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

Correlations of The Central Sensitization Inventory, conditioned pain modulation, cognitions and psychological factors in individuals with chronic neck pain: A cross-sectional study

INTRODUCTION

Chronic neck pain (CNP) is a global public health problem, with high prevalence and absenteeism rates. Central sensitization (CS) as a basis for chronic pain may play an essential role in its development and progression. It is often comorbid with low conditioned pain modulation (CPM) effects, cognitions, and psychological problems.

OBJECTIVES

The purposes of this study were to (1) explore the relationship between pain-related cognitions and psychological factors, CPM effects, and the central sensitization inventory (CSI) scores; and (2) determine whether cognitions and psychological factors can predict CSI scores and CPM effects in individuals with CNP.

METHODS

Fifty-four individuals with CNP were recruited for this cross-sectional study. The following outcome measures were evaluated: The CSI (screening tool) was compared with the cold pressor test (CPT), which was the psychophysical test used to assess the CPM; neck pain intensity using the visual analogue scale (VAS), as well as pain-related cognitions (including kinesiophobia and pain catastrophization) and psychological states (including anxiety and depression) using self-report questionnaires.

RESULTS

CSI score was not associated with the CPM effect (r = 0.257, p > 0.05), and no cognitions or psychological factors were associated with CPM (p > 0.05), but CSI score was moderately positively correlated with kinesiophobia (r = 0.554, p < 0.01), lowly positively correlated with pain catastrophization (r = 0.332, p = 0.017) and anxiety (r = 0.492, p < 0.01), but not depression (r = 0.207, p = 0.132). Multiple linear regression analysis showed that kinesiophobia (B = 1.308, p < 0.01) and anxiety (B = 1.806, p = 0.02) were significant positive predictors of CSI score.

CONCLUSIONS

The findings confirm some of our hypotheses. Accordingly, the findings inferred that the CSI does not seem to respond to CPM effect in patients with CNP effectively. In addition, CSI score was associated with cognitions and psychological factors, of which kinesiophobia and anxiety were effective predictors. In clinical practice, pain-related cognitions and psychological factors should be fully considered to manage neck pain efficiently.

Establishing central sensitization inventory cut-off values in Dutch-speaking patients with chronic low back pain by unsupervised machine learning

BACKGROUND

Human Assumed Central Sensitization (HACS) is involved in the development and maintenance of chronic low back pain (CLBP). The Central Sensitization Inventory (CSI) was developed to evaluate the presence of HACS, with a cut-off value of 40/100. However, various factors including pain conditions (e.g., CLBP), contexts, and gender may influence this cut-off value. Unsupervised clustering approaches can address these complexities by considering diverse factors and exploring possible HACS-related subgroups. Therefore, this study aimed to determine the cut-off values for a Dutch-speaking population with CLBP based on unsupervised machine learning.

METHODS

Questionnaire data covering pain, physical, and psychological aspects were collected from patients with CLBP and aged-matched healthy controls (HC). Four clustering approaches were applied to identify HACS-related subgroups based on the questionnaire data and gender. The clustering performance was assessed using internal and external indicators. Subsequently, receiver operating characteristic (ROC) analysis was conducted on the best clustering results to determine the optimal cut-off values.

RESULTS

The study included 63 HCs and 88 patients with CLBP. Hierarchical clustering yielded the best results, identifying three clusters: healthy group, CLBP with low HACS level, and CLBP with high HACS level groups. The cut-off value for the overall groups were 35 (sensitivity 0.76, specificity 0.76).

CONCLUSION

This study found distinct patient subgroups. An overall CSI cut-off value of 35 was suggested. This study may provide new insights into identifying HACS-related patterns and contributes to establishing accurate cut-off values.

Is the Central Sensitization Inventory (CSI) associated with quantitative sensory testing (QST)? A systematic review and meta-analysis

Central sensitization (CS) involves an amplification of neural processing within the central nervous system that can result in widespread pain patterns and hypersensitivity to stimuli. The Central Sensitization Inventory (CSI) and various quantitative sensory testing (QST) methods purport to assess clinical markers of CS. The purpose of this systematic review and meta-analysis was to summarize and quantify the associations between total CSI scores and QST measures from previous studies. A systematic search identified 39 unique studies that were deemed eligible for the systematic review and 33 studies for meta-analyses (with 3314 subjects and 154 effect sizes), including five QST modalities: conditioned pain modulation, temporal summation, pressure pain threshold, heat pain threshold, and cold pain threshold. The meta-analysis yielded statistically significant CSI-QST correlations in total subject samples for all five QST modalities. The strongest associations were identified between CSI scores and pain threshold testing, especially pressure pain threshold, in which 51% of effects sizes, from 29 studies and 3071 subjects, were determined to be in a medium to large range.

Exploring Interactions Between Sex, Pain Characteristics, Disability, and Quality of Life in People With Chronic Spinal Pain: A Structural Equation Model

In people with nonspecific chronic spinal pain (nCSP), disability and quality of life are associated with clinical, cognitive, psychophysical, and demographic variables. However, evidence regarding the interactions between these variables is only limited to this population. Therefore, this study aims to explore path models explaining the multivariate contributions of such variables to disability and quality of life in people with nCSP. This secondary analysis uses baseline data from a randomized controlled trial including 120 participants with nCSP. Structural equation modeling was used to explore path models for the Pain Disability Index (PDI), the Short Form 36-item physical (SF-36 PC), and mental (SF-36 MC) component scores. All models included sex, pain catastrophizing, kinesiophobia, hypervigilance, and pain intensity. Additionally, the PDI and SF-36 PC models included pressure pain thresholds (PPTs) at the dominant pain site (ie, neck or low back). Significant associations were found between sex, pain cognitions, pain intensity, and PPTs. Only pain catastrophizing significantly directly influenced the PDI (P ≤ .001) and SF-36 MC (P = .014), while the direct effects on the SF-36 PC from kinesiophobia (P = .008) and pain intensity (P = .006) were also significant. However, only the combined effect of all pain cognitions on the SF-36 PC was mediated by pain intensity (P = .019). Our findings indicate that patients' pain-related cognitions have an adverse effect on their physical health-related quality of life via a negative influence on their pain intensity in people with nCSP. PERSPECTIVE: This secondary analysis details a network analysis confirming significant interactions between sex, pain cognitions, pain intensity, and PPTs in relation to disability and health-related quality of life in people with chronic spinal pain. Moreover, its findings establish the importance of pain cognitions and pain intensity for these outcomes. TRIALS REGISTRATION: Clinicaltrials.gov (NCT02098005).

