Central Sensitization Inventory Scores Research Articles

The association between chronic pain and central sensitization following total knee replacement: A retrospective cohort study

Background: Pain still persists in 20% of patients who have had total knee replacement (TKR) surgery. It is important to investigate the reason for the persistent pain after surgery and related factors. This study aimed to elucidate any connection between central sensitization and ongoing pain after knee replacement surgery and other associated factors. Methods: The population was composed of 182 patients who had undergone TKR, and in follow-up visits from 1 mo to 2 yr after the operation, they were evaluated using the Pressure Pain Threshold (PPTs), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Central Sensitization Inventory (CSI), the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), the Beck Depression Inventory (BDI), and the painDETECT test. Results: The mean follow-up period was 6.84±4.10 (1-24) months. According to the postoperative LANSS score, neuropathic mechanisms were responsible for pain in 48.4% (88/182) of the patients. CSI showed central sensitization in 41.2% (75/182) of the patients (CSI score ≥40). Patients whose pain was not associated with neuropathic mechanisms (LANSS score <12 or painDETECT score<19) saw more benefit from surgery (P<0.001). Additionally, pain relief after TKR was more prevalent in patients whose CSI score was <40 points (P<0.001). Conclusions: This study showed that neuropathic mechanisms and central sensitization are important sources of persistent pain in patients who have had total knee replacement. Evaluation of central sensitization and neuropathic mechanisms may play an important role in management of pain. Level of Evidence: Level III.

Central Sensitization Syndrome and Hypothyroidism: An Evaluation of Symptom Severity and Comorbid Diagnoses

Abstract Objective: Central sensitization is considered the cause of medically unexplained pain-related conditions, often expressed with other somatoform disorders. This study aimed to evaluate the degree of overlap of symptom severity and comorbid diagnoses between hypothyroidism and central sensitization syndrome (CSS). Methods: Three hundred eighty-five individuals with hypothyroidism completed the Central Sensitization Inventory (CSI) and measures evaluating symptom severity and comorbid diagnoses. Results: Hypothyroid patients with high CSI scores (Severe and Extreme subscales) were more likely to report fibromyalgia, musculoskeletal pain, arthritis, and migraine, along with chronic fatigue syndrome, gastrointestinal problems, depression and anxiety disorders. The key symptoms related to CSS were depressive symptoms, fatigue, headaches, and aches/pains. The key comorbidities related to CSS were lower age, and depression and/or anxiety diagnoses. Conclusion: Hypothyroid patients reporting greater ratings of hypothyroid symptoms, particularly fatigue, aches/pains, and depression symptoms may be exhibiting central sensitization, and further testing for CSS conditions should be considered. Keywords: Hypothyroidism, Central Sensitization, Fibromyalgia, Chronic Pain, Depression

Predictors of Pelvic Floor Muscle Dysfunction Among Women With Lumbopelvic Pain.

There is evidence to suggest that a large proportion of individuals seeking care for lumbopelvic pain also have pelvic floor muscle dysfunction (PFMD). Because the majority of physical therapists do not have the requisite training to adequately assess pelvic floor musculature, determining predictors of PFMD could be clinically useful. The objective was to establish a combination of factors (self-report and physical) predictive of PFMD in women with lumbopelvic pain. This was a cross-sectional study. Participants completed a battery of self-report and physical assessments (masked assessors). Three clinical findings characterized PFMD: weakness of the pelvic floor, lack of coordination of the pelvic floor, and pelvic floor muscle tenderness on palpation (bilateral obturator internus). Univariate and multivariate logistic regression analyses were used to determine the extent to which different predictors were associated with PFMD. One hundred eight women with self-reported lumbopelvic pain (within the past week) were included in the study (mean age=40.4years; SD=12.6years). None of the examined factors predicted pelvic floor muscle weakness. Two factors independently predicted pelvic floor muscle tenderness on palpation: very strong and/or uncontrollable urinary urges (odds ratio [OR]=2.93; 95% confidence interval [CI]=1.13-7.59) and Central Sensitization Inventory scores of 40 or greater (OR=3.13; 95% CI=1.08-9.10). The sample consisted of young women, some of whom were not actively seeking care. Additionally, the technique for assessing pelvic floor muscle tenderness on palpation requires further validation. Women who have lumbopelvic pain, uncontrollable urinary urgency, and central sensitization were, on average, 2 times more likely to test positive for pelvic floor muscle tenderness on palpation. Further studies are needed to validate and extend these findings.

