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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Effect of Central Sensitization in Patients with Familial Mediterranean Fever, Axial Spondyloarthritis, and Both Diseases
Kaya, M. N., Kılıç, Ö., Doğan, A., Yılmaz, S., & Tecer, D. (2023) · Cureus · doi:10.7759/cureus.45459 · Cited by 4
“In a study of 89 patients with CS syndrome, 47% of the patients reported tension headaches/migraines, 47% as myofascial pain syndrome and 38% as fibromyalgia [29].”
Background
Validation of a questionnaire for central nervous system aspects of joint pain: the CAP questionnaire
McWilliams, D. F., Georgopoulos, V., Patel, J., Millar, B., Smith, S. L., & Walsh, D. A. (2024) · Rheumatology · doi:10.1093/rheumatology/keae342 · Cited by 4
“Pain distribution is addressed by questionnaires such as the 9-item Central Sensitization Inventory (CSI9) [10, 11] and 8-item Somatic Symptom Scale (SSS8) [12], each of which addresses frequently co-existing medically unexplained symptoms, and is also associated with QST evidence of central pain…”
Differences in self-reported signs related to central sensitization and pressure pain threshold related to knee osteoarthritis and sarcopenia
Imai, R., Tanaka, S., Kubo, T., Hida, M., Nakao, H., Imaoka, M., & Nishigami, T. (2024) · European Geriatric Medicine · doi:10.1007/s41999-024-01018-6 · Cited by 4
“Central sensitization cannot be measured clinically, so screening tools such as the Central Sensitization Inventory (CSI) or quantitative sensory testing are often used to identify central sensitiza-tion-related symptoms [7, 8].”
Pain medication tapering for patients with Persistent Spinal Pain Syndrome Type II, treated with Spinal Cord Stimulation: A RCT–study protocol of the PIANISSIMO study
Moens, M., Crunelle, C. L., Putman, K. D., Wuyts, E., Bultinck, F., Puyenbroeck, H. V., & Goudman, L. (2024) · PLoS ONE · doi:10.1371/journal.pone.0302842 · Cited by 4
Optimizing an automated sleep detection algorithm using wrist-worn accelerometer data for individuals with chronic pain
Faust, L. J., Fortune, E., Jahanian, O., Oloyede, S. V., Trouard, C., Dixon, S., Torres, E., Sletten, C., & Scholten, P. (2025) · PLoS ONE · doi:10.1371/journal.pone.0319348 · Cited by 3
“…had a mean duration of pain of 9.99 years (SD = 8.73), mean severity of pain, as measured by pain numeric rating scale (NRS), of 6.38 (SD = 2.03) [45], SF-36 (quality of life measure) for pain of 30.62 (SD = 15.04) [44] and Central Sensitization Score (CSS) of 54.12 (SD = 7.53) [46, 47].”
Influential
Validierung einer deutschen Version des „Central Sensitization Inventory“ zur Identifizierung zentralnervöser Schmerzentwicklungen
Schumacher, S., & Waschescio, H. J. (2019) · manuelletherapie · doi:10.1055/a-0903-9654 · Cited by 4
Criterion validity and discriminatory ability of the central sensitization inventory short form in individuals with inflammatory bowel diseases
Falling, C., Stebbings, S. M., Baxter, D. G., Gearry, R. B., & Mani, R. (2021) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2021-0021 · Cited by 4
Shoulder pain, disability and psychosocial dimensions across diagnostic categories: Profile of patients attending shoulder physiotherapy clinics
White, R., Olds, M., Cadogan, A., Betteridge, S., & Sole, G. (2022) · New Zealand Journal of Physiotherapy · doi:10.15619/nzjp/50.1.02 · Cited by 4
“%) across all diagnostic groups were above the cut-off score that may indicate the presence of central sensitivity syndrome (≥ 40) (Neblett et al., 2013).”
