Central Sensitization Inventory Scores Research Articles

Central sensitization: its prevalence and impact on quality of life among hemodialyzed patients.

Data on the role of central sensitization in hemodialyzed patients are scarce. The aim was to identify the impact of central sensitization on quality of life and elucidate the risk factors for the development of central sensitization in patients receiving hemodialysis. Central sensitization, quality of life, psychological well-being, and sleep were assessed by the Central Sensitization Inventory (CSI), abbreviated version of the World Health Organization Quality of Life Instrument (WHOQOL-BREF), Hospital Anxiety and Depression Scale (HADS), and Jenkins Sleep Evaluation Scale (JSS), respectively. The effect of central sensitization on quality of life and the predictors of the development of central sensitization were assessed by regression analyses. The frequency of central sensitization was 48% in the study population (n = 100). Patients with central sensitization had significantly higher pain intensity, worse sleep quality, and more impaired psychological status (p < 0.05 for all). The CSI score negatively affected all quality of life domains on its own (p < 0.001 for all, adjusted R2 ranged from 0.17 to 0.47). Dialysis vintage (OR, 0.8; 95% CI, 0.7 to 1.0), pain (OR, 1.5; 95% CI, 1.1 to 2.0), JSS (OR, 1.3; 95% CI, 1.1 to 1.5), and HADS-total (OR, 1.1; 95% CI, 1.0 to 1.2) were determined as the independent risk factors for central sensitization (p < 0.05 for all). This study confirms that given the high frequency of central sensitization and its significant negative impact on quality of life, the presence of central sensitization should be investigated in patients undergoing hemodialysis.

Association between central sensitivity syndrome and psychophysical factors in patients with masticatory myofascial pain.

This study explored the relationship between central sensitization symptoms, assessed using the Central Sensitization Inventory (CSI), and psychophysical factors in patients with chronic masticatory myofascial pain (MMP) transitioning from the acute to chronic stages. In this study, 23 patients with MMP and 22 healthy volunteers were assessed using psychophysical tests, including measurements of pressure pain threshold (PPT) and temporal summation of pain (TSP). Additionally, CSI scores were recorded to evaluate central sensitization symptoms. Patients with chronic MMP showed significantly lower PPT in all masticatory muscles and extratrigeminal areas compared with controls. However, there was no significant correlation between CSI scores and psychophysical test results in patients with MMP. The significant enhancement of TSP in patients with subchronic MMP suggests a potential role in the onset of myofascial pain. The main finding suggests that sub-chronic symptom patients show higher CSI scores despite no sensory testing changes, indicating that central sensitization possibly precedes observable symptoms.

Pain phenotypes in caregivers of children with cerebral palsy.

To determine the phenotypes of chronic pain seen in individuals caring for children with cerebral palsy (CP). A current classification system was used to determine the prevalence of predominant pain phenotypes in caregivers of children with CP. To this end, the Visual Analog Scale, Margolis pain diagram, Central Sensitization Inventory, and Short Form-36 questionnaire were administered to the participants. In addition, the participants underwent a quantitative sensory examination. This study was concluded with 60 individuals. The predominant pain phenotype was nociceptive pain in 30% of the participants, nociplastic pain in 25%, and neuropathic pain in 5%. The pain duration (p=0.365) and quality of life of the individuals did not significantly differ according to the predominant pain phenotypes (p>0.05). However, there was a statistically significant difference between the pain phenotypes in terms of pain severity (p=0.016) and the Central Sensitization Inventory scores (p<0.001). Nociceptive pain was the most common pain phenotype in caregivers of children with CP. We also concluded that among the pain phenotypes, pain intensity was highest in neuropathic pain. There is a need for further studies in this area to demonstrate the validity and reliability of the evaluated mechanism-based classification system in order for it to be included in clinical guidelines.