Central Sensitization Inventory Mediates the Relationship Between Inflammatory Bowel Disease Activity and Worse Musculoskeletal Pain Experiences.

Musculoskeletal conditions are well documented in inflammatory bowel disease (IBD). However, whether IBD activity influences musculoskeletal pain experiences is uncertain. Central sensitization has been proposed in patients with IBD who are suffering from persistent pain. Identification of central sensitization symptomology using the Central Sensitization Inventory (CSI) has been reported in many pain-related disorders. Aims of this study were to explore predictive relationships between IBD activity and musculoskeletal pain experiences (severity/interference), and the mediating effects of the CSI. A cross-sectional online survey was performed exploring self-reported musculoskeletal pain in adults with IBD. Survey questionnaires included IBD activity indices, numeric rating scales, PROMIS Pain Interference, and the CSI. Linear regression was used to examine the relationship between active IBD and pain experiences. Simple and serial mediation analyses were used to explore mediation models: independent variable (IBD activity), dependent variables (severity/interference), and mediators (CSI/severity). 208 adults with IBD, 18 to 88years of age, reported musculoskeletal pain. Regression analysis identified IBD activity as a significant predictor of worse pain severity (R2 =0.039, P<0.005) and interference (R2 =0.067, P<0.001). Simple mediation showed a significant indirect effect from CSI scores between IBD activity and pain severity. Serial mediation analysis showed a significant indirect effect from CSI scores and pain severity, between IBD activity and pain interference. Active IBD demonstrated a positive association with worse musculoskeletal pain experiences. The CSI demonstrated significant mediation between active IBD and pain severity. Additionally, the CSI and pain severity demonstrated significant mediation between active IBD and pain interference. This suggests that symptoms of central sensitization significantly influence musculoskeletal pain experiences in IBD.

The central sensitization inventory predict pain-related disability for musculoskeletal disorders in the primary care setting.

Central sensitization (CS) is found in patients with musculoskeletal disorders and is related to clinical symptoms, including pain-related disability. The Central Sensitization Inventory (CSI) has been developed for patients who are at risk of symptoms related to CS, and CSI severity levels are suggested for clinical interpretation of the CSI score. However, the longitudinal relationship between CSI severity and pain-related disability is unclear in primary care. In this study, we investigated the association between CSI severity levels and the profiles of patients with musculoskeletal disorders as well as the longitudinal relationship between CSI severity levels and pain-related disability in primary care settings. A total of 553 patients were assessed using CSI, EuroQol-5 dimension (EQ5D), and Brief Pain Inventory (BPI). Of the 553 patients, 150 patients were reassessed at the 3-month follow-up. Patients were grouped into three severity levels according to baseline CSI score: subclinical, mild, and moderate to higher level. As the CSI severity levels increased, the clinical symptoms tended to worsen on cross-sectional analysis (p<0.05). Pain-related disability at the 3-month follow-up was significantly higher for patients with moderate to high baseline CSI severity levels than for patients with subclinical baseline CSI levels (p<0.001). Furthermore, pain-related disability increased according to the CSI severity level, with a medium to large effect size. However, there were no differences in pain duration across the CSI severity levels. CSI has clinical utility as a prediction tool regardless of pain duration in patients with musculoskeletal disorders in primary care settings. Higher CSI severity levels predicted higher pain-related disability for patients with musculoskeletal disorders in a primary care setting. CSI is a clinically useful prediction tool in patients with musculoskeletal disorders.

Trait Sensitivity, Anxiety, and Personality Are Predictive of Central Sensitization Symptoms in Patients with Chronic Low Back Pain.