Effectiveness of pain neuroscience education on somatosensory functioning after surgery for breast cancer: A double-blinded randomized controlled trial

Pain is one of the most prevalent and long-term adverse effects described by people who have undergone breast cancer surgery. Non-helpful perceptions and thoughts about pain may contribute to the transition of acute to persistent pain. Adding educational interventions to the current physical therapy program in this population may help to improve or prevent persistent pain. Pain neuroscience education (PNE) is a type of educational intervention that addresses the experience of pain in a broader sense by explaining pain not only from a biomedical perspective, but also from a psychological and social perspective. A double-blinded randomized controlled trial (EduCan trial) investigated whether PNE, in addition to a standard physiotherapy program immediately after surgery for breast cancer, was more effective on somatosensory functioning in the short (4 months postoperatively) and long term (18 months postoperatively), than providing a biomedical explanation for pain. Somatosensory functioning was evaluated using a self-reported questionnaire as well as a comprehensive quantitative sensory testing evaluation. The findings of this study revealed that adding six sessions of PNE to a standard physical therapy program (n = 184) did not result in a significantly different course of somatosensory functioning up to 18 months postoperatively as compared to biomedical pain education. These findings provide an interesting basis for future research into who should receive PNE after surgery for breast cancer (e.g., patient profiling or phenotyping) and how we can tailor it to the individual to increase its effectiveness.

Exercise-Induced Hypoalgesia in Patients with Chronic Whiplash-Associated Disorders: Differences between Subgroups Based on the Central Sensitization Inventory

BACKGROUND

Physical exercise is an important element in the rehabilitation of chronic whiplash-associated disorders, with the physiological process underlying pain reduction called exercise-induced hypoalgesia. In chronic whiplash-associated disorders, exercise-induced hypoalgesia appears impaired, and the research suggests a relationship with symptoms of dysfunctional nociceptive processing, such as central sensitization. This study improves our understanding of exercise-induced hypoalgesia in chronic whiplash-associated disorders by examining the differences between the extent of exercise-induced hypoalgesia in subgroups based on scores on the central sensitization inventory (CSI).

METHODS

Data were collected from 135 participants with chronic whiplash-associated disorders who completed a set of questionnaires. Pain pressure thresholds and temporal summations were assessed before and after a submaximal aerobic bicycle exercise test.

RESULTS

We observed no interaction effect between exercise-induced hypoalgesia and the CSI scores for both pain pressure threshold and temporal summation. No overall statistical effect was measured in the analysis of the effect of time. The pain pressure threshold significantly related to the CSI. The temporal summation showed no correlation.

CONCLUSIONS

During this study, we did not find evidence for a difference in the presence of exercise-induced hypoalgesia when the subgroups were created based on the central sensitization cluster calculator. Limited evidence was found for the influence of CSI scores on the delta pain pressure threshold.

Central sensitization as a predictive factor for the surgical outcome in patients with lumbar spinal stenosis: a multicenter prospective study

PURPOSE

The impact of central sensitization (CS) on neurological symptoms and surgical outcomes in patients with lumbar spinal stenosis (LSS) remains unknown. This study aimed to investigate the influence of preoperative CS on the surgical outcomes of patients with LSS.

METHODS

A total of 197 consecutive patients with LSS (mean age 69.3) who underwent posterior decompression surgery with or without fusion were included in this study. The participants completed the CS inventory (CSI) scores and the following clinical outcome assessments (COAs) preoperatively and 12 months postoperatively: the Japanese Orthopaedic Association (JOA) score for back pain, JOA back pain evaluation questionnaire, and Oswestry Disability Index (ODI). The association between preoperative CSI scores and preoperative and postoperative COAs was analyzed, and postoperative changes were statistically evaluated.

RESULTS

The preoperative CSI score significantly decreased at 12 months postoperatively and was significantly correlated with all COAs preoperatively and 12 months postoperatively. Higher preoperative CSI showed worse postoperative COAs and inferior postoperative improvement rates in the JOA score, VAS score for neurological symptoms, and ODI. Multiple regression analysis demonstrated that preoperative CSI was significantly associated with postoperative low back pain (LBP), mental health, quality of life (QOL), and neurological symptoms at 12 months postoperatively.

CONCLUSIONS

Preoperative CS evaluated by CSI had a significantly worse impact on surgical outcomes, including neurological symptoms, disability, and QOL, especially related to LBP and psychological factors. CSI can be used clinically as a patient-reported measure for predicting postoperative outcomes in patients with LSS.

Association of central sensitization, visceral fat, and surgical outcomes in lumbar spinal stenosis

BACKGROUND

Controversy remains regarding predictors of surgical outcomes for patients with lumbar spinal stenosis (LSS). Pain sensitization may be an underlying mechanism contributing to LSS surgical outcomes. Further, obesity is associated with dissatisfaction and poorer outcomes after surgery for LSS. Therefore, this study aimed to examine the relationship between central sensitization (CS), visceral fat, and surgical outcomes in LSS.

METHODS

Patients with LSS were categorized based on their central sensitization inventory (CSI) scores into low- (CSI < 40) and high- (CSI ≥ 40) CSI subgroups. The participants completed clinical outcome assessments preoperatively and 12 months postoperatively.

RESULTS

Overall, 60 patients were enrolled in the study (28 men, 32 women; mean age: 62.1 ± 2.8 years). The high-CSI group had significantly higher mean low back pain (LBP), leg pain, and leg numbness visual analogue scale (VAS) scores than the low-CSI group (p < 0.01). The high-CSI group had a significantly higher mean visceral fat area than the low-CSI group (p < 0.01). Postoperatively, LBP VAS score was significantly worse in the high-CSI group. Relative to preoperatively, postoperative leg pain and leg numbness improved significantly in both groups.

CONCLUSIONS

We believe that neuro decompression can be effective for LSS surgical outcomes in patients with CS; nonetheless, it should be approached with caution owing to the potential for worsening LBP. Additionally, visceral fat is an important indicator suggesting the involvement of CS.

Impact of central sensitization on pain, disability and psychological distress in patients with knee osteoarthritis and chronic low back pain

BACKGROUND

Central sensitization (CS) is becoming increasingly recognized as a significant factor in many chronic pain conditions, including knee osteoarthritis (KOA) and chronic low back pain (CLBP). Yet it presently remains unclear how strong is the involvement of CS in KOA and CLBP and which factors are involved in CS in these two chronic disabling diseases.