Evaluation of central sensitization and presence of neuropathic pain in patients with rheumatoid arthritis and its relationship with quality of life

Central sensitization and neuropathic pain may develop in rheumatological diseases. This study aimed to investigate the presence of central sensitization and neuropathic pain in patients with rheumatoid arthritis (RA). We used the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) questionnaire to evaluate neuropathic pain (NP) in patients with RA. The presence of central sensitization in patients was evaluated using the central sensitization inventory (CSI). Demographic and clinical data were obtained from patients and interviews. Beck Depression Scale (BDS) was used to evaluate the mood of the patients, and the Short Form-36 (SF-36) quality of life scale was used to evaluate the quality of life. A total of 104 patients participated in our study, and 33 (31.7%) of them were found to be NP. CSI scores indicated central sensitization in 41 (39.4%) of the patients. A positive significant relationship was detected between LANSS and Visual Analog Scale (VAS), BDI, and Disease Activity Score 28 (DAS28). Central sensitization (CS) and neuropathic pain (NP) significantly contribute to functional disability in RA patients. Central sensitization and neuropathic pain significantly contribute to functional disability in patients experiencing neuropathic pain, with CS having a detrimental impact on their quality of life. Thus, it is imperative to consider neuropathic pain and CS during disease monitoring and follow-up.

Central sensitization and comorbid disorders in patients with coronary heart disease

Study of central sensitization (CS), insomnia and meteosensitivity in patients with coronary heart disease (CHD) admitted for a routine examination. 67 patients (29 men and 38 women), aged 50-87 years, average age 73 [67; 85] years, with chronic forms of coronary heart disease were examined. The examination included the Russian version of the central sensitization inventory (CSI); assessment of meteosensitivity using a visual analogue scale (VAS); questionnaire for semi-quantitative assessment of subjective sleep characteristics (ASHS). Patients with the presence of CS were prescribed Anvifen 250 mg 3 times a day; in addition, patients could take the drug during the day if necessary, as well as during night or early morning awakening (without exceeding the maximum daily dose of 1500 mg). The duration of drug administration and observation of patients was 30 days. The severity of CS (before and after treatment): subclinical - in 14 and 20, mild - in 15 and 37, moderate - in 17 and 10, severe - in 14 and 0, critical - in 7 and 0 patients, respectively. The average CSI score was 40.5[30; 50] and 32.5[25; 37.3] (p=0.00001). The severity of meteosensitivity according to VAS before and after treatment was 70 [60; 80] and 25 [20; 30] points (p=0.00002). The average ASHS score for subjective sleep characteristics before and after treatment was 13 [12; 15] and 26 [25; 28] points (p=0.00001). Central nervous system, insomnia and meteosensitivity are common clinical conditions in patients with coronary artery disease. Inattention to them leads to insufficient effectiveness of specific therapy and worsening of the course of cardiovascular diseases. The GABAergic drug Anvifen effectively reduces CS, meteosensitivity and improves sleep. The CSI is a simple and informative tool for assessing cerebral dysfunction in patients with coronary artery disease and can be recommended for daily routine practice in order to optimize personalized medical care.

Association between central sensitization, pain sensitivity and balance control in patients with migraine.

Balance alterations are prevalent among pain conditions, including migraine. The mechanisms explaining the association between pain and balance are unclear, as well as whether levels of pain sensitivity correlate with impaired balance. Our aim was therefore to investigate the association between balance, central sensitization symptoms and pain sensitivity in patients with migraine. This cross-sectional study included 50 patients and demographic, clinical information, central sensitization inventory (CSI) and pain catastrophizing (PCS) scores were obtained. Patients underwent a standardized protocol evaluating balance and pain thresholds for cold (CPT), heat (HPT), mechanical (MPT) and pressure (PPT) in trigeminal (V1) and extra-trigeminal (C6) dermatomes. Data were analysed using Person's correlation, linear regression models and contrasting the presence and absence of central sensitization symptoms through T-tests. Mild-to-moderate correlations were observed between balance and MPT in V1 (r = -0.24, p = 0.046) and C6 (r = -0.41, p = 0.002), CPT in V1 (r = 0.31, p = 0.026), CSI scores (r = 0.27, p = 0.029) and migraine frequency (r = 0.25, p = 0.040). Balance was explained by CPT and MPT (R2 = 0.32, p = 0.001). The variance of CSI was explained by PCS scores and balance (R2 = 0.28, p = 0.001). Patients with symptoms of central sensitization presented an increased balance impairment (p = 0.044) and higher catastrophizing levels (p = 0.001) in contrast to patients without symptoms. Balance impairment is associated with reduced pain thresholds and higher CSI scores. These results may help to elucidate the aetiology of balance alterations among chronic pain conditions. For the first time, it has been shown that balance alterations can reflect greater pain sensitivity and signs of central sensitization in patients with migraine. This opens up perspectives for future studies to understand the mechanisms and further factors associated with balance and pain sensitivity in migraine.