High-definition transcranial infraslow pink noise stimulation for chronic low back pain: protocol for a pilot, safety and feasibility randomised placebo-controlled trial
Adhia, D. B., Mani, R., Reynolds, J. N. J., Vanneste, S., & Ridder, D. D. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-056842 · Cited by 4
Pain and frailty among community-dwelling older people in Hong Kong
Miu, D. K. Y. (2022) · Asian Journal of Gerontology and Geriatrics · doi:10.12809/ajgg-2022-529-oa · Cited by 4
Post‐amputation pain: Comparing pain presentations between adults with and without increased amputated‐region sensitivity
Beisheim, E. H., Pohlig, R. T., Hicks, G. E., Horne, J. R., & Sions, J. M. (2022) · Pain Practice · doi:10.1111/papr.13172 · Cited by 4
Physiotherapeutische Kenntnisse, Fertigkeiten und Kompetenzen in der Versorgung von Menschen mit chronischen Schmerzen
Stelljes, R., Weber, E., & Roesner, A. (2022) · Der Schmerz · doi:10.1007/s00482-022-00654-w · Cited by 4
Neuroimmune responses following joint mobilisation and manipulation in people with persistent neck pain: a protocol for a randomised placebo-controlled trial
Schipholt, I. J. L., Scholten-Peeters, G. G. M., Bontkes, H. J., & Coppieters, M. W. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-055748 · Cited by 5
Dolor nociplástico y sensibilización central en pacientes con dolor crónico: actualizando conceptos y terminología
Montero, A. A., de Vasconcelos, S. R. P., & Arias, A. C. (2024) · Atención Primaria · doi:10.1016/j.aprim.2024.102898 · Cited by 4
Establishing an optimal central sensitization inventory cut-off value affecting postoperative outcomes of osteotomy around the knee
Hasegawa, S., Koga, H., Nakagawa, Y., Ding, H., Yoshihara, A., Amemiya, M., Hoshino, T., Katakura, M., Ozeki, N., Nakamura, T., et al. (2024) · Journal of Orthopaedic Science · doi:10.1016/j.jos.2024.09.009 · Cited by 3
Pain sensitivity questionnaire in endometriosis
Gentles, A., Wong, S., Orr, N. L., Noga, H. L., Allaire, C., Williams, C., Bedaiwy, M. A., Lee, C., Kramer, J., & Yong, P. J. (2025) · Journal of Pain · doi:10.1016/j.jpain.2025.105357 · Cited by 3
The Effects of Physical Therapy Management and Pain Neuroscience Education for Patients With Musculoskeletal Pain Undergoing Rehabilitation for Substance Use Disorder: A Quality Improvement Project
Johnson, H., Carper, R., English, R. A., Xia, Y., & Uhl, T. L. (2025) · JOSPT open. · doi:10.2519/josptopen.2025.0111 · Cited by 3
A Physiotherapy-Based Dance Exercise Intervention Can Improve Body Awareness and Reduce Pain Perception But Does Not Affect Kinesiophobia in Women with Fibromyalgia
Contreras-Castillo, E. V., Riquelme-Aguado, V., Morales, C. R., Cerquera-Trujillo, O. S., Barrera-Cruz, M. A., Alonso-Pérez, J. L., & Villafañe, J. H. (2025) · Journal of Dance Medicine & Science · doi:10.1177/1089313x251391542 · Cited by 3
“The Central Sensitization Inventory (CSI) 26 is designed to evaluate central sensitization in patients with chronic pain.”
Arthritis Pain; Rheumatoid Arthritis, Osteoarthritis, and Fibromyalgia
Khan, A., Correia, J. C., & Walsh, D. A. (2020) · Springer eBooks · doi:10.1007/978-981-15-2933-7_27 · Cited by 3
Modulation of Central Nociceptive Transmission by Manual Pressure Techniques in Patients with Migraine: An Observational Study
Hertogh, W. D., Amons, A. L., daele, L. V., Vanbaelen, E., & Castien, R. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11216273 · Cited by 4
Multidimensional evaluation of the pain profile as prognostic factor in individuals with hip or knee osteoarthritis receiving total joint replacement: protocol of a 2-year longitudinal prognostic cohort study
Florêncio, L. L., Palacios‐Ceña, M., Fuensalida‐Novo, S., De-la-Llave-Rincón, A. I., Ambite‐Quesada, S., Ortega‐Santiago, R., Arias‐Buría, J. L., Cigarán‐Méndez, M., Arendt‐Nielsen, L., & Fernández‐de‐las‐Peñas, C. (2023) · BMJ Open · doi:10.1136/bmjopen-2022-066745 · Cited by 5
Assessment of functional respiratory complaints and related factors in people with hypermobile Ehlers-Danlos syndrome: Cross-sectional study
Reina‐Gutiérrez, S., Caty, G. D., Torres-Costoso, A. I., Pitance, L., Manicourt, D. H., & Reychler, G. (2023) · Respiratory Medicine and Research · doi:10.1016/j.resmer.2023.101017 · Cited by 3
Does central sensitization correlate with two-year postoperative functional outcome scores following hip arthroscopy?
