The Central Sensitization Inventory (CSI): …

1 The Central Sensitization Inventory (CSI): EstablishingClinically-Significant Values for Identifying Central SensitivitySyndromes in an Outpatient Chronic Pain SampleRandy Neblett,*Howard Cohen,yYunHee Choi,*Meredith M. Hartzell,*Mark Williams,*Tom G. Mayer,zand Robert J. Gatchelx*PRIDE Research Foundation, Dallas, School of Nursing, The University of Texas at Arlington, and Associate Medical Director, PRIDE, Dallas, of Orthopedic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, of Psychology, The University of Texas at Arlington, Arlington, : Central Sensitization (CS) is a proposed physiological phenomenon in which Central ner-vous system neurons become hyperexcitable, resulting in hypersensitivity to both noxious and non-noxious stimuli.

2 The term Central sensitivity syndrome (CSS) describes a group of medically indistinct(or nonspecific) disorders, such as fibromyalgia, chronic fatigue syndrome, and irritable bowel syn-drome, for which CS may be a common etiology. In a previous study, the Central Sensitization inven-tory (CSI) was introduced as a screening instrument for clinicians to help identify patients with a 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 paincenter, which specializes in the assessment and treatment of complex pain and psychophysiologicaldisorders, including CSSs.

3 A large percentage of patients (n = 89, 74%) met clinical criteria for one ormore CSSs, and CSI scores were positively correlated with the number of diagnosed CSSs. A receiveroperating characteristic analysis determined that a CSI score of 40 out of 100 best distinguished be-tween the CSS patient group and a nonpatient comparison sample (N = 129) (area under thecurve = .86, sensitivity = 81%, specificity = 75%).Perspective:The CSI is a new self-report screening instrument to help identify patients with CSSs,including fibromyalgia.

4 The present study investigated CSI scores in a heterogeneous pain popula-tion, with a large percentage of CSSs, and a normative nonclinical sample to determine a clinicallyrelevant cutoff value. 2013 by the American Pain SocietyKey words: Central Sensitization Inventory (CSI), Central sensitivity syndrome, fibromyalgia, chronicwidespread pain, irritable bowel Sensitization (CS)is a proposed physiologicalphenomenon in which dysregulation in the centralnervous system causes neuronal dysregulation andhyperexcitability, resultinginhypersensitivitytobothnoxious and non-noxious stimuli.

5 The presence of CS hasbeen demonstrated in Central sensitivity syndrome (CSS)populations by comparing the pain thresholds of CSSpatients to the thresholds of pain-free controls to variousstimuli (such as electrical, pressure, cold, and heat). Objec-tive measures of CS, which complement subjectiveself-report, include brain imaging and nociceptive spinalreflex ,25,43CS is associated with allodynia,hyperalgesia (excessive sensitivity to a normally painfulstimulus), expansion of the receptive field (pain extendingbeyond the area of peripheral nerve supply), andunusually prolonged pain after a painful stimulus hasbeen removed (usually throbbing, burning, tingling, ornumbness).

6 44CS has been proposed as the root etiologyfor CSSs,15,30,41which refer to a group of medicallyindistinct disorders for which no organic cause can beReceived August 16, 2012; Revised November 6, 2012; AcceptedNovember 27, paper has, in part, been possible by a grant from the National Insti-tutes of Health (1UO1 DEO10713-12A2).This manuscript was prepared without other financial support and withno support of any kind that may represent a possible conflict of reprint requests to Tom G. Mayer, MD, 5701 Maple Ave.

7 #100,Dallas, TX 75235. 2013 by the American Pain Journal of Pain, Vol-,No-(-), 2013: pp 1-8 Available online ,30,40-42 These include fibromyalgia, chronicfatigue syndrome, irritable bowel syndrome (IBS), temporomandibular joint disorder (TMD), and tensionheadache/migraine, among others. These CSSs are highlyintercorrelated, share many common symptoms, includingpain, and demonstrate evidence of ,42In addition to these previously mentioned core CSSs,other pain-related disorders, often viewed as peripheralpain disorders, may also fit into the CSS family or sharesome degree of CS.

8 For instance, although myofascialpain syndrome is less interrelated with other CSSs, andperipheral pain mechanisms have been implicated, re-duced pain thresholds to a variety of stimuli (suggestingthe presence of CS) have been identified in this popula-tion in a number of ,11,21,42 The presence of CS,and associations with other CSSs, have also been foundin other disorders in which pain is not a primarysymptom, such as restless leg syndrome2,33andposttraumatic stress disorder (PTSD).5,26A list ofproposed CSSs,15,42which were analyzed in the currentstudy, is presented inTable , a new comprehensive self-report Inventory ,the Central Sensitization Inventory (CSI)

9 , was developedto assess the overlapping symptom dimensions measure is intended as a screening instru-ment to help identify the presence of a CSS and to alertclinicians that presenting symptoms may be related ,effort,and resourcesare oftenspent onsuper-fluous diagnostic testing (such as colonoscopy, cardiaccatheterizations, or imaging) and surgical proceduresor implantable devices for patients with CSSs, when lessexpensive, alternative interventions (such as cognitive-behavioral and physical therapies) may be more effectivefor this ,16,37,39 Part A of the CSI assesses 25health-related symptoms that are common to CSSs, withtotal scores ranging from 0 to 100.

10 Part B (which is notscored) asks if one has previously been diagnosed with1 or more specific disorders, including 7 separate its initial comprehensive evaluation,18the CSI wasfound to be psychometrically sound, with a highdegree of test-retest reliability and internal consistency(Pearson s r = .817; Cronbach s alpha = .879). Evaluationof the construct validity of the CSI in 4 samples (3 withina work-related injury population and 1 nonclinicalnormative sample) confirmed that fibromyalgia patients(with increased tenderness to palpation, suggesting themost CS) scored the highest on the CSI; chronic wide-spread pain patients, without fibromyalgia (with less ten-derness to palpation, suggesting less CS), and chronic lowback pain patients (without chronic widespread pain,suggesting less CS) scored somewhat lower.