Central Sensitization in Psoriatic Arthritis: Relationship With Composite Measures of Disease Activity, Functional Disability, and Health-Related Quality of Life.

To investigate the prevalence of central sensitization (CS) in patients with psoriatic arthritis (PsA) and its association with disease activity and patient-reported outcome measures. This cross-sectional study included adults with PsA without coexisting fibromyalgia (FM). Patients underwent a clinimetric assessment to collect variables regarding disease activity, quality of life (QOL), functional ability, impact of disease, and CS. Spearman ρ was used to examine the relationship between CS Inventory (CSI) scores and other variables. A multivariate analysis was performed to determine the independent contribution of each variable to the 12-item Psoriatic Arthritis Impact of Disease (PsAID-12) score. One hundred fifty-seven patients were enrolled. Of them, 45.2% scored a CSI ≥ 40, indicating a high probability of CS. Significant correlations were found between CSI and disease activity, as evaluated by Disease Activity in Psoriatic Arthritis score and Psoriatic Arthritis Disease Activity Score (ρ 0.587 and ρ 0.573, respectively), between CSI and the Health Assessment Questionnaire (ρ 0.607), and between CSI and the 36-item Short Form Health Survey physical component summary and mental component summary scores (ρ -0.405 and ρ -0.483, respectively). In multivariate analysis, CSI score was the principal independent variable (P < 0.001) contributing to PsAID-12 score. Patients with PsA with symptoms of CS had higher disease activity, worse functional ability, and worse QOL. The presence of CS is the major contributor in the impact of disease.

The relation of psychological status and type D personality with central sensitization in knee osteoarthritis: everything is in your mind!

To evaluate the relation of psychosocial parameters and type D personality with central sensitization in knee osteoarthritis (OA). The study included 126 patients with knee OA according to the American College of Rheumatology criteria. Sociodemographic variables (age, gender, education, marital status, annual income), alcohol consumption/smoking, body mass index, comorbidities, and duration of symptoms were noted. Radiographic evaluation was performed according to the Kellgren-Lawrence grading system. The Western Ontario and McMaster Universities Osteoarthritis Index was used for clinical evaluation. Type D personality, negative affectivity, and social inhibition were evaluated using the type D Scale-14 (DS14). Central sensitization was assessed by the central sensitization inventory (CSI), while psychological status, quality of life, and sleep were assessed by the Hospital Anxiety and Depression Scale (HADS), an abbreviated version of the World Health Organization Quality of Life Instrument (WHOQOL-BREF), and the Jenkins Sleep Evaluation Scale (JSS), respectively. The effect of type D personality on study parameters including central sensitization, as well as the risk factors for the development of central sensitization were assessed by regression analyses. Patients with type D personality had higher CSI, HADS scores and lower WHOQOL-BREF scores for psychological health, social relationship, environment and general quality of life. Linear regression analysis showed that the DS14 total score has a significant positive relation with CSI (β = 0.4, p < 0.05), HADS-depression (β = 0.4, p < 0.05), HADS-anxiety (β = 0.5, p < 0.05), and HADS-total scores (β = 0.5, p < 0.05). It also had a significant negative effect on all domains of WHOQOL-BREF (p < 0.05 for all). Logistic regression analysis revealed that JSS [Odds ratio (OR) 0.83, 95% CI 0.73-0.94; p = 0.003] and negative affectivity (OR 0.78, 95% CI 0.65-0.94; p = 0.008) were independent risk factors for the development of central sensitization in knee OA. Type D personality has an impact on quality of life, central sensitization, and psychological health, with negative affectivity and sleep impairment serving as independent risk factors for central sensitization. While managing patients with knee OA, these intimate relationships should be taken into consideration.