METHODS

This is a cross-sectional study in which included a total of 178 patients with KOA and 118 patients with CLBP. Inclusion criteria for eligible participants for the KOA group were a confirmed diagnosis of KOA according to the American College of Rheumatology criteria, and for the CLBP group a chronic low back pain for more than 3 months. Subjects were excluded if they presented with a diagnosed psychiatric disorder or if they lacked the capacity to provide informed consent, understand study questionnaires or perform physical performance tests. In each group, were assessed; CS-related symptoms using the Central Sentization Inventory (CSI); demographic and clinical characteristics such as disease duration, pain intensity on a visual analog scale, self-reported function using the Lequesne index for KOA patients and the Oswestry Disability index for CLBP patients, and physical performance with the 6 minutes' walk test; as well as psychosocial risk factors using the Patient Health Questionnaire for depression (PHQ-9), the Generalized Anxiety Disorder (GAD-7) and the Pain Catastrophizing Scale (PCS).

RESULTS

CSI scores significantly correlated with pain intensity and disability in KOA and CLBP patients, and were highly correlated with self-reported symptoms of depression, anxiety and pain catastrophizing. Depression significantly predicted the CSI score in both groups.

CONCLUSION

These findings provide further evidence for the impact of CS on pain, function and physical performance in KOA and CLBP patients. Psychosocial symptoms such as pain catastrophizing, anxiety and depression should also be considered as they are also associated with CS.

Psychophysical assessment of pain in adults with moderate and severe haemophilia: A cross-sectional study

BACKGROUND

Joint pain is the hallmark of haemophilia; therefore it seems clinically rather a musculoskeletal than a bleeding disorder. Although joint pain in people with haemophilia (PwH) is a complex and multidimensional problem, pain assessment remains primarily focused on the structural evaluation of their joints. Whereas, only few data are available on the potential implication of psychophysical and psychological factors.

OBJECTIVE

This study aimed to perform a psychophysical pain assessment including quantitative sensory testing (QST) and an evaluation of psychological factors in a large sample of PwH, to get insight into the individuals' pain system.

METHODS

Ninety-nine adults (36.9 ± 13.5 years) with moderate/severe haemophilia A/B and 46 healthy controls filled in self-reported pain and psychological questionnaires and underwent a QST evaluation including static and dynamic tests. Static tests focused on the determination of thermal detection and pain thresholds and mechanical pressure pain thresholds. Dynamic tests evaluated pain facilitation and the efficacy of endogenous pain inhibition. Besides comparing PwH and healthy controls, between-subgroup differences were studied in PwH based on their pain distribution.

RESULTS

The study revealed increased thermal and mechanical pain sensitivity and the presence of unhelpful psychological factors such as anxiety/depression in PwH. Among the subgroups, especially PwH with widespread pain showed altered somatosensory functioning. Enhanced pain facilitation and impaired efficacy of endogenous pain inhibition in PwH could not be observed.

CONCLUSION

Altered somatosensory functioning and unhelpful psychological factors, appear to play an important role in the pathophysiology of pain in PwH, especially in PwH with widespread pain.

Patients with neuropathic pain from lumbosacral radiculopathy demonstrate similar pressure pain thresholds and conditioned pain modulation to those with fibromyalgia

OBJECTIVE

The purpose of the study was to evaluate pain thresholds, impairment of the endogenous pain modulatory system, and self-reported cognitive-emotional and central sensitization-related symptoms among three subject groups: a rarely studied patient cohort with neuropathic pain from lumbosacral radiculopathy (NPLSR), patients with fibromyalgia (FM) and healthy controls (HC).

METHODS

Patient-reported pain-related symptomology was evaluated with psychometricallyvalidated questionnaires. Pressure pain threshold (PPT), heat pain threshold (HPT), and cold pain threshold (CPT) were assessed in the low back and contralateral forearm. Conditioned pain modulation (CPM) was evaluated with a recently introduced methodology that accounts for a standard error of measurement.

RESULTS

Compared to the HC subjects, the FM and NPLSR subjects had significantly lower pain thresholds and more CPM impairment. No significant differences in PPT and CPM were observed between the FM and NPLSR groups. Significant group differences were found in self-reported symptoms of depression, anxiety, stress, and central sensitization. Self-reported symptom severity increased in a stair-step fashion, with the HC group scoring lowest and FM group scoring highest.

CONCLUSION

The NPLSR group manifested CPM dysfunction and pressure hyperalgesia at similar levels to the FM group, indicating that these two chronic pain syndromes, likely based on different pathophysiological mechanisms, in fact share some common pain processing features. However, though both patient groups demonstrated similarities in pain processing, self-reported cognitive-emotional and central sensitization-related symptom severity was significantly higher in the FM cohort, which distinguished them from the chronic NPLSR cohort.

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.

Do "central sensitization" questionnaires reflect measures of nociceptive sensitization or psychological constructs? A systematic review and meta-analyses

ABSTRACT

Central sensitization (CS) is defined as an increased nociceptive responsiveness due to sensitization of neurons in the central nervous system, usually the result of prolonged nociceptive input or a disease state associated with noxious inputs (eg, polyarthritis). The concept of CS has recently been adopted in clinical assessments of chronic pain, but its diagnosis in humans may now include a wide range of hypervigilant responses. The purpose of this review is to ascertain whether self-report questionnaires linked with CS are associated with enhanced nociceptive responses or whether they measure sensitivity in a broader sense (ie, emotional responses). According to our published, PROSPERO-registered review protocol (CRD42021208731), a predefined search of studies that involve the Central Sensitization Inventory (CSI) or Pain Sensitivity Questionnaire (PSQ), correlated with either nociceptive sensory tests or emotional hypervigilance was conducted on MEDLINE, PsycINFO, and Web of Science. Correlations between the CSI or PSQ with our primary outcomes were extracted and meta-analysed. A review of 66 studies totalling 13,284 participants found that the CSI (but not the PSQ) strongly correlated with psychological constructs: depression, anxiety, stress, pain catastrophising, sleep, and kinesiophobia. The CSI and PSQ showed weak or no correlations with experimental measures of nociceptive sensitivity: pain thresholds, temporal summation, or conditioned pain modulation. The PSQ did, however, correlate strongly with phasic heat and tonic cold pain tests. The studies reviewed did not provide sufficient evidence that self-report measures reflect a canonical understanding of CS. The CSI more closely reflects psychological hypervigilance than increased responsiveness of nociceptive neurons.

High intensity training improves symptoms of central sensitization at six-month follow-up in persons with chronic nonspecific low back pain: Secondary analysis of a randomized controlled trial

BACKGROUND

High intensity training (HIT) improves disability and physical fitness in persons with chronic nonspecific low back pain (CNSLBP). However, it remains unclear if HIT affects pain processing and psychosocial factors.

