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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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“Assessments of CS, particularly the CSI, seem to have used this strong association to help determine characteristics of CS syndromes.(18,19) Although these assessments serve great utility in a diagnostic sense, we would like to explore the extent to which these questionnaires truly assess “increased responsiveness of…”
MethodAndias, R., & Silva, A. G. (2022) · Pain Medicine · doi:10.1093/pm/pnac053 · Cited by 21
Pacho-Hernández, J. C., Fernández‐de‐las‐Peñas, C., Fuensalida‐Novo, S., Jiménez‐Antona, C., Ortega‐Santiago, R., & Cigarán‐Méndez, M. (2022) · Brain Sciences · doi:10.3390/brainsci12101363 · Cited by 18
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“Analogously, the Central Sensitization Inventory, a self-report instrument aimed at identifying central sensitization through assessment of multiple pain condition symptoms, includes several items evaluating aspects of MSS, such as, “I am sensitive to bright lights”.(40) Accordingly, while MSS is not a measure of pain…”
BackgroundFernández‐de‐las‐Peñas, C., Herrero‐Montes, M., Cancela‐Cilleruelo, I., Rodríguez‐Jiménez, J., Parás‐Bravo, P., Varol, U., Loarte, P. D. V., Flox-Benítez, G., Arendt‐Nielsen, L., & Valera‐Calero, J. A. (2022) · Diagnostics · doi:10.3390/diagnostics12071538 · Cited by 19
“Its score ranges from 0 to 100 points, where >40 points suggest the presence of sensitization-associated symptoms [19].”
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“Furthermore, its results are reliable and valid for quantifying the severity of painful symptoms (Scerbo et al., 2018) when compared to self-report questionnaires (Neblett et al., 2013) or patient characteristics using clinical criteria as a reference (Neblett et al., 2015).”
Systematic Review of Methods for Individual Prediction of Postoperative Pain
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“…were provided a list of common CSS, developed to represent conditions with research evidence of altered nociceptive response in the central nervous system (i.e., central sensitization), along with consensus across researchers as falling under the umbrella of CSS (Neblett et al. 2013; Yunus 2008).”
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“Total scores ≥40/100 have been suggested as indicative of the presence of “central sensitization” (29).”
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“CSI has been validated to identify symptomology related to syndromes where the underlying aetiology is believed to be related to CS [30, 31].”
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“With the cutoff score of ≥ 40, the CSI has 81% sensitivity and 75% specificity for syndromes strongly associated with central sensitization such as chronic low back pain, FM and irritable bowel syndrome [37].”
Prevalence of Central Sensitization in Patients With Hidradenitis Suppurativa
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“Higher CSI scores indicate increased symptomology related to central sensitization, with scores ≥ 40 indicating the presence of central sensitivity syndromes.(15,16)”
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Kano, M., Oudenhove, L. V., Dupont, P. J., Wager, T. D., & Fukudo, S. (2020) · The Tohoku Journal of Experimental Medicine · doi:10.1620/tjem.250.137 · Cited by 17
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“The central sensitization inventory may be helpful to get an idea for such a differential diagnosis.(26) Protection or guidance of the CRPS extremity can lead to inappropriate overuse of contralateral joints, overuseinduced nerve entrapment (eg, contralateral carpal tunnel syndrome)(27) or myofascial pain because of n…”
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“A sum score > 40 classifies patients with central sensitization (21).”
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Pelvic organ prolapse: Women’s experiences of Accessing Care & Recommendations for improvement
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“Validated patient-reported outcome measures (Central Sensitization Inventory (CSI) [22] and Pelvic Organ Prolapse Quality of Life Questionnaire (P-QOL) [23, 24] were completed by participants.”
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Translation and cross-cultural adaptation of the Polish Central Sensitization Inventory
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“The CSI, and its Dutch version as used here, has been shown to be reliable and valid.(61,76,83,84)”
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“35 The first section was used in this study.”
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“Generalized pain, as opposed to localized chronic pain, may represent another type of chronic pain where central cognitive and affective processes are more important for the pain experience, possibly through mechanisms such as central sensitization [33, 34].”
