Cited by 757Fibromyalgia and Chronic Fatigue Syndrome ResearchPain Mechanisms and TreatmentsMusculoskeletal pain and rehabilitation

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The Central Sensitization Inventory (CSI): establishing clinically-significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample

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Neblett, Randy, Cohen, Howard, Choi, YunHee, Hartzell, Meredith M., Williams, Mark, Mayer, Tom G., Gatchel, Robert J.·2013·The Journal of Pain

DOI 10.1016/j.jpain.2012.11.012PMC PMC3644381

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Abstract

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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Background
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Method
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BackgroundMethodInfluential
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“%) values of the test were demonstrated 28 .”
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“The Central Sensitization Inventory (CSI) is a screening instrument for central pain sensitization [67].”
Background
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Background
Validation psychométrique des critères de Convergences PP
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“According to previous studies [21, 42], the assessment of central sensitization with the CSI is very precise, but in the present study we did not directly extract physiological changes, and it is unclear how the history of CSS was diagnosed.”
Method
Treatment decisions in axial spondyloarthritis daily clinical practice are more than treat-to-target
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Method
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“Respondents reported an average Brief PEDQ-CV score of 29.08 (SD = 12.22), Pain Interference score of 9.80 (SD = 4.10), Pain Intensity score of 4.97 (SD = 2.34), CSI score of 63.90 (SD = 18.33), and Depression score of 8.87 (SD = 4.61).”
BackgroundInfluential
Musculoskeletal pain in Primary Care Physiotherapy: Associations with demographic and general health characteristics
Kennedy, P. C., Purtill, H., & O’Sullivan, K. (2018) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2018.03.001 · Cited by 9
Symptoms of central sensitization in patients with inflammatory bowel diseases: a case-control study examining the role of musculoskeletal pain and psychological factors
Falling, C., Stebbings, S. M., Baxter, D. G., Siegel, C. A., Gearry, R. B., Nijs, J., & Mani, R. (2020) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2020-0109 · Cited by 9
Are Reports of Pain, Disability, Quality of Life, Psychological Factors, and Central Sensitization Related to Outcomes of Quantitative Sensory Testing in Patients Suffering From Chronic Whiplash Associated Disorders?
Lenoir, D., Willaert, W., Ickmans, K., Bernaers, L., Nijs, J., Malfliet, A., Danneels, L. A., Leysen, L., Pauw, R. D., Cagnie, B. J., et al. (2021) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001013 · Cited by 9
Predictors of pain reduction following a program of manual therapies for patients with temporomandibular disorders: A prospective observational study
Asquini, G., Devecchi, V., Borromeo, G., Viscuso, D., Morato, F., Locatelli, M., & Falla, D. (2022) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2022.102634 · Cited by 10
Depression levels and symptoms in athletes with chronic gastrocnemius myofascial pain: A case-control study
San‐Antolín, M., Rodríguez‐Sanz, D., López‐López, D., Morales, C. R., Carbajales-Lopez, J., Vallejo, R., Losa‐Iglesias, M. E., & Calvo‐Lobo, C. (2020) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2020.03.002 · Cited by 13
Test-Retest Reliability and Construct Validity of the Dutch Injustice Experience Questionnaire in Patients with Chronic Pain
Bults, R., Reneman, M. F., van Wilgen, C. P., & Preuper, H. R. S. (2020) · Psychological Injury and Law · doi:10.1007/s12207-020-09380-z · Cited by 9
Pain and the Non-Pharmacological Management of Pain in People with Parkinson’s Disease
Allen, N. E., Ромалійська, О. В., & Naisby, J. (2024) · Journal of Parkinson s Disease · doi:10.3233/jpd-230227 · Cited by 9
Association between central sensitization and multisite pain in the general population: A cross-sectional analysis of The Wakayama Health Promotion Study
Inoue, S., Hashizume, H., Murata, S., Oka, H., Kozaki, T., Minakata, K., Taiji, R., Teraguchi, M., Iwasaki, H., Tsutsui, S., et al. (2025) · Journal of Orthopaedic Science · doi:10.1016/j.jos.2025.02.001 · Cited by 8
Pain Science Education, Stress Management, and Cognition-Targeted Exercise Therapy in Chronic Whiplash Disorders
Malfliet, A., Lenoir, D., Murillo, C., Huysmans, E., Cagnie, B. J., Meeus, M., Willaert, W., Ickmans, K., Danneels, L. A., Bontinck, J., et al. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.26674 · Cited by 8
Central sensitization adversely affects quality of recovery following lumbar decompression surgery
Mui, T., Iwata, E., Nakajima, H., Sada, T., Tanaka, M., Okuda, A., Kawasaki, S., Shigematsu, H., & Tanaka, Y. (2022) · Journal of Orthopaedic Science · doi:10.1016/j.jos.2022.11.020 · Cited by 8
Psychometric properties of the Turkish version of Central Sensitization Inventory-9 in patients with chronic musculoskeletal pain
Bazancir‐Apaydin, Z., & Sarı, F. (2024) · International Journal of Rehabilitation Research · doi:10.1097/mrr.0000000000000617 · Cited by 8
“In the second part of the scale, the focus shifts to physician-diagnosed conditions that might be related to CS, such as restless leg syndrome, chronic fatigue syndrome, fibromyalgia syndrome, temporomandibular joint problems, migraine, irritable bowel syndrome, anxiety, and depression [9,17].”