OBJECTIVE

To evaluate 1) the effects of HIT on symptoms of central sensitization and perceived stress and 2) the relationship of symptoms of central sensitization and perceived stress with therapy success, at six-month follow-up, in persons with CNSLBP.

METHODS

This is a secondary analysis of a previously published randomized controlled trial. Persons with CNSLBP (n = 51, age=43.6y) completed the Central Sensitization Inventory (CSI) and Perceived Stress Scale (PSS) at baseline (PRE) and six months after 12-week of HIT consisting of concurrent exercise therapy (FU). Two groups were formed based on CSI scores (low-CSI/high-CSI). First, linear mixed models were fitted for each outcome, with time and groups as covariates. Multiple comparisons were executed to evaluate group (baseline), time (within-group), and interaction (between-group) effects. Second, correlation and regression analyses were performed to evaluate if baseline and changes in CSI/PSS scores were related to therapy success, operationalized as improvements on disability (Modified Oswestry Disability Index), and pain intensity (Numeric Pain Rating Scale).

RESULTS

Total sample analyses showed a decrease in both CSI and PSS. Within-group analyses showed a decrease of CSI only in the high-CSI group and a decrease of PSS only in the low-CSI group. Between-group analyses showed a pronounced decrease favouring high-CSI (mean difference: 7.9; 95%CI: 2.1, 12.7) and no differences in PSS (mean difference: 0.1; 95%CI: -3.0, 3.2). CSI, but not PSS, was weakly related to therapy success.

CONCLUSION

HIT improves symptoms of central sensitization in persons with CNSLBP. This effect is the largest in persons with clinically relevant baseline CSI scores. HIT also decreases perceived stress.

Mechanisms of chronic pain in inflammatory rheumatism: the role of descending modulation

ABSTRACT

Persistent pain despite satisfactory disease treatment is frequent in rheumatoid arthritis (RA) and spondyloarthritis (Spa) and may result from specific changes in central pain processing. We assessed these mechanisms further by systematically comparing thermal pain thresholds and conditioned pain modulation (CPM) between patients with active RA or Spa and healthy controls. We included 50 patients with RA and 50 patients with Spa and 100 age-matched and sex-matched controls. Heat and cold pain thresholds (HPT-CPT) were measured on the dominant forearm, and CPM was assessed by applying conditioning stimuli (immersion in a cold-water bath) to one foot and the nondominant hand in 2 successive randomized sequences. Descending pain modulation was assessed as the difference in HPTs (in °C) before and after conditioning. Larger HPT differences (ie, a larger CPM effect) reflected more efficient descending inhibition. Potential associations between changes in CPM and clinical data, including disease activity, pain intensity, and psychological and functional variables, were systematically assessed. Heat pain threshold and cold pain threshold were similar in patients and controls. The mean CPM effect was significantly weaker in patients than that in controls for conditioning applied to either the foot (0.25°C ±2.57 vs 2.79°C ±2.31; P < 0.001) or the nondominant hand (0.57°C ±2.74 vs 2.68°C ±2.12; P < 0.001). The smaller CPM effect in patients was correlated with average pain intensity, but not with disease activity or other clinical characteristics, suggesting a significant pathophysiological role for changes in endogenous pain modulation in the mechanisms of chronic pain associated with inflammatory rheumatism.

Association between Experimental Pain Measurements and the Central Sensitization Inventory in Patients at Least 3 Months after COVID-19 Infection: A Cross-Sectional Pilot Study

Fatigue, pain, headache, brain fog, anosmia, ageusia, mood symptoms, and sleep disorders are symptoms commonly experienced by people with post-COVID-19 condition. These symptoms could be considered as manifestations of central sensitization. The aim of this study is to evaluate whether there are indicators of central sensitization by using experimental pain measurements and to determine their association with patient-reported outcome measures (PROMs). A cross-sectional study including 42 patients after COVID-19 infection was conducted. The central sensitization inventory (CSI) was administered as a PROM to evaluate central-sensitization-associated symptoms. Pressure pain thresholds (PPT), temporal summation, and descending nociceptive pain inhibition (CPM) were assessed as experimental pain measurements. The median score on the CSI was 46.5 (Q1-Q3: 33-54). The presence of central-sensitization-associated symptoms was seen in 64.3% of patients based on the CSI (≥40/100 points). A deficient CPM was seen in 12% and 14% of patients when measured at the trapezius and rectus femoris, respectively. A negative correlation between pressure sensitivity on the rectus femoris and the CSI score (r = -0.36, 95%CI -0.13 to -0.65, p = 0.007) was observed. Central-sensitization-associated symptoms were present in up to 64.3% of patients post-COVID-19 infection, based on a PROM, i.e., the CSI. A more objective evaluation of nociceptive processing through experimental pain measurements was less suggestive of indicators of central sensitization. Only a small negative correlation between pressure sensitivity and the CSI was observed, thereby pointing towards the discrepancy between the CSI and experimental pain measurements and presumably the complementary need for both to evaluate potential indicators of central sensitization in this population.

Sensitivity to movement-evoked pain, central sensitivity symptoms, and pro-nociceptive profiles in people with chronic shoulder pain: A parallel-group cross-sectional investigation

OBJECTIVE

To investigate whether sensitivity to movement-evoked pain (SMEP), central sensitivity symptom burden, and quantitative sensory testing (QST) outcomes differ between healthy controls and people with chronic shoulder pain.

METHODS

People with chronic shoulder pain (n = 39) and healthy controls (n = 26) completed validated questionnaires measuring demographic, pain characteristics, psychological factors, social support, sleep quality, central sensitivity inventory (CSI), and physical activity levels. A blinded assessor administered QST measuring pressure pain threshold, temporal summation, conditioned pain modulation, and cold hyperalgesia. All participants performed repeated lifting of weighted canisters and reported severity of pain over successive lifts of the weighted canisters. Between-group differences in the QST, SMEP and CSI scores were investigated. Demographic and psychosocial variables were adjusted in the analyses.

RESULTS

Dynamic mechanical allodynia, mechanical temporal summation, movement-evoked pain scores, SMEP index, and CSI scores were significantly (p ≤ 0.05) higher in the chronic shoulder pain group than in healthy controls. A significant proportion of people with chronic shoulder pain presented with pro-nociceptive profiles and experienced higher pain severity, interference, and disability.