Sensitivity-related trait characteristics involving physical and emotional sensitivities and high trait anxiety personality types have been observed in individuals with nonspecific chronic low back pain (NSCLBP). High trait sensitivity to sensory stimulation combined with interpretation biases based on personality type may contribute to the development of central sensitization (CS) symptoms. To date, there is limited research that has considered both sensitivity levels and personality type in NSCLBP with CS. The purpose of this study was to investigate (1) relationships between trait sensory profiles, trait anxiety, and CS symptoms, and (2) the predictive capacity of sensory profiles, trait anxiety, and personality types on CS symptoms in people with NSCLBP. This was a cross-sectional observational study using 4 self-report measures on adults (N=165, mean age=45±12 [standard deviation] years) from physiotherapy clinics in England, Ireland, and New Zealand. Inclusion: NSCLBP>6months, age 18 to 64 years, predominant CS pain presentation, no other pathology. Parametric and nonparametric correlation statistics and regression analyses were used. Positive correlations were found between central sensitization inventory (CSI) scores and sensory hypersensitivity profiles and trait anxiety. CSI score increases could be predicted by sensory-sensitive, low-registration profiles; trait anxiety scores; and extreme defensive high anxious personality type. Trait sensory hyper- and/or hyposensitivity and high trait anxiety-related personality type characteristics predict the extent of CS symptoms in people with NSCLBP. Further investigation is required to establish causality between these characteristics and CS symptoms.

Prevalence of Extreme Trait Sensory Profiles and Personality Types in Nonspecific Chronic Low Back Pain with Predominant Central Sensitization: Secondary Analysis of an International Observational Study

Background: Individuals with nonspecific chronic low back pain (NSCLBP) and central sensitization (CS) exhibit sensory hypersensitivity that may be related to pre-existing trait characteristics. Sensory profiles and trait anxiety-related characteristics have sensory sensitivity in common with CS. Objectives: The objectives of this study were 1) to observe the prevalence of 4 personality types and extreme scores of 4 trait sensory profiles in people with NSCLBP and predominant CS; and 2) to compare these between 2 subgroups based on high and low self-reported CS symptoms. Study Design: An international cross-sectional observational study was undertaken. Setting: Adults (n = 165; mean age = 45 ± 12 standard deviation) were recruited from physiotherapy clinics across 3 countries and 2 continents. Methods: The inclusion criteria were: NSCLBP, aged 18-64 years, with clinically identified predominant CS pain, without specific pathology. The outcome measures were: Central Sensitization Inventory (CSI), Adolescent/Adult Sensory Profile, State/Trait Anxiety Inventory, and Marlowe Crowne Social Desirability Scale. Descriptive and comparative statistics were used. Results: CSI scores ranged from 19-79 (mean = 50). There was a high prevalence of extreme 1) trait sensory hyper- and, unexpectedly, hyposensitivity profile scores (P &lt; 0.001) and Defensive High Anxious personality type (P &lt; 0.01) in the high-CSI (CSI ≥ 40; 78%) subgroup, and 2) trait sensory hyposensitivity profile scores (P &lt; 0.01) and Repressor personality type (P &lt; 0.01) in the low-CSI subgroup (CSI &lt; 40; 22%). Limitations: Self-report measures only were used; limited demographics. Conclusions: To our knowledge, these results are the first to demonstrate extreme trait sensory profiles and personality types in people with NSCLBP and predominant CS. A subgroup who reports low levels of CS symptoms may have a hyposensitive sensory profile and Repressor personality type. Further study is required to investigate the extent to which these trait characteristics may predict CS symptoms in people with NSCLBP. Key words: Central sensitization, nonspecific chronic low back pain, prevalence of extreme trait characteristics, sensory profiles, trait anxiety-related personality types

Difference in the impact of central sensitization on pain-related symptoms between patients with chronic low back pain and knee osteoarthritis.

