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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) was used to assess central sensitization, a physiological phenomenon in which dysfunction in the central nervous system leads to neuronal dysregulation and increased excitability, causing heightened sensitivity to both painful and nonpainful stimuli 46 .”
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“It also was noted that the decrease of MEPs in the high CS group after rTMS corresponded to the decrease of pressure pain sensitivity, further indicating a differential effect of rTMS based on CS.”
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“Notably, although CSI was analyzed as a continuous variable in the present study, previous validation studies have shown that a CSI score ≥ 40 may indicate clinically relevant CS, with acceptable sensitivity and specificity in KOA populations [61,62].”
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“Higher scores for this scale indicate that self-perceived central sensitization is more severe [57].”
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“The Central Sensitization Inventory (CSI) (6), originally developed by Mayer & Neblett et al., (2012), is commonly used in research to assess symptoms of what pain researchers call “central sensitivity syndromes” (or “central sensitization associated symptoms”), such as fibromyalgia, migraine…”
Macian, N., Dualé, C., DeLay, M., Leray, V., Pereira, B., Renaud, Y., Gloor, Y. S., Desmeules, J. A., & Pickering, G. T. (2026) · European Journal of Pain · doi:10.1002/ejp.70308
“The higher TS ratio and CSI scores also supported increased CS (Neblett et al. 2013) even if for CSI the reliability of the results in FMS patients should be taken with caution because many items of the CSI overlap with those of the diagnostic criteria for FMS (Leone et al. 2025).”
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“A score of ≥ 40/100 points indicates the presence of symptoms common to central sensitization (Neblett et al. 2013).”
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“The assessment battery comprises the AEQ; the CSI [22]; the PCS [12]; the BDI-II [23]; the STAI-Y, forms 1 and 2 [24]; the DERS [10], administered in the Italian 33-item adaptation [25]; and a 0 to 10 visual analog scale (VAS) for current pain intensity.”
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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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