CONCLUSIONS

People with chronic shoulder pain displayed symptoms and signs of central sensitization. Future research should investigate the predictive role of central sensitization on clinical outcomes in shoulder pain.

Cross cultural adaptation, validity, and reliability of Central Sensitization Inventory in Arabic language

PURPOSE

The Central Sensitization Inventory (CSI) is a tool that aid in identifying symptoms associated with nociplastic pain. The aim of this study is to adapt CSI to Arabic language, and to examine its psychometric properties.

METHODS

Adaptation process followed recommended guidelines. Participants with self-reported chronic pain completed a web-based survey. The internal consistency was calculated. Test-retest reliability was examined by allowing 7-9 day gap between two rounds of measurements. Convergent validity was examined by measuring the correlation with Pain Catastrophizing Scale (PCS), EQ-VAS, and EQ-5D-3L. Discriminant validity was examined by testing four priori hypotheses. Factor analysis with principal components extraction was conducted.

RESULTS

CSI-Arabic (CSI-Ar) was successfully produced. Its internal consistency and test-retest reliability were excellent (Cronbach's α = 0.88 and ICC_2,1=0.94). The standard error of measurement and minimal detectable change 95% were 3.45 and 9.57, respectively. CSI total score correlation with PCS, EQ-5D-3L, and EQ-VAS was moderate. The results lend support to the four hypothesis related to discriminant validity. Factor analysis revealed a four-factor structure of CSI-Ar.

CONCLUSIONS

CSI-Ar showed an internal consistency, test-retest reliability, and validity that are comparable to similar studies. The results support the use of CSI-Ar in assessing chronic pain in Arabic-speaking population.Implications for rehabilitationCentral sensitization (CS) mechanisms are thought to contribute to chronic pain.Identifying the presence of CS would personalize management.The Central Sensitization Inventory (CSI) is a valid and reliable tool to aid in identifying symptoms associated with CS.The Arabic version of the CSI is valid and reliable to use in Arabic speaking patients suffering from chronic pain.

The relationship between the Keele STarT back screening tool, the short form of central sensitivity inventory and health-related quality of life in patients with low back pain

INTRODUCTION

It has been reported that the scores of the Keele STarT Back Screening Tool (SBST) and the short form of Central Sensitization Inventory (CSI-9) are associated with Health-Related Quality of Life (HRQoL) in patients with low back pain (LBP). However, it is unclear which screening tool is more associated with HRQoL in patients with LBP.

OBJECTIVE

To identify which SBST and CSI-9 are more related to HRQoL and investigate the association between SBST and CSI-9 scores.

STUDY DESIGN

Cross-sectional study.

METHOD

A multiple regression analysis was conducted to examine the factors associated with the HRQoL using age, pain intensity, disability, SBST score, and CSI-9 score as independent variables. Spearman's rank correlation coefficient was also conducted to determine the association between SBST and CSI-9 score.

RESULTS

Multiple regression analysis revealed that the Oswestry Disability Index (ODI) score (p < 0.01, β = -0.62, VIF = 1.70) and SBST score (p < 0.01, β = -0.32, VIF = 1.86) were significant associated variables. A significant association was found between SBST and CSI-9 scores (p < 0.01, ρ = 0.47).

CONCLUSION

The results showed that in patients with LBP the association of HRQoL with SBST was more substantial than with CSI-9.

Central sensitization and functioning in patients with chronic low back pain: A cross-sectional and longitudinal study

BACKGROUND

Central sensitization (CS) is present in a subgroup of patients with chronic low back pain (CLBP). Studies on the relationship between CS and functioning have limited operationalizations of CS and functioning.

OBJECTIVE

To determine whether CS was related to functioning in patients with CLBP (cross-sectional); and to determine whether changes in CS were related to changes in functioning (longitudinal).

METHODS

An observational prospective cohort study with data collected at baseline and discharge of an interdisciplinary pain rehabilitation program was executed. CS indicators: CS Inventory part A (CSI-A), quantitative sensory testing (QST), root mean square of successive differences of heart-rate variability (RMSSD). Functioning measures: lifting capacity, physical functioning subscale of Rand36 (Rand36-PF), Work Ability Score (WAS), Pain Disability Index (PDI). Main analyses included correlation and multiple regression controlling for confounders; cross-sectional with baseline data and longitudinal with deltas (Δ).

RESULTS

76 patients with primary CLBP participated at baseline and 56 at discharge. Most associations were weak (cross-sectional r𝑝𝑎𝑟𝑡𝑖𝑎𝑙=-0.30-0.24; longitudinal r𝑝𝑎𝑟𝑡𝑖𝑎𝑙=-0.37-0.44). Cross-sectional multiple regression significant associations: mechanical pain threshold-QST and lifting capacity (r𝑝𝑎𝑟𝑡𝑖𝑎𝑙=-0.39), parasympathetic/vagal tone-RMSSD and physical functioning-Rand36-PF (r𝑝𝑎𝑟𝑡𝑖𝑎𝑙= 0.26). Longitudinal multiple regression significant associations: Δ parasympathetic/vagal tone-RMSSD and Δ lifting capacity (r𝑝𝑎𝑟𝑡𝑖𝑎𝑙= 0.48), ΔCSI-A and Δdisability-PDI (r𝑝𝑎𝑟𝑡𝑖𝑎𝑙= 0.36). Cross-sectional and longitudinal final regression models explained 24.0%-58.3% and 13.3%-38.0% of total variance.

CONCLUSION

CS was weakly related to functioning, and decreases in CS were weakly-moderately related to increases in functioning.

Cross-Sectional Comparative Study on Central Sensitization-Psychosocial Associated Comorbidities and Psychological Characteristics in Breast Cancer Survivors with Nociceptive Pain and Pain with Neuropathic Features and without Pain

Simple Summary

Persistent pain after breast cancer treatment is still under research due to its complex and multifactorial underlying pathogenesis, including phycological factors. Further research is needed to elucidate more information about the factors that cause and perpetuate this pain. Thus, this study defined the influence of psychosocial and psychological factors on breast cancer survivors who report pain and those who do not. The psychosocial factors assessed were those that are associated with a central sensitization process, and the psychological factors were pain catastrophizing, fear of movement, anxiety and depression. Hence, the psychosocial symptom clusters were identified related to the clinical features of pain or to not reporting pain, which may encourage health clinicians to establish a customized biopsychosocial model focused on the management of pain-catastrophizing thoughts and fear of movement. Furthermore, anxiety and depression should be detected early by health professionals and referred to psychologists to be managed.