Purpose: The aims of the present study were to investigate whether the association between the Central Sensitization Inventory (CSI) score, pain-related symptoms, pain-related disability, and health-related quality of life differed by disease (chronic low back pain [CLBP] vs knee osteoarthritis [KOA]), and to determine optimal cutoff scores for the CSI reflecting disease-specific characteristics.Patients and methods: A total of 104 patients with CLBP and 50 patients with KOA were recruited. Central sensitization-related symptoms (CSI), EuroQol 5-dimension (EQ-5D), Brief Pain Inventory, widespread pain (Widespread Pain Index [WPI]), pressure pain threshold (PPT), and temporal summation (TS) were assessed and compared between the CLBP and KOA groups. Univariate correlation analysis was performed in each group. The receiver operating characteristic (ROC) curve analysis was performed to identify 1) presence/absence of central sensitization (CS), 2) presence/absence of central sensitivity syndromes (CSSs), and 3) pain intensity and pain interference in each group.Results: The CSI and WPI scores were significantly higher in the CLBP group than in the KOA group. EQ-5D and pain interference scores significantly correlated with the CSI score in both the CLBP and KOA groups. The WPI score, PPT, and TS did not correlate with the CSI score in either the CLBP or KOA group. The suggested cutoff scores were 28 in the CLBP group and 17 in the KOA group to identify presence or absence of CSSs, and 34 in the CLBP group and 18–19 in the KOA group to identify pain severity.Conclusion: The impact of CS on pain could differ between CLBP and KOA and that cutoff scores differ by each parameter we attempted to identify. Therefore, we should use the appropriate cutoff scores for the purposes and consider the difference in the impact of CS on pain by the patient group.

Chronic pain intervention using pulsed shortwave therapy: the relationship between pain demographics and central sensitization inventory.

Aim: The central sensitization inventory (CSI) is a validated, patient-reported questionnaire that quantifies symptoms of hypersensitivity disorders such as chronic pain, for which central sensitization (CS) may be the etiology. Objective: To investigate the analgesic effectiveness of ActiPatch and analyze the relationship between baseline CSI scores and demographics of chronic pain sufferers. Methods: Upon completing a 7-day ActiPatch trial, baseline CSI scores along with other assessment measures were obtained via e-mail from 174 chronic pain sufferers. Conclusion: CSI scores were positively correlated with gender (higher for women), baseline visual analog scale scores and pain duration. ActiPatch was found to be effective in reducing baseline pain for all subjects by an average of 4.3 visual analog scale points.

Central Sensitization Is a Risk Factor for Persistent Postoperative Pain and Dissatisfaction in Patients Undergoing Revision Total Knee Arthroplasty

BackgroundThe objective of this study is to investigate whether central sensitization (CS) was associated with patient dissatisfaction after revision total knee arthroplasty (TKA). MethodsBetween 2012 and 2016, 68 cases (68 patients) of revision TKA performed by a single surgeon were included in this study with a minimum follow-up of 2 years. Patients were categorized into 2 groups by 40-point preoperative Central Sensitization Inventory (CSI) scores. The control group consisted of 48 patients (48 knees) with CSI scores of less than 40 points, while the CS group consisted of 20 patients (20 knees) with CSI scores of 40 points or more. Clinical outcomes were evaluated using an 11-point visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index scores. Patient satisfaction was evaluated using the satisfaction items of the new Knee Society Scores, where scores ≥20 indicated satisfaction. ResultsHigher preoperative pain VAS scores in the CS group were maintained 3, 6, 12, and 24 months postoperatively (all P < .05). The CS group showed significantly worse pain, function subscores, and total scores of the Western Ontario and McMaster Universities Osteoarthritis Index preoperatively and at 2 years postoperatively. Forty-four (91.7%) patients in the control group and 3 (15.0%) patients in the CS group were satisfied with their revision TKAs (P < .001). Multivariate logistic regression analysis demonstrated that the odds of dissatisfaction after revision TKAs were increased 39.081 times (95% confidence interval 6.926-220.504, P < .001) in patients with CSI scores ≥40. Higher VAS intensity 2 years postoperatively also predicted dissatisfaction following revision TKA (odds ratio 1.864, 95% confidence interval 1.086-3.199, P = .024). ConclusionCS is a risk factor for persistent postoperative pain and dissatisfaction in patients undergoing revision TKAs. Level of EvidenceIII.