Background
Preoperative glycaemic control, number of pain locations, structural knee damage, self‐reported central sensitisation, satisfaction and personal control are predictive of 1‐year postoperative pain, and change in pain from pre‐ to 1‐year posttotal knee arthroplasty
Vervullens, S., Meert, L., Smeets, R., Verbrugghe, J., Baert, I. A. C., Rahusen, F. T. G., Heusdens, C. H. W., VERDONK, P. C. M., & Meeus, M. (2024) · Knee Surgery Sports Traumatology Arthroscopy · doi:10.1002/ksa.12265 · Cited by 9
Association of OPRM1 rs1799971, HTR1B rs6296 and COMT rs4680 polymorphisms with clinical phenotype among women with fibromyalgia
Fernández‐de‐las‐Peñas, C., Ambite‐Quesada, S., Fernández-Méndez, L. M., Jiménez‐Antona, C., Gómez‐Calero, C., Pocinho, R. F. D. S., Valera‐Calero, J. A., Cigarán‐Méndez, M., & Arendt‐Nielsen, L. (2024) · Scientific Reports · doi:10.1038/s41598-024-62240-7 · Cited by 9
Laryngeal and Global Somatosensation in Primary Muscle Tension Dysphonia
Shembel, A. C., Mau, T., Zafereo, J. A., Morrison, R. A., Crocker, C., Moore, A., & Khan, A. (2024) · Journal of Voice · doi:10.1016/j.jvoice.2024.08.003 · Cited by 8
The place of S-ketamine in fibromyalgia treatment (ESKEFIB): study protocol for a prospective, single-center, double-blind, randomized, parallel-group, dose-escalation controlled trial
Javorcikova, Z., Dangoisse, M., Nikis, S., Lechat, J.-P., Gillain, A., Fils, J., & der Linden, P. V. (2021) · Trials · doi:10.1186/s13063-021-05814-4 · Cited by 8
“determined that a CSI score of 40 out of 100 best distinguished patients with a central sensitization syndrome from those without it [8].”
Background
Central Sensitization Is Associated with Inferior Patient-Reported Outcomes and Increased Osteotomy Site Pain in Patients Undergoing Medial Opening-Wedge High Tibial Osteotomy
Kim, J.-J., Koh, I.-J., Kim, M. S., Choi, K.-Y., Kang, K.-H., & In, Y. (2022) · Medicina · doi:10.3390/medicina58121752 · Cited by 8
“The Central Sensitization Inventory (CSI) is frequently used to evaluate CS [23,24]; in addition, a whole-body pain diagram or quantitative sensory testing (QST) can be used for assessment [30–33].”
BackgroundMethod
Adaptation and validation of the Chinese version of the Central Sensitisation Inventory in patients with chronic pain
Liang, D., Yu, X., Guo, X., & Zhang, J. (2022) · General Psychiatry · doi:10.1136/gpsych-2022-100919 · Cited by 8
“See: http://creativecommons.org/licenses/by-nc/4.0/.”