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Predictors of Pelvic Floor Muscle Dysfunction Among Women With Lumbopelvic Pain
Keizer, A., Vandyken, B., Vandyken, C., Yardley, D., Macedo, L. G., Kuspinar, A., Fagahani, N., Forget, M.-J., & Dufour, S. P. (2019) · Physical Therapy · doi:10.1093/ptj/pzz124 · Cited by 16
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“, tension-type headache/migraines, fibromyalgia, irritable bowel syndrome, restless leg syndrome, temporomandibular joint disorder, chronic fatigue syndrome, and multiple chemical sensitivities, but this part is not included in the total score [24].”
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“The Central Sensitization Inventory (CSI) was developed as a screening tool to identify and quantify patients with CS-related symptoms.[14,15] The CSI-9 (a short version of the CSI) is a symptomatological and self-reported questionnaire consisting of 9 items assessing health-related symptoms that are common among indi…”
BackgroundMethodSchipholt, I. J. L., Scholten-Peeters, G. G. M., Koop, M. A., Bonnet, P., Bontkes, H. J., & Coppieters, M. W. (2022) · Frontiers in Molecular Neuroscience · doi:10.3389/fnmol.2022.1003821 · Cited by 15
Proença, J. D. S., Baad‐Hansen, L., Braido, G. V. D. V., Campi, L. B., & Gonçalves, D. A. D. G. (2023) · Journal of Oral Rehabilitation · doi:10.1111/joor.13598 · Cited by 15
Cetera, G. E., Merli, C. E. M., Barbàra, G., Caia, C., & Vercellini, P. (2023) · Reproductive Sciences · doi:10.1007/s43032-023-01343-4 · Cited by 16
“CSI’s reliability, which is the extent to which repeated measurements agree with one another [43], has been extensively measured in chronic pain populations in terms of test-retest reliability (intraclass correlation coefficients 0.82–0.97) [31, 32, 48, 55, 56].”
BackgroundInfluentialThe effect of balance exercises on central sensitization in patients with knee osteoarthritis
Tirasci, E., Sarpel, T., Benlidayı, İ. C., & Deniz, V. (2024) · Rheumatology International · doi:10.1007/s00296-024-05550-3 · Cited by 14
“…American College of Rheumatology criteria [19], (ii) having bilateral grade 2 or higher knee OA according to the Kellgren and Lawrence (KL) radiological grading system [20], and (iii) having a central sensitization score of 40 or higher according to the Central Sensitization Inventory (CSI) [21].”
BackgroundMethodEfficacy of galcanezumab in migraine central sensitization
Danno, D., Imai, N., Kitamura, S., Ishizaki, K., Kikui, S., & Takeshima, T. (2024) · Scientific Reports · doi:10.1038/s41598-024-72282-6 · Cited by 14
“Central sensitization is a physiological phenomenon in which the CNS becomes hypersensitive to both noxious and non-noxious stimuli 25 .”
BackgroundUçar, I. Ç., Esen, F., Turhan, S. A., Oğuz, H., Ulasoglu, H. C., & Aykut, V. (2021) · Graefe s Archive for Clinical and Experimental Ophthalmology · doi:10.1007/s00417-021-05269-y · Cited by 14
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Wheeler, P. C., Dudson, C., Gregory, K., Singh, H., & Boyd, K. T. (2022) · Foot & Ankle International · doi:10.1177/10711007211061365 · Cited by 14
Matesanz-García, L., Cuenca‐Martínez, F., Simón, A. I., Cecilia-López, D., Goicoechea, C., Fernández‐Carnero, J., & Schmid, A. B. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11041075 · Cited by 14
Audoux, C. R., Estrada-Barranco, C., Martínez‐Pozas, O., Gozalo-Pascual, R., Montaño-Ocaña, J., García-Jiménez, D., Vicente-De-Frutos, G., Cabezas-Yagüe, E., & Romero, E. A. S. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20021061 · Cited by 15
Köse, S. G., Kose, H. C., Çelikel, F., Tulgar, S., & Akkaya, T. (2023) · The Korean journal of pain · doi:10.3344/kjp.22325 · Cited by 14
“A score of 40 or more points is considered a higher probability of central sensitivity syndromes or central sensitization [24].”