Perez, A. R., Baker, W. F., Patel, N. K., Destine, H., Muchintala, R. R., Looney, A. M., Szukics, P. F., & Salvo, J. P. (2023) · Journal of Orthopaedics · doi:10.1016/j.jor.2023.11.035 · Cited by 3
Exploring Traits Associated With Central Sensitization Features in Patients With Chronic Cough
Jun, H., Park, J. Y., Oh, J.-Y., Won, H., Kang, S., Park, S., Kim, B., Kim, M., Kim, Y. C., Lee, H. Y., et al. (2024) · Allergy Asthma and Immunology Research · doi:10.4168/aair.2024.16.6.690 · Cited by 3
“18 Hence, an optimal threshold score warrants validation in patients with chronic cough.”
Psychological, disability, and somatosensory characteristics across different risk levels in individuals with low back pain: A cross-sectional study
den Bandt, H. L., Ickmans, K., Buyl, R., Leemans, L., Nijs, J., & Voogt, L. P. (2025) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2025.101185 · Cited by 3
Prevalence, associated factors, and short-term impact of central sensitization in high-altitude patients undergoing total knee arthroplasty
Zhang, S., Tan, L., Bai, X., Deng, L., Wan, S., Ding, M., Lin, K., Tian, Z., & Li, L. (2025) · International Orthopaedics · doi:10.1007/s00264-025-06560-x · Cited by 3
“A CSI score of ≥ 40 has been validated as the threshold for identifying central sensitization [ 18 ].”
Association between chronotype and central sensitization in patients with non-specific low back pain
Uçkun, A. Ç., Doğan, N., İnce, B., Yalbuzdağ, Ş. A., Kaya, T., & Karatepe, A. G. (2025) · Chronobiology International · doi:10.1080/07420528.2025.2515990 · Cited by 3
“CS has been described as heightened neural signaling within the central nervous system, leading to increased sensitivity to pain, which can be directly assessed in clinical practice using the Central Sensitization Inventory (CSI) (Neblett et al. 2013).”
Pelvic floor examination in vulvodynia: VAMP protocol validation in correlation with central sensitization
Baszak-Radomańska, E., Wańczyk-Baszak, J., & Paszkowski, T. (2025) · Women s Health · doi:10.1177/17455057251338410 · Cited by 3
“54 The higher the score, the more severe the somatic and emotional symptoms common to CS.”
Nociceptive and neuropathic pain descriptors in adults with sickle cell disease are associated with overlap activity in the default, salience and somatosensory networks
Disu, J. D. K., Jonassaint, C. R., Santini, T., Ibrahim, T. S., Novelli, E. M., & Wood, S. (2025) · Journal of Pain · doi:10.1016/j.jpain.2025.105532 · Cited by 3
Characteristics of central sensitization and its relationship with demographics and pain indicators among veterans with chronic pain: A cross-sectional study
Tuell, A., Dirette, D. P., & Krein, S. L. (2025) · Medicine · doi:10.1097/md.0000000000044054 · Cited by 3
“[21] The PCS is a self-reported instrument used to evaluate cata-strophic thinking related to pain in adult chronic pain patients.”
Central sensitization: a pathogenic mechanism in complex undefined diseases
Fern, J., & ez-Sola (2019) · Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) · doi:10.37532/1758-2008.2019.9(6).599 · Cited by 3
Associations Among Nitric Oxide and Enkephalinases With Fibromyalgia Symptoms
Aguilar‐Ferrándiz, M. E., Barragán, A. C., Rus, A., Tapia-Haro, R. M., Martı́nez-Martos, J. M., Molina, F., & Correa‐Rodríguez, M. (2020) · Nursing Research · doi:10.1097/nnr.0000000000000496 · Cited by 3
“The symptoms associated with central sensitization syndrome were assessed using the Spanish version of the Central Sensitization Inventory (Cuesta-Vargas et al., 2016), which has an internal consistency (Cronbach's alpha) of .88 (Neblett et al., 2013).”
Method
Intravesical indwelling lidocaine‑releasing devices for IC/BPS (Review)
Watanabe, T., Sadahira, T., Watanabe, M., Maruyama, Y., Wada, K., Sekito, T., Edamura, K., Kobayashi, Y., Araki, M., & Watanabe, T. (2022) · World Academy of Sciences Journal · doi:10.3892/wasj.2022.163 · Cited by 3
“Chronic pain syndromes, such as migraines, fibromyalgia, vulvodynia, chronic pelvic pain and irritable bowel syndrome, which are considered to involve central nerve sensitization and often co‑exist, are now designated as central sensitivity syndrome (CSS) (13).”