Influential
Noziplastischer Schmerz in Forschung und Praxis
Schmidt, H., & Blechschmidt, V. (2023) · Der Schmerz · doi:10.1007/s00482-023-00734-5 · Cited by 9
Further evaluation of inflammatory and non-inflammatory aspects of pain in rheumatoid arthritis patients
Jansen, N., ten Klooster, P. M., Vonkeman, H. E., van den Berg, B., & Buitenweg, J. R. (2023) · Rheumatology Advances in Practice · doi:10.1093/rap/rkad076 · Cited by 8
“A score of (cid:2) 40 on part A of the questionnaire is indicative of the presence of central sensitization syndrome [33].”
Pain sensitisation and the risk of poor outcome following physiotherapy for patients with moderate to severe knee osteoarthritis: protocol for a prospective cohort study
O’Leary, H., Smart, K. M., Moloney, N. A., Blake, C. M., & Doody, C. (2015) · BMJ Open · doi:10.1136/bmjopen-2014-007430 · Cited by 8
“48 Good sensitivity (81%) and specificity (79%) values were found with a cut-off score of 40 (of 100) to identify patients with symptoms of central sensitisation.(48)”
Background
Effects of Experimental Pain and Lidocaine on Mechanical Somatosensory Profile and Face Perception
Costa, Y. M., Castrillón, E., Bonjardim, L. R., Conti, P. C. R., Baad‐Hansen, L., & Svensson, P. J. (2017) · Journal of Oral & Facial Pain and Headache · doi:10.11607/ofph.1758 · Cited by 8
Recognition of central nervous system sensitization and its risk factors in patients with unilateral musculoskeletal shoulder pain
Alagappan, T., Senthilkumar, S., Dhanani, D., Vashi, R., Barot, D., & Savani, M. (2019) · Physiotherapy - The Journal of Indian Association of Physiotherapists · doi:10.4103/pjiap.pjiap_17_18 · Cited by 8
An examination of the validity of the central sensitization inventory with Chronic Disabling Occupational Musculoskeletal Disorders
Choi, Y. (2013) · UTA ResearchCommons (University of Texas Arlington) · Cited by 8
Mental Health Outcomes of Endometriosis Patients during the COVID-19 Pandemic: Impact of Pre-pandemic Central Nervous System Sensitization
Liu, Y. D., Noga, H. L., Allaire, C., Bedaiwy, M. A., Lee, C. E., Williams, C., Booth, A., Galea, L. A. M., Kaida, A., Ogilvie, G. S., et al. (2024) · Journal of Pain · doi:10.1016/j.jpain.2024.01.346 · Cited by 8
The Association Between the Central Sensitisation Inventory and Temporomandibular Disorders Is Confounded by Migraine, Depression, Widespread Pain and Parafunction. A Cross‐Sectional Telehealth Study
Calixtre, L. B., van der Meer, H. A., Visscher, C. M., Oliveira, A. B., & Gonçalves, D. A. D. G. (2024) · Journal of Oral Rehabilitation · doi:10.1111/joor.13852 · Cited by 7
Clinical comparisons between post-traumatic headache and migraine: A cross-sectional study
Al‐Khazali, H. M., Christensen, R. H., & Ashina, H. (2025) · Cephalalgia · doi:10.1177/03331024251331605 · Cited by 7
The effect of blood flow restricted aerobic exercise training on pain, functional status, quality of life and hormonal response to exercise in fibromyalgia patients: a randomized double-blind study
Zure, M., Arman, S., & Ketenci, A. (2025) · European Journal of Physical and Rehabilitation Medicine · doi:10.23736/s1973-9087.25.08817-3 · Cited by 11
The pivotal role of central sensitization in long COVID, fibromyalgia and myalgic encephalomyelitis/chronic fatigue syndrome
Goldenberg, D. L. (2025) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2025.2516097 · Cited by 9
Evaluation of kinesiophobia, central sensitization, and related factors in patients with gout: a cross-sectional study
Tuncer, K., Kozanoğlu, E., Sarıyıldız, A., & Yetişir, A. (2025) · Clinical Rheumatology · doi:10.1007/s10067-025-07862-6 · Cited by 7
“If the total scores are ≥ 40, that indicates the presence of CS [21, 22].”