Abstract

The frequency of a high Central Sensitization Inventory (CSI) total score and the prevalence of pain have already been established among breast cancer survivors (BCS). However, the psychological factors’ influence based on the clinical features of pain is still unknown, as well as BCS characteristics with no pain. Thus, our main aim was to evaluate the presence of a high CSI total score in BCS with pain and compare it with BCS without pain and to evaluate the influence of psychosocial factors. A cross-sectional comparative study was designed to compare BCS with nociceptive pain (n = 19), pain with neuropathic features (n = 19) or no pain (n = 19), classified by the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS). CSI, pain catastrophizing, fear of movement, anxiety and depression symptoms were analyzed and compared among the three groups. The CSI total score was higher in both BCS pain groups compared to BCS without pain, but there were no statistical differences between the pain groups. The same observation was made when comparing pain catastrophizing. The neuropathic feature group showed greater levels of fear of movement, anxiety and depression compared to the no pain group. Thus, CS-psychosocial associated comorbidities and pain-catastrophizing thoughts were more prevalent among BCS with pain, regardless of the clinical features of pain. BCS with neuropathic pain features showed greater psychological disturbances.

Convergent Validity of the Central Sensitization Inventory in Women with Fibromyalgia: Association with Clinical, Psychological and Psychophysical Outcomes

BACKGROUND

To assess the relationship between demographic, clinical, psychological, and pressure pain sensitivity outcomes with the central sensitization inventory (CSI) in female with fibromyalgia (FMS).

METHODS

One hundred twenty-six (n=126) females with FMS completed demographic (age, body mass index, height, weight), clinical (pain history, pain intensity at rest and during daily living activities), psychological (depression/anxiety levels) outcomes and widespread pressure pain sensitivity as well as the central sensitization inventory (CSI). After conducting a multivariable correlation analysis to identify the association between variables, a multiple linear regression model was performed to identify CSI predictors.

RESULTS

The CSI was negatively associated with age (r=-0.262) and PPTs (r ranged from -0.221 to -0.372) and positively associated with anxiety (r=0.541), depression (r=0.415), mean intensity (r=0.305), worst pain (r=0.249), and pain during daily living activities (r= 0.398). The stepwise regression analysis revealed that 47.4% of CSI variance in this sample was explained by anxiety levels (27.8%), PPT at greater trochanter (10.5%), age (1.4%), years with pain (4.8%) and pain during daily living activities (2.9%).

CONCLUSION

The current study found that age, pain intensity at rest and pain during daily living activities, anxiety levels, and pressure pain sensitivity are associated with the CSI (associated sensitization symptoms) in women with FMS.

"Convergent validity of the central sensitization inventory and experimental testing of pain sensitivity"

OBJECTIVES

The aim of the current study was to examine the convergent validity of the Central Sensitization Inventory by quantifying the correlation with experimental measures of pain sensitivity and self-reported psycho-social questionnaires, in a low back pain population.

METHODS

All participants were recruited from an outpatient hospital spine care clinic (Spine Centre of Southern Denmark). Participants underwent a standardized experimental pain test protocol and completed the Central Sensitization Inventory (CSI) along with additional self-reported questionnaires to assess psycho-social constructs across different domains. The association between the CSI, experimental pain measures and other self-reported psycho-social questionnaires were analyzed using correlation and contingency tests. ROC-curve analysis was used to determine sensitivity and specificity for CSI.

RESULTS

One hundred sixty-eight (168) participants were included. The CSI was weakly correlated with nine out of 20 variables in the experimental pain test protocol (rho range -0.37 to 0.22). The CSI was more closely correlated with psycho-social factors such as work ability, disability, and symptoms of exhaustion disorder. ROC-analysis identified an optimal cut-point of 44 on CSI (Sn=39.1% Sp=87.4%). The CSI had an area under the ROC curve of 0.656. Fisher's exact test demonstrated a statistically significant association between participants scoring ≥40 on CSI and participants categorized as sensitized by experimental pain tests (p-value=0.03).

CONCLUSIONS

Our findings are consistent with previous studies, indicating that the CSI is related to psycho-social constructs. However, the convergent validity with experimental pain measures is small and probably not clinically meaningful.

The Self-Reported Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and PainDETECT Questionnaires in COVID-19 Survivors with Post-COVID Pain

This study aimed to analyze correlations between Self-Report Leeds Assessment of Neuropathic Symptoms (S-LANSS) and PainDETECT with proxies of sensitization, pain-related, or psychological/cognitive variables in coronavirus disease, 2019 (COVID-19) survivors exhibiting post-COVID pain. Demographic, clinical, psychological, cognitive, sensitization-associated symptoms, and health-related quality of life were collected in 146 survivors with post-COVID pain. The PainDETECT and S-LANSS questionnaires were used for assessing neuropathic pain-related symptoms. Patients were assessed with a mean of 18.8 (SD 1.8) months after hospitalization. Both questionnaires were positively associated with pain intensity (p < 0.05), anxiety (PainDETECT p < 0.05; S-LANSS p < 0.01), sensitization-associated symptoms (p < 0.01), catastrophism (p < 0.01), and kinesiophobia (p < 0.01) and negatively associated with quality of life (PainDETECT p < 0.05; S-LANSS p < 0.01). Depressive levels were associated with S-LANSS (p < 0.05) but not with PainDETECT. The stepwise regression analyses revealed that 47.2% of S-LANSS was explained by PainDETECT (44.6%), post-COVID pain symptoms duration (1.7%), and weight (1.1%), whereas 51.2% of PainDETECT was explained by S-LANSS (44.6%), sensitization-associated symptoms (5.4%), and anxiety levels (1.2%). A good convergent association between S-LANSS and PainDETECT was found. Additionally, S-LANSS was associated with symptom duration and weight whereas PainDETECT was associated with sensitization-associated symptoms and anxiety levels, suggesting that the two questionnaires evaluate different aspects of the neuropathic pain spectrum in post-COVID pain patients.