BackgroundA Review of Select Centralized Pain Syndromes
Spiegel, D. R., Chatterjee, A. S., Mccroskey, A. L., Ahmadi, T., Simmelink, D., Oldfield, E. C., Pryor, C. R., Faschan, M., & Raulli, O. (2015) · Health Services Research and Managerial Epidemiology · doi:10.1177/2333392814567920 · Cited by 14
“Furthermore, several studies link childhood psychosocial trauma to the development of a CSS, although this association is complex.(5) The purpose of this review is to examine non-nociceptive CPS in a way that focuses both on the similarities and on the differences between the syndromes, which may provide a better unde…”
BackgroundWalsh, T. P., Arnold, J. B., Gill, T. K., Evans, A., Yaxley, A., Hill, C. L., & Shanahan, E. M. (2017) · Rheumatology International · doi:10.1007/s00296-017-3743-0 · Cited by 14
Hoshino, H., Sasaki, N., Ide, K., Yamato, Y., Watanabe, Y., & Matsuyama, Y. (2021) · Journal of Orthopaedic Science · doi:10.1016/j.jos.2021.05.003 · Cited by 13
Chen, Y., Wang, E. J., Sites, B. D., & Cohen, S. P. (2023) · Regional Anesthesia & Pain Medicine · doi:10.1136/rapm-2022-104203 · Cited by 13
Shin Yee, L. O. H., Zakaria, R., & Mohamad, N. (2023) · Medeniyet Medical Journal · doi:10.4274/mmj.galenos.2023.14478 · Cited by 13
Bento, A. P. D. S., Meziat‐Filho, N., Ferreira, A. D. S., Cassetta, A. P., & de Almeida, R. S. (2023) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2023.100504 · Cited by 13
“Patients with chronic pain and signs of central sensitization can present changes in motor patterns, cerebral cortex activation, and endogenous pain modulation.(20,21) However, our findings also draw attention to other possible aspects that may be associated with chronic pain.”
BackgroundSachau, J., Kersebaum, D., Hüllemann, P., Adolf, D., Kabelitz, M., Keller, T., Freynhagen, R., Tölle, T. R., Binder, A., & Baron, R. (2023) · PAIN Reports · doi:10.1097/pr9.0000000000001098 · Cited by 13
Tekaya, A. B., Saïd, H. B., Youssfi, I., Dhia, S. B., Bouden, S., Rouached, L., Mahmoud, I., Tekaya, R., Saidane, O., & ABDELMOULA, L. (2024) · Reumatologia/Rheumatology · doi:10.5114/reum/185390 · Cited by 13
“According to previous research on chronic pain patients, a cutoff of 40 appears to be associated with a higher likelihood of central sensitization [13].”
Lang-Illievich, K., Klivinyi, C., Ranftl, J., Elhelali, A., Hammer, S., Szilagyi, I.-S., & Bornemann‐Cimenti, H. (2024) · Pain and Therapy · doi:10.1007/s40122-024-00642-1 · Cited by 13
Kim, M. S., Koh, I. J., Choi, K. Y., Ju, G. I., & In, Y. (2021) · Knee Surgery Sports Traumatology Arthroscopy · doi:10.1007/s00167-021-06561-4 · Cited by 13
Mikkonen, J., Leinonen, V., Luomajoki, H. A., Kaski, D. N., Kupari, S., Tarvainen, M. P., Selander, T. A., & Airaksinen, O. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10214887 · Cited by 13
Standard Correction of Vision Worsens EMG Activity of Pericranial Muscles in Chronic TMD Subjects
Monaco, A., Ortu, E., Giannoni, M., D’Andrea, P., Cattaneo, R., Mummolo, A., & Pietropaoli, D. (2020) · Pain Research and Management · doi:10.1155/2020/3932476 · Cited by 13
“4, thereby revealing a severe form of central sensitization [30, 31].”