Central sensitization negatively influences the level of disability in female patients with anterior knee pain.

To define the prevalence of Central Sensitization (CS) in patients with Anterior Knee Pain (AKP) and determine whether there is an association between CS and the magnitude of pain, disability, quality-of-life and psychological impairment. The data of a total of 44 AKP female patients with a mean age of 27.7years (15-50) recruited consecutively from hospital outpatient knee clinics were prospectively included in this study. The patients had no antecedents of knee trauma or surgery and no history of injury or disease of the nervous system. There were also 50 healthy female controls with a mean age of 26.1years (16-46). CS was evaluated using the Central Sensitization Inventory (CSI). Quality-of-life was evaluated using the EuroQoL-5D questionnaire. Self-reporting of clinical pain intensity was obtained using the Visual Analogue Scale. The Kujala Knee Scale and IKDC form were used to evaluate disability. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Subscale (HAD). Kinesiophobia was measured with the Tampa Scale for Kinesiophobia (TSK-11) and catastrophizing by means of the Pain Catastrophizing Scale (PCS). Sixteen AKP patients (36%), and 2 (4%) of the healthy controls presented with central sensitization (p < 0.01). AKP patients with CS have a greater degree of disability based on the Kujala Scale and higher levels of anxiety and depression than AKP patients without CS. The score of AKP patients in the CSI correlated weakly with disability and quality of life and moderately with anxiety and depression. However, no association was seen between CSI score and pain intensity, nor with catastrophizing and kinesiophobia. A multivariate logistic regression analysis showed that only depression was statistically significant in the prediction of the presence of CS (odds ratio 1.45; 95% CI 1.07 to 1.96). AKP patients have a significantly higher prevalence of CS in comparison with what has been reported for the general population. This finding suggests the presence of altered pain modulation in a subgroup of AKP patients. Level III.

Negative correlation between central sensitization and forgotten joint score-12 after total hip arthroplasty

BackgroundCentral sensitization is a condition in which even mild stimuli cause pain due to increased neuronal reactivity in the dorsal horn of the spinal cord. It is one of factors of chronic pain in patients with osteoarthritis. However, it is unknown whether central sensitization relates to clinical outcomes after total hip arthroplasty (THA). This study aimed to clarify whether preoperative central sensitization relates to the forgotten joint score-12 (FJS) after THA. Moreover, the secondary outcome was to identify which items in the FJS were most related by central sensitization.MethodsThis retrospective analysis included 263 hips (263 patients; 51 males and 212 females) that underwent primary THA in our institute and were available for evaluation one year postoperatively. The average patient age was 64.8 ± 11.9 years. The Central Sensitization Inventory (CSI) part A, which is a patient-reported outcome, was used to measure preoperative central sensitization. The correlation between preoperative CSI and postoperative FJS and the association between postoperative FJS and preoperative CSI severity were determined. Moreover, difference in each FJS item was evaluated by CSI severity.ResultsTwenty-six patients (9.9%) had central sensitization preoperatively. Preoperative CSI scores and postoperative FJS were negatively correlated (r = − 0.331, p < 0.0001). The postoperative FJS was significantly lower in patients with moderate or higher preoperative CSI severity than that in patients with subclinical or mild preoperative CSI severity (p < 0.05). FJS items with movement of daily life were significantly worse in the moderate or higher CSI severity compared with subclinical group (p < 0.05 or p < 0.01).ConclusionCentral sensitization prior to THA negatively related to postoperative FJS. In particular, the relationship of central sensitization was found to be significant in FJS items with movement, which would lead to lower patient satisfaction after THA. To get better postoperative outcomes in patients with preoperative central sensitization, improving central sensitization would be important.

Assessment of Prevalence and Risk Factors for Central Sensitization Related to Shoulder Osteoarthritis and Rotator Cuff Tears Using the Central Sensitization Inventory: A Cross-Sectional Study in Shoulder Surgery Patients.