Determinants of Pain-Induced Disability in German Women with Endometriosis during the COVID-19 Pandemic

(1) Background: The main aim of this research was to examine the factors leading to pain-induced disability by assessing the impact of demographic, endometriosis-specific, pandemic-specific, and mental health factors. (2) Methods: Women with endometriosis who attended online support groups were invited to respond to an online survey during the first wave of the COVID-19 pandemic in Germany. The Pain Disability Index (PDI) was employed to assess disability-related daily functioning. Independent predictors of pain-induced disability were determined using univariate and multivariate logistic regression analyses. (3) Results: The mean PDI score of the study population was 31.61 (SD = 15.82), which was significantly higher (p < 0.001) than that reported in a previously published normative study of the German population. In the present study, a high level of pain-induced disability, as defined by scores equal to or higher than the median of the study population, older age (OR 1.063, 95% CI 1.010−1.120, p = 0.020), dysmenorrhea (OR 1.015, 95% CI 1.005−1.026, p = 0.005), dysuria (OR 1.014; 95% CI 1.001−1.027, p = 0.029), lower back pain (OR 1.018, 95% CI 1.007−1.029, p = 0.001), and impaired mental health (OR 1.271, 95% CI 1.134−1.425, p < 0.001) were found to be independent risk factors. Pandemic-specific factors did not significantly influence the pain-induced disability of the participants in this study. (4) Conclusions: The level of pain-induced disability was significantly higher among the women with endometriosis than among women in the normative German validation study. Our findings identified risk factors for experiencing a high level of pain-induced disability, such as demographic and specific pain characteristics. Pandemic-specific factors did not significantly and independently influence the pain-induced disability during the first wave of the COVID-19 pandemic in Germany. Impaired mental health negatively influenced functioning during daily activities. Thus, women with endometriosis should be managed by a multidisciplinary team of healthcare professionals to prevent negative effects of pain-induced disability on their quality of life.

Differences in Quantitative Sensory Testing Outcomes Between Patients With Low Back Pain in Primary Care and Pain-free Controls

OBJECTIVES

Quantitative Sensory Testing (QST) is used to test somatosensory functioning in on people with chronic LBP in secondary/tertiary health care facilities. Studies using QST-testing on LBP populations in primary care are scarce. Central Sensitization Inventory (CSI) measures central sensitization (CS)-related symptoms and studies investigating the differences between QST-testing and participants with LBP with a positive and negative score on the CSI questionnaire are also rare. This case-control study investigates differences of an extensive QST-measurement between patients with acute, chronic LBP, and pain-free controls (PFCs) in primary care. Secondary aim is to investigate differences of an extensive QST-measurement between "CS" and "no-CS" group.

MATERIALS AND METHODS

Participants with LBP were recruited from November 2016 to October 2019. Demographic and clinical information was collected and a standardized QST protocol was taken. Data analysis involved determining differences between groups.

RESULTS

Data of 100 participants with LBP and 50 PFCs were analyzed. Heat pain thresholds, pressure pain threshold, and conditioned pain modulation local and remote were significantly moderately to relatively strongly affected by acute, chronic LBP and PFCs (P<0.001 to 0.001). Lumbar temporal summation was significantly moderately affected by acute, chronic LBP, and PFCs (P=0.001). Only pressure pain threshold showed significant difference between "CS" and "no-CS" group (P=0.001 to 0.002).

DISCUSSION

Signs of enhanced nociceptive processing and disturbed top-down nociceptive modulation are apparent in people with acute and chronic LBP in primary care. Results indicate existence of central mechanisms in LBP in primary care.

Questionnaire-based somatosensory profiling in breast cancer survivors: are we there yet? Associations between questionnaires and quantitative sensory testing

PURPOSE

Pain and sensory disturbances are common side effects of breast cancer treatment. Differential somatosensory functioning may reflect distinct pathophysiological backgrounds and therapeutic needs. Aim was to examine whether questionnaires evaluating signs and symptoms related to somatosensory functioning correlate sufficiently with quantitative sensory testing (QST) in breast cancer survivors to warrant consideration for somatosensory profiling in clinical practice.

METHODS

One year after breast cancer surgery, 147 women underwent QST and completed following questionnaires: Douleur Neuropathique en 4 questions (DN4), Central Sensitization Inventory, Margolis Pain Diagram and Visual Analog Scales (VAS). Associations between the questionnaires and QST were evaluated using Spearman correlation coefficients (rs).

RESULTS

Significant but weak (rs < 0.30) correlations were found between total DN4 score and QST results at the inner upper arm for detection of sharp stimuli (rs = 0.227), cold stimuli (rs = -0.186), and painful heat stimuli (rs = 0.179), as well as between QST evaluating conditioned pain modulation and the Margolis Pain Diagram on one hand (rs = 0.176) and minimum-maximum pain intensity differences (VAS) on the other (rs = -0.170).

CONCLUSION

Questionnaires evaluating signs and symptoms related to somatosensory functioning are insufficient for somatosensory profiling. Although somatosensory profiling may be valuable in a mechanism-based management, more research on the most appropriate clinical tools is needed.IMPLICATIONS FOR REHABILITATIONClinicians should be able to recognize that patients with persistent pain or sensory disturbances following breast cancer surgery may have a component of altered somatosensory processing as a significant contributor to their complaint in order to address it appropriately.Somatosensory profiling has yet to be implemented into clinical practice.No evidence-based recommendations can be made on the use of self-reported questionnaires to assess somatosensory processing in a breast cancer population based on the findings of this study.It is suggested to combine information on how individuals process and experience somatosensory stimulation with information from the patient interview or questionnaires to consider which biological, psychological and/or social factors may drive or sustain these neurophysiological processes.

Bayesian Linear Regressions Applied to Fibromyalgia Syndrome for Understanding the Complexity of This Disorder

A better understanding of the connection between factors associated with pain sensitivity and related disability in people with fibromyalgia syndrome may assist therapists in optimizing therapeutic programs. The current study applied mathematical modeling to analyze relationships between pain-related, psychological, psychophysical, health-related, and cognitive variables with sensitization symptom and related disability by using Bayesian Linear Regressions (BLR) in women with fibromyalgia syndrome (FMS). The novelty of the present work was to transfer a mathematical background to a complex pain condition with widespread symptoms. Demographic, clinical, psychological, psychophysical, health-related, cognitive, sensory-related, and related-disability variables were collected in 126 women with FMS. The first BLR model revealed that age, pain intensity at rest (mean-worst pain), years with pain (history of pain), and anxiety levels have significant correlations with the presence of sensitization-associated symptoms. The second BLR showed that lower health-related quality of life and higher pain intensity at rest (mean-worst pain) and pain intensity with daily activities were significantly correlated with related disability. These results support an application of mathematical modeling for identifying different interactions between a sensory (i.e., Central Sensitization Score) and a functional (i.e., Fibromyalgia Impact Questionnaire) aspect in women with FMS.