BackgroundCentral sensitization and its relationship with health profile in Behçet’s disease
Ayar, K., Ökmen, B. M., Altan, L., & ÖZTÜRK, E. K. (2020) · Modern Rheumatology · doi:10.1080/14397595.2020.1780076 · Cited by 13
Aoyagi, K., & Sharma, N. K. (2020) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2020.07.008 · Cited by 13
Roldán‐Jiménez, C., Pajares, B., Campos, M. I., Trinidad‐Fernández, M., Sánchez, D. G., Ribelles, N., Alba, E., & Cuesta‐Vargas, A. (2021) · Pain Practice · doi:10.1111/papr.13009 · Cited by 13
“neurons become hyperexcitable, resulting in hypersensitivity to both noxious and non-noxious stimuli.(7) CS”
BackgroundReynolds, C. J., & Tragesser, S. L. (2018) · Pain Medicine · doi:10.1093/pm/pny052 · Cited by 13
de la Coba, P., Bruehl, S., & del Paso, G. A. R. (2020) · Pain Medicine · doi:10.1093/pm/pnz346 · Cited by 12
Fernández‐de‐las‐Peñas, C., Valera‐Calero, J. A., Arendt‐Nielsen, L., Martín‐Guerrero, J. D., Cigarán‐Méndez, M., Navarro‐Pardo, E., & Pellicer-Valero, Ó. J. (2022) · Pain Medicine · doi:10.1093/pm/pnac206 · Cited by 12
Central sensitization in osteoarthritic knee pain: A cross-sectional study
Kılıçaslan, H. Ö., Genç, A., & Tuncer, S. (2022) · Turkish Journal of Physical Medicine and Rehabilitation · doi:10.5606/tftrd.2023.10470 · Cited by 12
“[16] Neblett et al.[17] determined that a CSI score of 40 out of 100 best distinguished central sensitization patients with 81% sensitivity and 75% specificity.”
BackgroundHarris‐Hayes, M., Zorn, P., Steger-May, K., Burgess, M. M., DeMargel, R. D., Kuebler, S., Clohisy, J. C. F., & Haroutounian, S. (2023) · Physical Therapy · doi:10.1093/ptj/pzad111 · Cited by 12
Imagama, T., Okazaki, T., Matsuki, Y., Kaneoka, T., Kawakami, T., Yamazaki, K., & Sakai, T. (2023) · Journal of Orthopaedic Surgery and Research · doi:10.1186/s13018-023-04175-9 · Cited by 12
“Patients scoring 40 points or more (moderate or higher) are considered to have central sensitization [10, 11].”
BackgroundBorst, M., Moeyaert, M., & van Rood, Y. (2024) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2024.2314883 · Cited by 12
“A score of 0 – 29 is de fi ned as “ subclinical ” , 30 – 39 as “ mild ” , 40 – 49 as “ moderate ” , 50 – 59 as “ severe ” and 60 – 100 as “ extreme ” (Neblett et al., 2013).”
Vervullens, S., Meert, L., Smeets, R., Verbrugghe, J., VERDONK, P. C. M., & Meeus, M. (2024) · Clinical Rheumatology · doi:10.1007/s10067-024-06976-7 · Cited by 12
“…for the absence in differences between the recovered and persistent disturbed somatosensory functioning group is, apart from the cut-off of 40 on the CSI [31], a consensus about the optimal methodology to assess disturbed somatosensory functioning, including normative and cut-off values is lacking.”
A Multi-Systems Approach to Human Movement after ACL Reconstruction: The Nervous System
Chaput, M., Ness, B. M., Lucas, K. C. H., & Zimney, K. J. (2022) · International Journal of Sports Physical Therapy · doi:10.26603/001c.30020 · Cited by 17
Goudman, L., Smedt, A. D., Roggeman, S., Fernández‐de‐las‐Peñas, C., Hatem, S. M., Schiltz, M., Billot, M., Manuel Roulaud, B., Rigoard, P., & Moens, M. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12020661 · Cited by 12
“A total score of ≥40/100 is indicative of the presence of central sensitization symptomatology (sensitivity: 81% and specificity: 75%) [25].”
BackgroundResultKnežević, A., Kovačević, M., Jeremić-Knežević, M., Nikolašević, Ž., Tomašević-Todorović, S., Živanović, Ž., Spasojević, T., Garipi, E., Vojnović, L., Popović, D., et al. (2023) · Neurophysiologie Clinique · doi:10.1016/j.neucli.2022.102841 · Cited by 11
Herrero‐Montes, M., Fernández‐de‐las‐Peñas, C., Pargada, D. J. F., Izquierdo‐Cuervo, S., Abascal-Bolado, B., Valera‐Calero, J. A., & Parás‐Bravo, P. (2023) · Diagnostics · doi:10.3390/diagnostics13050847 · Cited by 12
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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