Shoulder disorders occasionally cause intractable pain. Central sensitization (CS) may be involved in such pain. Identifying risk factors associated with CS is crucial for effective pain control. This study aimed to determine the effects of shoulder osteoarthritis and rotator cuff tears (RCT) on CS and associated factors. This study included patients evaluated for CS using the Central Sensitization Inventory (CSI) before surgery for shoulder osteoarthritis, RCT, or cuff tear arthropathy. Patients with a CSI score of 40 or higher were defined as having CS. The relationships between glenohumeral osteoarthritis (GHOA), RCT size, and CS were statistically analyzed. Multiple regression analysis was performed to examine the factors affecting CSI scores. Subjects included 167 patients: 131 patients had RCT without GHOA, 23 had GHOA with RCT, and 13 had GHOA without RCT. The GHOA group had a significantly higher CSI score (27.5 [10.8-40.5] vs. 18.0 [10.0-27.5]) and CS prevalence (27.8% vs. 8.4%) than the RCT without GHOA group. There was no significant correlation between RCT size and CSI scores. Multiple regression analysis showed that female sex, severe pain, and long pain duration were associated with higher CSI scores. Considering the risk factors for CS might be helpful in shoulder treatment.

The relationship between inadequate response to physical therapy and central sensitization in patients with knee osteoarthritis: A prospective cohort study.

Objectives: This study aims to investigate the relationship between physical therapy response and the presence of central sensitization (CS) in patients with painful knee osteoarthritis (OA). Patients and methods: Between May 2019 and March 2020, a total of 84 patients with knee OA (12 males, 72 females; mean age: 60.7±7.7 years; range 50 to 74 years) and 30 age and sex-matched controls (6 males, 24 females; mean age: 59.2±8.9 years; range 50 to 75 years) were included in this study. Knee pain and functional status were evaluated by Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Structural damage was assessed by knee radiography. The Central Sensitization Inventory (CSI), Beck Depression Inventory (BDI), Insomnia Severity Index (ISI), Pain Catastrophizing Scale (PCS), and PainDETECT Questionnaire (PDQ) were applied at baseline. Pain pressure thresholds (PPTs) of the patients were measured and compared with the control group. All patients underwent a total of 15 sessions of physical therapy program for five sessions/weekly. After treatment, the patients were divided into two groups as responders and non-responders according to the Osteoarthritis Research Society International (OARSI) criteria. Results: The CSI score of the patients in non-responder group was significantly higher compared to the responder group (p=0.004). Using a cut-off value of ≥40, the proportion of patients with CSI scores of ≥40 was significantly lower in the responder group compared to non-responder group (p=0.021). The PPT measurement values were significantly lower in the non-responder group compared to the responder and control groups (p <0.01). There was a significant difference in the frequency of hyperalgesia between the groups (p=0.021). Central sensitization and depression were the most significant predictors of non-response to physical therapy (p=0.045 and p=0.024, respectively). Conclusion: Our study results suggest the presence of CS and depression may result in an inadequate response to physical therapy in patients with knee OA. Clinicians should consider the findings of CS and depression in treatment planning.

Central Sensitization in Spondyloarthritis: The Crossroads between Disease Activity, Health-related Quality of Life and Fibromyalgia.

To assess central sensitization in young patients with spondyloarthritis (SpA) and to study the associated factors with higher central sensitization scores. This was a cross-sectional study including patients with SpA (ASAS criteria) aged less than 50 years. For all patients, we collected the sociodemographic and disease characteristics data. Central sensitization was assessed using a validated tool: The Central Sensitization inventory (CSI). Pain status, fibromyalgia, quality of life, anxiety and depression were screened by the Brief pain inventory, the Fibromyalgia rapid screening tool (FiRST), the ASQoL, and the Hospital anxiety and depression scale (HAD) anxiety and depression. Univariable and multivariable linear regression analyses were performed to achieve our objective. Seventy-two patients were enrolled (65,2% males). The median age was 39 (28,25-46) years. Median BASDAI and ASDAS-CRP scores were 3 (2.1 - 4.7) and 2.7 (1.9 - 3.48), respectively. The median value of the CSI score was 15 (6,25-33,75); a CSI≥40 was noted in 15.3% of patients. Depression, anxiety scores, fibromyalgia and impaired QoL were screened in 11%, 9,7%, 9,7%, and 44,4%, respectively. CSI≥40 was positively correlated with ASQoL, FiRST, HAD anxiety, HAD depression and the 5 categories of pain interference (mood, regular work, relationships, sleep and enjoyment of life). Multivariate analysis identified a predictive model which included the combination of FiRST, BASDAI and ASQoL. First was the strongest predictive factor of a higher central sensitization. CS is frequent among SpA patients and should be looked for in order to improve QoL.