BackgroundInfluential
The Effect of Spinal Muscle Fatigue and Psychosocial Factors on Pressure-Pain Threshold in Healthy Adults
Mais, S., & Smith, J. A. (2023) · Pain Research and Management · doi:10.1155/2023/7336477 · Cited by 3
Central sensitization negatively influences the level of disability in female patients with anterior knee pain
Sanchis‐Alfonso, V., Robles, M. B., Navarro‐Calvo, A., Roselló‐Añón, A., & Doménech, J. (2023) · Knee Surgery Sports Traumatology Arthroscopy · doi:10.1007/s00167-023-07591-w · Cited by 3
“One was the Central Sentizitation Inventory (CSI) that was used to evaluate Central Sensitization (CS) [23, 25, 27].”
Personal factors and baseline function in patients undergoing non-operative management for chronic hip-related groin pain: a cross-sectional study
DeMargel, R. D., Steger-May, K., Haroutounian, S., Zorn, P., Cheng, A. L., Clohisy, J. C. F., & Harris‐Hayes, M. (2023) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2023-001685 · Cited by 3
“The step height used was based on each patient’s height: 15.2 cm for heights<163 cm, 20.3 cm for heights 163–180 cm, and 25.4 cm for heights >180 cm.”
BackgroundMethodInfluential
Sensory profiles and their role in the persistence of central sensitization symptoms in low back pain. A prospective cohort study
Gräper, P. J., Hartvigsen, J., Scafoglieri, A., Clark, J. R., van Trijffel, E., & Hallegraeff, J. M. (2024) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2024.2326592 · Cited by 3
“…analysis purposes, on the basis that different levels of measures can be used when interpreting CSI-scores: continuous, binary, and categorical (Neblett et al., 2013, 2017; Scerbo et al., 2018), we chose not to dichot-omize the continuous data, in accordance with Royston, Altman, and Sauerbrei…”
Characterizing Chronic Pelvic Pain: The Relationship Between Extrapelvic Muscle Stiffness, Pain Level, Health History, and Pelvic Floor Symptoms in Women With Chronic Pelvic Pain
Proulx, L., Brizzolara, K. J., Thompson, M., Wang-Price, S. S., Rodríguez, P., & Koppenhaver, S. L. (2024) · Journal of Women s & Pelvic Health Physical Therapy · doi:10.1097/jwh.0000000000000309 · Cited by 3
“24,25 The NPRS is a reliable, generalizable, and internally consistent measure of clinical and experimental pain intensity in individuals with musculoskeletal disorders.”
Personality Profile and Low Back Pain: Are Clinicians Missing an Important Factor That Influences Pain Perception and Treatment Options?
Hanney, W. J., Smith, T., Shiley, C., Howe, J., Kolber, M. J., & Salamh, P. A. (2021) · NeuroSci · doi:10.3390/neurosci2030019 · Cited by 3
“Heightened central sensitivity may increase kinesiophobia, fear-avoidance, and pain catastrophizing behaviors, further stunting recovery due to the complexity of central sensitization and the difficulty in shaping a treatment plan that can adequately address it [15].”
Background
Bayesian Linear Regressions Applied to Fibromyalgia Syndrome for Understanding the Complexity of This Disorder
Cigarán‐Méndez, M., Pellicer-Valero, Ó. J., Martín‐Guerrero, J. D., Varol, U., Fernández‐de‐las‐Peñas, C., Navarro‐Pardo, E., & Valera‐Calero, J. A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19084682 · Cited by 4
“The CSI is a self-reported questionnaire evaluating 25 symptoms associated with sensitization with a 5-point Likert scale resulting in a score ranging from 0 to 100, where >40 points suggests the presence of sensitization [13].”
Background
Central Sensitization in Patients Attending Physical Therapy for Musculoskeletal Disorders
Louw, A., Hartman, D. J., Weber, B., Shuda, D., Obert, C., Louw, H., & Farrell, K. P. (2021) · Physical Medicine and Rehabilitation - International · doi:10.26420/physmedrehabilint.2021.1194 · Cited by 3
Psychophysical assessment of pain in adults with moderate and severe haemophilia: A cross‐sectional study
Foubert, A., Chantrain, V., Meeus, M., Maes, P., Haenen, V., Lobet, S., Lambert, C., Hermans, C. R. J. R., & Roussel, N. A. (2023) · Haemophilia · doi:10.1111/hae.14830 · Cited by 3
Acceptance and commitment therapy for prevention of chronic pain after total knee arthroplasty.
Giusti, E. M., Castelnuovo, G., Manna, C., Varallo, G., Cattivelli, R., Petrachi, B. V., Stramba-Badiale, M., & Spatola, C. A. M. (2026) · Pain Medicine · doi:10.1093/pm/pnaf145 · Cited by 2
“30 The cross-cultural adaptation of the CSI showed that its Italian version has good reliability and content validity.”

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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