(183) Central Sensitization Inventory Discriminates between Pain Groups in Individuals with Inflammatory Bowel Disease

Abdominal and musculoskeletal (MSK) pain experiences are common in inflammatory bowel diseases (IBD). Recent evidence suggests that MSK pain severity is influenced by IBD activity and it is mediated by symptoms commonly related to central sensitization syndromes. However, it is not known whether severity of central sensitization symptoms can discriminate the type of pain presentation in individuals with IBD. A cross-sectional online survey among 305 New Zealand adults with IBD (aged 18-88 years) was conducted. Features of IBD, abdominal pain, and MSK pain were examined using multiple validated questionnaires. Presence and severity of symptoms commonly seen in central sensitivity syndromes were assessed using the central sensitization inventory (CSI). One-way analysis of variance with post-hoc multiple comparisons, while controlling for age and gender, was used to determine differences in CSI scores based on the type of pain presentation: no pain (n=61), only abdominal pain (n=36), only MSK pain (n=82), and both abdominal/MSK pain (n=125). Analysis indicated significantly different CSI scores between identified pain presentations (F (3,298) = 32.187, p ≤ .000). Individuals reporting no pain demonstrated the lowest CSI scores (M = 31.25, SD = 12.39), while those with both abdominal/MSK pain demonstrated the highest (M = 51.48, SD = 13.22). Post-hoc comparisons described significant differences (p ≤ .05) in CSI scores between all pain groups, except between individuals only reporting musculoskeletal pain and those only reporting abdominal pain (MD = 1.07, SE = 2.52). In the present study, CSI scores were able to discriminate pain presentations in IBD, with higher CSI scores in individuals with both abdominal/MSK pain. Future research should explore the relationship between CSI scores in this population with clinical measures of central sensitization.

Lower Urinary Tract Symptoms in a Chronic Pelvic Pain Population.

This study aimed to characterize the prevalence of lower urinary tract symptoms in a chronic pain population. In this observational cohort study, patients referred to a female pelvic pain clinic completed several validated questionnaires assessing bladder symptoms, central sensitization, pain symptoms, depression, anxiety, and neuropathic pain. Patients diagnosed as having interstitial cystitis were excluded. Patient demographic characteristics and survey responses were compared across American Urological Association Symptom Index (AUA-SI) severity categories. Multivariable logistic regression was performed to identify independent predictors of moderate-to-severe AUA-SI scores. A total of 177 patients were included in the analysis. American Urological Association Symptom Index data showed that 48.8% of patients had mild, 31.2% had moderate, and 20.0% had severe symptoms. Patients reporting moderate or severe AUA-SI scores had higher mean Central Sensitization Inventory (CSI) scores (46.7 ± 16.0 vs 32.9 ± 13.8, P < 0.0001), McGill scores (median, 25 [interquartile range, 16-38] vs 13 [5-27]; P = 0.0003), Patient-Reported Outcomes Measurement Information System depression T-scores (median, 53.9 [interquartile range, 46.2-61.6] vs 51.2 [37.1-55.3]; P = 0.009), Pelvic Pain and Urgency/Frequency Symptoms Scale scores (18.4 ± 6.2 vs 12.5 ± 5.4, P < 0.0001), and Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs scores (median, 10.5 [interquartile range, 3.0-16.5] vs 6.0 [1.0-12.0]; P = 0.02). The odds of moderate-to-severe AUA-SI symptoms were higher with a positive PUF and CSI score and were lower with a diagnosis of vestibular pain. There is a high prevalence of lower urinary tract symptoms among patients with chronic pelvic pain. Vestibulodynia was associated with lower odds of bladder symptoms. High PUF and CSI scores were significantly associated with moderate-to-severe bladder symptoms.

Validity of the central sensitization inventory with measures of sensitization in people with knee osteoarthritis.