Are You Listening? Facilitation of the Auditory Blink Response in People with Fibromyalgia
Berryman, C. F., Wallwork, S. B., Heredia‐Rizo, A. M., Knight, E., Camfferman, D., Russek, L. N., & Moseley, G. L. (2021) · Journal of Pain · doi:10.1016/j.jpain.2021.03.141 · Cited by 7
High-Definition Transcranial Infraslow Pink-Noise Stimulation Can Influence Functional and Effective Cortical Connectivity in Individuals With Chronic Low Back Pain: A Pilot Randomized Placebo-Controlled Study
Adhia, D. B., Mani, R., Reynolds, J. N. J., Hall, M. J., Vanneste, S., & Ridder, D. D. (2022) · Neuromodulation Technology at the Neural Interface · doi:10.1016/j.neurom.2022.08.450 · Cited by 7
“I'd never have that operation again” – a mixed‐methods study on how patients react to adverse outcomes following foot and ankle surgery
Abdalla, I., Robertson, A. P., Tippett, V. C., Walsh, T. P., & Platt, S. R. (2022) · Journal of Foot and Ankle Research · doi:10.1186/s13047-022-00590-z · Cited by 7
“The second phase (quantitative) entailed the participants completing the following questionnaires: Manchester-Oxford Foot and Ankle Questionnaire (MOxFQ) [8], Central Sensitization Inventory (CSI) [9], Pain Catastrophizing Scale (PCS) [10], Decision Regret Scale (DRS) [11] and the EuroQol 5-dimensions 5-levels (EQ-5D-…”
BackgroundMethodInfluential
Evidence- and data-driven classification of low back pain via artificial intelligence: Protocol of the PREDICT-LBP study
Belavý, D. L., Tagliaferri, S. D., Tegenthoff, M., Enax‐Krumova, E., Schlaffke, L., Buehring, B., Schulte, T. L., Schmidt, S. H., Wilke, H., Angelova, M. N., et al. (2023) · PLoS ONE · doi:10.1371/journal.pone.0282346 · Cited by 10
Effect of dry needling on pain and central sensitization in women with chronic pelvic pain: A randomized parallel-group controlled clinical trial
Sedighimehr, N., Razeghi, M., & Rezaei, I. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e31699 · Cited by 7
“Factors such as anxiety, depression, sleep disturbance, catastrophic and fear-avoidant cognitions can result in inactivity, functional limitations and decreased quality of life [26,27].”
Background
McKenzie mechanical syndromes coincide with biopsychosocial influences, including central sensitization: a descriptive study of individuals with chronic neck pain
Lam, O. T., Dumas, J.-P., Simon, C. B., & Tousignant‐Laflamme, Y. (2018) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2018.1439672 · Cited by 7
“[20] Recent research established CSI severity levels as follows: subclinical = 0–29; mild = 30–39; moderate = 40–49; severe = 50–59; extreme = 60+.[20] (d) Cognitive-emotional drivers of pain: Their presence was measured with the Tampa Scale of Kinesiophobia (TSK) and the Pain Catastrophizing Scale (PCS).”
BackgroundMethodInfluential
Profile of musculoskeletal pain in patients with inflammatory bowel disease: a study protocol for assessing the multidimensional experience of self-reported pain
Falling, C., Stebbings, S. M., Baxter, D. G., Gearry, R. B., & Mani, R. (2018) · Physical Therapy Reviews · doi:10.1080/10833196.2018.1500149 · Cited by 7
Pro-nociceptive pain modulation profile in patients with acute and chronic shoulder pain: a hypothesis-generating topical review
Othman, R., Swain, N., Tumilty, S., Jayakaran, P., & Mani, R. (2021) · Physical Therapy Reviews · doi:10.1080/10833196.2021.1973776 · Cited by 6
Does a combination of self‐reported signs related to central sensitization and pressure pain threshold allow for a more detailed classification of pain‐related characteristics in patients with chronic musculoskeletal pain?: A cross‐sectional study
Mibu, A., Nishigami, T., Tanaka, K., Yono, S., Manfuku, M., & Imai, R. (2022) · Pain Practice · doi:10.1111/papr.13125 · Cited by 7
Nociceptive withdrawal reflexes of the trunk muscles in chronic low back pain
Massé‐Alarie, H., Hamer, G. V., Salomoni, S. E., & Hodges, P. W. (2023) · PLoS ONE · doi:10.1371/journal.pone.0286786 · Cited by 7
“the cut-off for clinical symptoms of central sensitization [57].”