Validity of the Central Sensitization Inventory to Address Human Assumed Central Sensitization: Newly Proposed Clinically Relevant Values and Associations.

Central sensitization cannot be directly demonstrated in humans and thus a gold standard is missing. Therefore, we used human assumed central sensitization (HACS) when associated with humans. The central sensitization inventory (CSI) is a screening questionnaire for addressing symptoms that are associated with HACS. This cross-sectional study compared patients with chronic pain and at least one central sensitivity syndrome with healthy, pain-free controls via ROC analyses. Analyses were performed for all participants together and for each sex separately. Regression analyses were performed on patients with chronic pain with and without central sensitivity syndromes. Based on 1730 patients and 250 healthy controls, cutoff values for the CSI for the total group were established at 30 points: women: 33 points; men: 25 points. Univariate and multivariate regression analyses were used to identify possible predictors for the CSI score in 2890 patients with chronic pain. The CSI score is associated with all independent factors and has a low association with pain severity in women and a low association with pain severity, age, and body mass index in men. The newly established CSI cutoff values are lower than in previous studies and different per sex, which might be of clinical relevance in daily practice and importance in research.

Preoperative education on realistic expectationsimproves the satisfaction of patients with central sensitization after total knee arthroplasty: a randomized-controlled trial.

The aim of this study was to investigate whether an additional module on realistic expectations following total knee arthroplasty (TKA) would lead to a higher proportion of satisfied patients compared to existing preoperative education. This was a single-center, randomized-controlled trial. A total of 172 patients who were scheduled for TKA between September 2020 and October 2021 were enrolled. Patients were randomized to receive either only standard preoperative education, or an additional module on realistic expectations following TKA. The primary outcome was patient satisfaction. Secondary outcomes were Short Form-36, Western Ontario and McMaster Universities Osteoarthritis Index, crepitus score, and range of motion. Subgroup analysis was performed based on central sensitization inventory (CSI) score stratification. Assessment was performed at the 3-month, 6-month, and > 1-year follow-up. At more than 1year, 65/78 (83.3%) patients in the intervention group and 52/80 (65.0%) patients in the control group were satisfied (P = 0.03). The mean satisfaction score was measured as 4.2 ± 0.9 in the intervention and 3.9 ± 0.9 in the control at > 1year (P = 0.01). There were significant differences in Short Form-36 physical and mental component summary scores and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and stiffness scores at 6months (P = 0.02, P = 0.02, P = 0.04, P = 0.04). The frequency of satisfaction and mean satisfaction score in the top 25 percentile CSI group were 15/16 (93.8%) and 4.6 ± 0.6 in those who received intervention and 12/19 (63.2%) and 3.8 ± 0.8 in those who did not (P = 0.01, P = 0.01). Thorough preoperative education on realistic expectations following TKA showed effects on WOMAC pain and satisfaction at > 1year after surgery. It was more prominent in the group with a higher CSI score at > 1-year follow-up. Level I.

The effect of graded motor imagery training on pain, functional performance, motor imagery skills, and kinesiophobia after total knee arthroplasty: randomized controlled trial.