Our purpose was to determine the validity of the Central Sensitization Inventory (CSI) with psychophysical tests, psychological and physical factors in patients with Knee Osteoarthritis (KOA). Patients with KOA were recruited from three Montreal hospitals. Psychophysical tests (pressure pain threshold, conditioned pain modulation, temporal summation) were conducted and questionnaires administered to determine the presence of neuropathic pain, somatization, anxiodepressive symptoms, pain catastrophizing (PC), and widespread pain (WSP). Relations between the CSI, psychophysical tests, and questionnaires were assessed using correlations and chi-square analysis. Receiver Operating Characteristics (ROC) curves determined sensitivity and specificity scores. Multiple linear regression was performed to predict the association of CSI scores with somatization, anxiodepressive symptoms, PC, and WSP factors. One hundred thirty-three participants were assessed, 56.4% female, mean age 63.5years. The CSI was weakly correlated with decreased pressure pain thresholds locally (rs - 0.264, p = 0.004) and remotely (rs - 0.235, p = 0.011) and with conditioned pain modulation (rs 0.187, p = 0.045). ROC curve analyses suggested an optimal CSI cut-point of 36 (Sn 75%, Sp 63.4%). Performance of the CSI used in combination with a neuropathic pain questionnaire was not significantly superior. After adjustment for covariates, a multivariable linear regression determined WSP (unstandardized ß 4.161(0.067, 8.255) p =0.046), somatization (unstandardized ß 1.828 (1.368, 2.288) p < 0.005), and anxiodepressive symptoms (unstandardized ß 0.419 (0.107, 0.730) p = 0.009) significantly predicted CSI scores. The CSI is more strongly associated with psychological factors than psychophysical test results in a KOA population. Its moderate sensitivity and specificity suggest it should be used as part of a more comprehensive evaluative toolkit.

Influence of centrally mediated symptoms on functional outcomes after carpal tunnel release

Patients with carpal tunnel syndrome (CTS) often show bilaterally increased pain sensitivity and widespread symptoms. We evaluated the influence of centrally mediated symptoms on functional outcomes of carpal tunnel release (CTR). A total of 120 patients with surgically treated CTS were enrolled. Centrally mediated symptoms were preoperatively measured by administering a self-reported central sensitization inventory (CSI) questionnaire and peripheral sensitization was measured by assessing patient’s pressure pain thresholds (PPT) in the forearm. Boston Carpal Tunnel Questionnaires (BCTQ) were assessed preoperatively and postoperatively at 3 and 12 months. CSI scores slightly correlated with symptom duration and moderately correlated with preoperative BCTQ scores, while PPT slightly correlated with the BCTQ scores. At 3 months, BCTQ symptom and function scores moderately correlated with lower PPTs and higher CSI scores. At 12 months, only severe electrophysiological grade was associated with BCTQ function scores. Multivariable analysis revealed that preoperative PPT, CSI, and female gender were associated with BCTQ scores at 3 months; these factors failed to be associated for 12-month outcomes. Centrally mediated symptoms measured by CSI and peripheral sensitization measured by PPTs correlated with symptom severity and duration. They were associated with poorer functional outcomes after CTR up to 3 months. However, they did not show persistent effects in the long term.

Effect of Pain Neuroscience Education Combined With Cognition-Targeted Motor Control Training on Chronic Spinal Pain

ImportanceEffective treatments for chronic spinal pain are essential to reduce the related high personal and socioeconomic costs.ObjectiveTo compare pain neuroscience education combined with cognition-targeted motor control training with current best-evidence physiotherapy for reducing pain and improving functionality, gray matter morphologic features, and pain cognitions in individuals with chronic spinal pain.Design, Setting, and ParticipantsMulticenter randomized clinical trial conducted from January 1, 2014, to January 30, 2017, among 120 patients with chronic nonspecific spinal pain in 2 outpatient hospitals with follow-up at 3, 6, and 12 months.InterventionsParticipants were randomized into an experimental group (combined pain neuroscience education and cognition-targeted motor control training) and a control group (combining education on back and neck pain and general exercise therapy).Main Outcomes and MeasuresPrimary outcomes were pain (pressure pain thresholds, numeric rating scale, and central sensitization inventory) and function (pain disability index and mental health and physical health).ResultsThere were 22 men and 38 women in the experimental group (mean [SD] age, 39.9 [12.0] years) and 25 men and 35 women in the control group (mean [SD] age, 40.5 [12.9] years). Participants in the experimental group experienced reduced pain (small to medium effect sizes): higher pressure pain thresholds at primary test site at 3 months (estimated marginal [EM] mean, 0.971; 95% CI, –0.028 to 1.970) and reduced central sensitization inventory scores at 6 months (EM mean, –5.684; 95% CI, –10.589 to –0.780) and 12 months (EM mean, –6.053; 95% CI, –10.781 to –1.324). They also experienced improved function (small to medium effect sizes): significant and clinically relevant reduction of disability at 3 months (EM mean, –5.113; 95% CI, –9.994 to –0.232), 6 months (EM mean, –6.351; 95% CI, –11.153 to –1.550), and 12 months (EM mean, –5.779; 95% CI, –10.340 to –1.217); better mental health at 6 months (EM mean, 36.496; 95% CI, 7.998-64.995); and better physical health at 3 months (EM mean, 39.263; 95% CI, 9.644-66.882), 6 months (EM mean, 53.007; 95% CI, 23.805-82.209), and 12 months (EM mean, 32.208; 95% CI, 2.402-62.014).Conclusions and RelevancePain neuroscience education combined with cognition-targeted motor control training appears to be more effective than current best-evidence physiotherapy for improving pain, symptoms of central sensitization, disability, mental and physical functioning, and pain cognitions in individuals with chronic spinal pain. Significant clinical improvements without detectable changes in brain gray matter morphologic features calls into question the relevance of brain gray matter alterations in this population.Trial Registrationclinicaltrials.gov Identifier: NCT02098005

