structures has been implicated in other chronic pain conditions [93,94,98,99].”
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“Each response is scored from 0 to 4, yielding a total score of 0 to 100 [14, 17].”
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Cross-cultural adaptation and validity of the Italian version of the Central Sensitization Inventory
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“It is probably true that some central sensitization might be related to BMS, as are other functional somatic syndromes [28, 29], however, recent evi-”
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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
“…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
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Chronic Pain in Breast Cancer Survivors: Nociceptive, Neuropathic, or Central Sensitization Pain?
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“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].”
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“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
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“Headache/Migraine, FM, IBS, Chronic Fatigue Syndrome, Multiple Chemical Sensitivity, and posttraumatic stress disorder with childhood onset [34].”
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Phenotyping Post-COVID Pain as a Nociceptive, Neuropathic, or Nociplastic Pain Condition
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“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 62
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 68
“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 65
“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
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
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
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
Fernández‐de‐las‐Peñas, C., & von Piekartz, H. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9113686 · Cited by 62
“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
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 58
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
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
“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 63
Clark, J. R., Nijs, J., Yeowell, G., Holmes, P. S., & Goodwin, P. C. (2019) · Pain Practice · doi:10.1111/papr.12809 · Cited by 53
“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
“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
“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
Midenfjord, I., Grinsvall, C., Koj, P., Carnerup, I., Törnblom, H., & Simrén, M. (2021) · Neurogastroenterology & Motility · doi:10.1111/nmo.14156 · Cited by 52
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
“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
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 54
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
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 54
“(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
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
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 47
“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 51
“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
Dizner-Golab, A., Lisowska, B., & Kosson, D. (2023) · Reumatologia/Rheumatology · doi:10.5114/reum/163094 · Cited by 59
“Another promising screening device is the central sensitization inventory (CSI) [75, 76].”
Background
Metadata
- 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 (medical) › Pain Mechanisms and Treatments
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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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