The aim was to investigate the effect of graded motor imagery (GMI) added to rehabilitation on pain, functional performance, motor imagery ability, and kinesiophobia in individuals with total knee arthroplasty (TKA). Individuals scheduled for unilateral TKA were randomized to one of two groups: control (traditional rehabilitation, n = 9) and GMI (traditional rehabilitation + GMI, n = 9) groups. The primary outcome measures were the visual analogue scale and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcome measures were knee range of motion, muscle strength, the timed up and go test, mental chronometer, Movement Imagery Questionnaire-3, lateralization performance, Central Sensitization Inventory, Pain Catastrophizing Scale, and Tampa Kinesiophobia Scale. Evaluations were made before and 6 weeks after surgery. Activity and resting pain were significantly reduced in the GMI group compared to the control group (P < 0.001 and P = 0.004, respectively). Movement Imagery Questionnaire-3 scores and accuracy of lateralization performance also showed significant improvement (P = 0.037 and P = 0.015, respectively). The Pain Catastrophizing Scale and Tampa Kinesiophobia Scale scores were also significantly decreased in the GMI group compared to the control group (P = 0.039 and P = 0.009, respectively). However, GMI did not differ significantly in WOMAC scores, range of motion, muscle strength, timed up and go test and Central Sensitization Inventory scores compared to the control group (P > 0.05). GMI improved pain, motor imagery ability, pain catastrophizing, and kinesiophobia in the acute period after TKA.

Does Central Sensitization Influence Outcomes of Lumbar Discectomy Surgery in Patients With Lumbar Disc Herniation? A Multicenter Prospective Study.

Multicenter prospective study. Patients with central sensitization (CS) are reported to be at high risk of poor outcomes after spinal surgery. However, the influence of CS on surgical outcomes for lumbar disc herniation (LDH) remains unknown. This study aimed to examine the association between preoperative CS and surgical outcomes in LDH patients. A total of 100 consecutive patients with LDH (mean age 51.2) who underwent lumbar surgery were included in this study. The extent of CS was evaluated using the central sensitization inventory (CSI), a screening tool for CS-related symptoms. The patients completed the following CSI and clinical outcome assessments (COAs) preoperatively and 12months postoperatively: the Japanese Orthopaedic Association (JOA) score for back pain, JOA back pain evaluation questionnaire (JOABPEQ), and Oswestry Disability Index (ODI). The association between preoperative CSI scores, and preoperative and postoperative COAs was analyzed, and the postoperative changes were statistically evaluated. The preoperative CSI score significantly decreased 12months postoperatively. Preoperative CSI scores showed a significant correlation with most COAs; however, a significant correlation was only identified in the social function and mental health domains of JOABPEC postoperatively. Higher preoperative CSI showed worse preoperative COAs; however, all COAs significantly improved regardless of CSI severity. There were no significant differences in any COAs among the CSI severity groups 12months postoperatively. The results of this study showed that lumbar surgeries significantly improved the COAs regardless of preoperative severity of CS in patients with LDH.

Functional ability in knee osteoarthritis: role of neuropathic pain and central sensitization

BackgroundPain in osteoarthritis (OA) has been attributed traditionally to local tissue injury causing ‘nociceptive pain’. However, recent studies suggest that neuropathic and central sensitization mechanisms may contribute to the pain experience. However, the relationship between these pain mechanisms and physical function has not been thoroughly addressed. This study aimed to assess the association of central sensitization and neuropathic pain with physical function in knee OA.ResultsParticipants with a positive central sensitization inventory score (CSI) (≥ 40) had a decreased total Knee injury and Osteoarthritis Outcome Score (KOOS) and its subscales (p < 0.001), a longer timed up and go test time (p = 0.002) and a higher PainDETECT questionnaire (PD-Q) and visual analogue scale (p < 0.001, p = 0.026 respectively). The severity of Kellgren-Lawrence grading (KL) (p < 0.001), depressive and anxiety symptoms (p < 0.001) increased with neuropathic pain severity. In addition, participants with a high PD-Q score (≥ 19) had a longer timed up and go test time (p < 0.001) and a decreased total KOOS score (p < 0.001). Moreover, we found that CSI score, KOOS score, and KL grading were significantly predicted the PD-Q score (p = 0.046, p < 0.001, p = 0.007, respectively). Regarding the physical function predictors, multivariate linear regression analysis revealed that pressure pain threshold at right elbow and right knee (p = 0.005, p < 0.001) in addition to PD-Q (P < 0.001) were significantly associated with KOOS score, while CSI and Hospital Anxiety Depression Scale were not.ConclusionKnee OA patients with significant central sensitization and neuropathic pain reported increased pain, more functional impairment, more anxiety and depressive symptoms than OA patients without central sensitization and neuropathic pain. Additionally, neuropathic pain and presence of central sensitization were significant predictors for functional ability.