Background
Sensitization-associated and neuropathic-associated symptoms in patients with unilateral lateral elbow tendinopathy: an exploratory study
Cancela‐Cilleruelo, I., Rodríguez‐Jiménez, J., Fernández‐de‐las‐Peñas, C., Arendt‐Nielsen, L., & Arias‐Buría, J. L. (2023) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2023.2264384 · Cited by 7
“Each symptom is scored on a 5-point Likert scale providing a score ranging from 0 to 100 points where a cutoff score of 40 points suggests the presence of sensitization (Neblett et al., 2013).”
Possible Involvement of Avoidant Attachment Style in the Relations Between Adult IBS and Reported Separation Anxiety in Childhood
Ben-Israel, Y., Shadach, E., Levy, S., Sperber, A. D., Aizenberg, D., Niv, Y., & Dickman, R. M. (2015) · Stress and Health · doi:10.1002/smi.2642 · Cited by 7
“For example, it may transpire that patients with diarrhoea-type IBS have bile acidmalabsorption and not IBS, or that IBS is actually a central sensitivity syndrome in a specific form (Neblett et al., 2013).”
Background
Prevalencia de fibromialgia en el distrito de Chiclayo
León-Jiménez, F., & Munarriz, C. A. L. (2015) · Revista Médica Herediana · doi:10.20453/rmh.v26i3.2582 · Cited by 10
The presence of Waddell signs depends on age and gender, not diagnosis
Yoo, J. U., McIver, T. C., Hiratzka, J. R., Carlson, H. L., Carlson, N. L., Radoslovich, S. S., Gernhart, T., Boshears, E., & Kane, M. S. (2018) · The Bone & Joint Journal · doi:10.1302/0301-620x.100b2.bjj-2017-0684.r2 · Cited by 7
Preoperative pain neuroscience education for shoulder surgery: A case series
Louw, A., Rico, D., Langerwerf, L., Maiers, N., Diener, I., & Cox, T. A. (2020) · South African Journal of Physiotherapy · doi:10.4102/sajp.v76i1.1417 · Cited by 7
“• Central sensitisation inventory: The CSI is a 25-question survey used in screening for CS.”
BackgroundInfluential
Central Sensitization Severity in Chronic Low Back Pain: Associations with Sleep, Distress, Cortisol, and Visuospatial Working Memory
Sahebalam, M., Hatef, B., & Jahromi, G. P. (2026) · Journal of Pain Research · doi:10.2147/jpr.s583843 · Cited by 6
“18,19 We administered the validated Persian version of the CSI, which has shown good psychometric properties in patients with chronic pain.”
The development of a novel questionnaire assessing alterations in central pain processing in people with and without chronic pain
Austin, P., Asghari, A., Costa, D. S. J., & Siddall, P. J. (2019) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2019-0087 · Cited by 6
“For example, we modified item nine from the CSI from “I feel pain all over my body” to “my pain has spread to other parts of my body”, thus highlighting important temporal features of the spread of pain [14].”
BackgroundMethodInfluential
Efficacy and safety of duloxetine for postoperative pain after total knee arthroplasty in centrally sensitized patients: study protocol for a randomized controlled trial
Wang, S., Wang, W., Shao, L., & Ling, J. (2021) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-021-04168-x · Cited by 6

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.
ORCID: Neblett, Randy
Choi, YunHee
Mayer, Tom G.
Gatchel, Robert J.
Venue: The Journal of Pain
Publisher: Elsevier BV
Published: 2013-05
Volume: 14
Issue: 5
Pages: 438-445
ISSN: 1526-5900 (ISSN-L)
DOI: 10.1016/j.jpain.2012.11.012
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: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 3785 d)
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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The Central Sensitization Inventory (CSI): establishing clinically-significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample

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