Central sensitization in breast cancer survivors

The goal of this study was to study central sensitization (CS)‐related symptoms in breast cancer (BC) survivors and to find if there are differences in clinical and functional variables. In this cross‐sectional study, 25 women aged between 32 and 69 years participated. CS pain was measured with the Central Sensitization Inventory (CSI). Forty points was considered the cutoff value. Cancer‐related fatigue (CRF), Quality of life, functional capacity, and handgrip strength (HGS) was assessed. A 60% of BC survivors showed a CSI score from 0 to 40, while the rest 40% of women had a score higher than 40, CSI scores being 38.35 ± 14.54 points in the whole sample. Significant differences were found in functional capacity, CRF and QoL (p &lt; .011). However, there were no differences in HGS (p = .089). This is the first study to report BC survivors CS‐related symptoms. The high CS‐related symptoms group showed differences in some symptoms and functional capacity in this population. Future research including a wider sample and more variables related to pain should be carried out.

Central sensitization is a risk factor for wound complications after primary total knee arthroplasty.

Postoperative wound complication is a significant risk factor for subsequent deep periprosthetic joint infection after total knee arthroplasty (TKA). Central sensitization is an abnormal enhancement of pain mechanism involving the central nervous system. Although psychological disorder is widely considered as a risk factor, the relationship between central sensitization and wound complication is currently unclear. Therefore, the purpose of this study was to investigate whether central sensitization was associated with high wound complication rate after primary TKA. Between January and June 2016, 161 patients undergoing unilateral TKA were prospectively divided into two groups based on central sensitization inventory score of 40 points after excluding cases with known risk factors such as physical comorbidities, health-related behaviors, and psychological disorders. Group 1 consisted of 112 patients (112 knees) whose central sensitization inventory score was < 40 points and group 2 consisted of 49 patients (49 knees) whose central sensitization inventory score was ≥ 40 points. Wound complications were defined as wound dehiscence, suture granuloma, prolonged wound oozing after postoperative day 5, significant hematoma formation, or surgical site infection recorded during the initial 90-day postoperative period. Demographic data, visual analog scale (VAS), central sensitization inventory score, and wound complications were compared between the two groups. Wound complications developed in 3 (2.7%) knees in group 1 and 14 (28.6%) knees in group 2 (p < 0.001). Multivariate logistic regression analysis showed that the odds of postoperative wound complications were increased 15.7 times in patients with central sensitization inventory score ≥ 40 (95% CI 4.1-60.0, p < 0.001). Central sensitization is a risk factor for the development of postoperative wound complication after primary TKA. II.