Central sensitization and mental health outcomes of endometriosis patients during the COVID-19 pandemic

To determine whether central nervous system sensitization in patients with endometriosis was associated with worse mental health outcomes during the COVID-19 pandemic. Data were linked between two British Columbia databases: the prospective Endometriosis Pelvic Pain Interdisciplinary cohort (EPPIC) that phenotypes endometriosis patients; and the Rapid Evidence Study of a Provincial Population Based Cohort for Gender and Sex cohort (RESPPONSE) that follows mental health outcomes during the COVID-19 pandemic. The predictors were the Central Sensitization Inventory (CSI) score and central sensitivity syndrome (CSS) comorbidities at baseline from EPPIC. The primary outcomes were PHQ-9 (depression) and GAD-7 (anxiety) scores in Phase 1 of the pandemic from RESPPONSE. Bivariate and multivariable analyses were performed. There were N=329 subjects in the linked dataset. On bivariate analysis, more central sensitization at baseline (i.e. higher CSI scores and more CSS comorbidities) was strongly associated with worse mental health during the pandemic (i.e. higher PHQ-9 and GAD-7 scores). On multivariable regression, after controlling for baseline mental health measures, age, BMI, and parity, both the CSI score and the number of CSS comorbidities at baseline were associated with worse PHQ-9 (P <0.0001, P = 0.0075) and worse GAD-7 (P <0.0001, P = 0.0054) scores during the pandemic. Central nervous system sensitization was associated with worse mental health for endometriosis patients during the COVID-19 pandemic. Central sensitization may predict mental health outcomes in the face of a pandemic or other stressors.

Central Pain Sensitization in Patients with Chronic Plaque Psoriasis.

Central sensitization (CS) is a condition characterized by a disproportionate response to pain stimuli, and is associated with chronic pain conditions such as fibromyalgia, but also with inflammatory arthropathies such as rheumatoid arthritis and psoriatic arthritis (PsA). CS has never been investigated in patients with psoriasis. The aim of this study is to investigate CS in patients with chronic plaque psoriasis. This research involved a cross-sectional observational study of adult patients with moderate-to-severe psoriasis consecutively attending the outpatient clinic of the University Hospital of Verona. Demography, measures of disease severity or activity [i.e., Psoriasis Area and Severity Index (PASI), Disease Activity in Psoriatic Arthritis (DAPSA)], diagnosis of PsA, hypertension, and diabetes were collected. Central Sensitization Inventory (CSI), Dermatology Life Quality Index (DLQI), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) were administered. A total of 194 patients, including 115 (59%) men, with mean age of 54 ± 13years, mean PASI of 12.7 ± 6.7, and mean DAPSA of 14.4 ± 3.8 were included. In total, 134 patients (79%) had only psoriasis while 60 (31%) had psoriasis and PsA; 19 (10%) patients had CSI score ≥ 40, which is the threshold for diagnosing CS. The proportion of CS ≥ 40 was higher in patients with PsA compared with psoriasis (17% versus 7%, p = 0.031). The mean CSI score in patients with PsA was higher compared with those with only psoriasis (27.5 ± 13.5 versus 20.7 ± 13.7, p = 0.002). An association between CSI and DLQI [β = 1.25 (95% CI 0.85-1.66)], PASI [β = 1.22 (95% CI 0.74-1.65)], GAD-7 [β = 2.07 (95% CI 1.69-2.45)] and PHQ-9 [β = 2.16 (95% CI 1.76-2.54)] was found independently from age, gender, diabetes, and PsA. Central sensitization may be associated with psoriasis, particularly in those with high PASI, concomitant PsA, anxiety, depression, and severe quality of life impairment.