Convergent validity and clinically relevant categories for the Dutch Central Sensitization Inventory in patients with chronic pain

The Central Sensitization Inventory (CSI) is a diagnostic tool, which assists the clinicians in the identification of signs of central sensitization (CS). Psychosocial factors contribute to the development and maintenance of signs of CS. But the relationship with the CSI is unknown. The aim of this study is to investigate the convergent validity for the Dutch CSI with CSS, depression, anxiety, widespread pain, catastrophizing, and pain intensity. The second aim is to determine clinically relevant categories for the Dutch CSI. In this cross‐sectional study, patients completed multiple questionnaires. Bivariate correlations were calculated and the Kruskal–Wallis one‐way analysis of variance test was used. One‐hundred and ninety‐eighth patients were included. The CSI scores were strongly correlated with depression (rs = .67; p &lt; .01), anxiety (rs = .65; p &lt; .01), and CSS (rs = .51; p &lt; .01). Moderate to strong relationships were found for the Widespread Pain Index (rs = .43; p &lt; .01) and a low relationship with pain intensity (rs = .36; p &lt; .01) and catastrophizing (rs = .39; p &lt; .01). Four clinical relevant categories were identified: low 0–26 points, mild 27–39 points, moderate 40–52 points, and high 53+ points. This study provides a weak to strong association between the total score of the Dutch CSI and psychosocial factors, and presents clinically relevant categories for the Dutch CSI.

Convergent Validity of the Dutch Central Sensitization Inventory: Associations with Psychophysical Pain Measures, Quality of Life, Disability, and Pain Cognitions in Patients with Chronic Spinal Pain.

Symptoms of central sensitization (CS) have been described in patients with chronic spinal pain (CSP). Although a gold standard to diagnose CS is lacking, psychophysical pain measures are often used. The Central Sensitization Inventory (CSI) is proposed as an alternative method and indirect tool for the evaluation of CS symptomatology. The aim of the current study was to evaluate the convergent validity of the CSI by investigating the association with psychophysical pain measures and self-reported measures of current pain intensity, quality of life, disability, and catastrophizing in CSP patients. One hundred sixteen patients with nonspecific CSP were included in the present study. Patients completed the CSI, were subjected to pressure pain thresholds (PPTs) and a conditioned pain modulation (CPM) paradigm, and completed questionnaires for current pain intensity, quality of life, pain disability, and pain catastrophizing. Higher CSI scores were weakly correlated with lower PPTs (-0.276≤r≤-0.237; all P≤0.01) and not with CPM efficacy (r=0.017; P=0.858). Higher CSI scores were moderately correlated with higher current pain intensity (r=0.320; P<0.001), strongly correlated with lower physical (r=-0.617; P<0.001) and emotional (r=-0.635; P<0.001) quality of life, and moderately correlated with higher pain disability (r=0.472; P<0.001) and higher pain catastrophizing (r=0.464; P<0.001). The CSI was weakly associated with PPTs and not with CPM efficacy in CSP patients. Moderate to strong associations were found with current pain intensity, quality of life, disability, and catastrophizing. The current results illustrate that the CSI does not reflect a direct measure of CS, yet is a representation of general distress, possible originating from CS symptoms.

Dimensionality and Reliability of the Central Sensitization Inventory in a Pooled Multicountry Sample

Central sensitization (CS) involves the amplification of neural signaling within the central nervous system, which evokes pain hypersensitivity. The Central Sensitization Inventory (CSI) assesses 25 overlapping health-related symptom dimensions that have been reported to be associated with CS-related disorders. Previous studies have reported satisfactory test-retest reliability and internal consistency, but factor analyses have exhibited conflicting results in different language versions. The purpose of this cross-sectional study was to thoroughly examine the dimensionality and reliability of the CSI, with pooled data from 1,987 individuals, collected in several countries. The principal component analysis suggested that 1 general factor of CS best described the structure. A subsequent confirmatory factor analysis revealed that a bifactor model, which accounted for the covariance among CSI items, with regard to 1 general factor and 4 orthogonal factors, fit the CSI structure better than the unidimensional and the 4-factor models. Additional analyses indicated substantial reliability for the general factor (ie, Cronbach α = .92; ω = .95; and ω hierarchical = .89). Reliability results for the 4 specific factors were considered too low to be used for subscales. The results of this study clearly suggest that only total CSI scores should be used and reported. PerspectiveAs far as we know, this is the first study that has examined the factor structure and reliability of the CSI in a large multicountry sample. The CSI is currently considered the leading self-report measure of CS-related symptoms worldwide.