Signs Indicative of Central Sensitization Are Present but Not Associated with the Central Sensitization Inventory in Patients with Focal Nerve Injury

Objective: Carpal tunnel syndrome (CTS) is the most common focal nerve injury. People with CTS may show alterations in central processing of nociceptive information. It remains unclear whether the central sensitization inventory (CSI) is capable of detecting such altered central pain processing. Methods: Thirty healthy volunteers were matched with 30 people with unilateral CTS from the orthopaedic waitlist. Changes to central pain processing were established through psychophysical sensory testing (bilateral pressure pain thresholds (PPT), conditioned pain modulation, temporal summation) and pain distribution on body charts. Patients also completed pain severity and function questionnaires, psychological questionnaires and the CSI. Results: Compared to healthy volunteers, patients with CTS have lower PPTs over the carpal tunnel bilaterally (t = −4.06, p < 0.0001 ipsilateral and t = −4.58, p < 0.0001 contralateral) and reduced conditioned pain modulation efficacy (t = −7.31, p <0.0001) but no differences in temporal summation (t = 0.52, p = 0.60). The CSI was not associated with psychophysical measures or pain distributions indicative of altered central pain processing. However, there was a correlation of the CSI with the Beck Depression Inventory (r = 0.426; p = 0.019). Conclusion: Patients with CTS show signs of altered central pain mechanisms. The CSI seems unsuitable to detect changes in central pain processing but is rather associated with psychological factors in people with focal nerve injuries.

Use of the painDETECT to discriminate musculoskeletal pain phenotypes

Background

Musculoskeletal pain patients present similar pain characteristics regardless of the clinical diagnosis. PainDETECT questionnaire is useful for screening neuropathic-like symptoms in many musculoskeletal conditions. However, no previous studies compared pain phenotypes of patients with musculoskeletal pain using the painDETECT. Therefore, the current study aimed to compare the pain characteristics of patients with musculoskeletal pain classified according to the painDETECT as nociceptive pain, unclear, and neuropathic-like symptoms.

Methods

A cross-sectional study was conducted in 308 participants with musculoskeletal pain. Demographic and clinical characteristics of the participants were examined. Neuropathic-like symptoms, pain intensity, pain area, Central Sensitization-related sign and symptoms, functional limitation, and conditioned pain modulation were assessed in patients with musculoskeletal pain. Independent one-way analysis of variance (ANOVA) was used to test for between-group differences for the outcome measures with continuous variables and Pearson chi-square test verified between-group differences on the efficiency of the conditioned pain modulation.

Results

Participants had a mean age of 52.21 (±15.01) years old and 220 (71.42%) were females. One hundred seventy-three (56.16%) participants present nociceptive pain, 69 (22.40%) unclear, and 66 (21.42%) neuropathic-like symptoms. A one-way ANOVA showed differences for the pain intensity [F (2,305) = 20.097; p < .001], pain area [F (2,305) = 28.525; p < .001], Central Sensitization-related sign and symptoms [F (2,305) = 54.186; p < .001], and functional limitation [F (2,256) = 8.061; p < .001]. However, conditioned pain modulation was similarly impaired among the three groups (X² = 0.333, p = 0.847).

Conclusion

Patients with neuropathic-like symptoms revealed unfavorable pain characteristics compared to their counterparts, including pain intensity, generalized pain, Central Sensitization-related sign and symptoms, and functional limitation.

Characteristics of clusters with contrasting relationships between central sensitization-related symptoms and pain

The central sensitization inventory (CSI) evaluates the central sensitization (CS)-related symptoms associated with increased pain sensitivity. However, the CSI includes items that are not directly related to pain. In this study, 146 patients with pain were classified into subgroups by k-means cluster analysis based on the short form of the central sensitization inventory (CSI9) and pain scores. In addition, inter-group and multiple comparisons were performed to examine the characteristics of each group. As a result of this study, there were three subgroups (clusters 1, 2, and 3) in which the CSI9 and pain intensity were both low, moderate, and high, and one subgroup (cluster 4) in which only CSI9 was high and pain intensity was low. Two subgroups with high CSI9 scores but contrasting pain intensities (clusters 3 and 4) were extracted; the pattern of CS-related symptoms in these two groups was very similar, with no differences in most of the non-pain factors. It is necessary to consider these points when interpreting the clinical condition of a patient with pain when using the assessment of CS-related symptoms.

Biopsychosocial risk factors for pain and pain-related disability 1 year after surgery for breast cancer

PURPOSE

Knowledge regarding risk factors for pain in the long term after surgery for breast cancer may be of great value in preventing this prevalent and debilitating side effect. Despite the biopsychosocial nature of pain, the predictive value of both pre- and postoperative biopsychosocial functioning for long-term pain intensity and pain-related disability has not yet been studied.

METHODS

One hundred sixty-six women planned for unilateral breast cancer surgery were included in this prospective cohort study. Pre- and postoperative outcomes related to pain, psychosocial, and somatosensory functioning (questionnaires and quantitative sensory testing) were evaluated as risk factors for pain intensity (visual analog scale) and pain-related disability (pain disability index) 1 year after surgery for breast cancer. Both bivariable and stepwise linear regression analyses were performed.

RESULTS

The most consistent biopsychosocial risk factors were symptoms related to altered central somatosensory functioning (central sensitization inventory), psychological symptoms, and social support (psychological symptoms and support subscale of McGill Quality of Life Questionnaire). Results also showed that a pre- and postoperative disturbed functioning of the somatosensory nervous system in the surgical area could provide additional information regarding pain intensity or pain-related disability in the long term after surgery for breast cancer.

CONCLUSION

This study revealed several biopsychosocial characteristics that might be used to identify women more vulnerable to have pain and pain-related disability in the long term after surgery for breast cancer, allowing for more effective pain management and prevention.

Central sensitization has major impact on quality of life in patients with axial spondyloarthritis

INTRODUCTION

Persistent pain has large potential impact on quality of life (QoL). During the course of the disease, many patients with axial spondyloarthritis (axSpA) report persistent pain. Central sensitization (CS) may explain part of this chronic pain. However, the role of CS in relation to QoL has been sparsely studied in axSpA. Therefore, our aim was to explore the relationship between CS and QoL in patients with axSpA.

METHODS

Consecutive outpatients from the Groningen Leeuwarden axSpA (GLAS) cohort completed the Central Sensitization Inventory (CSI; range 0-100) and the AS Quality of Life (ASQoL; range 0-18). Multivariable linear regression analysis was used to explore the relationship between CSI and ASQoL scores correcting for potential confounders.

RESULTS

Of the 178 included axSpA patients, mean CSI score was 38.0 ± 14.1 and 45% scored ≥40, which indicates a high probability of CS. Mean ASQoL score was 6.0 ± 5.3 and mean ASDAS_CRP 2.1 ± 1.0. A CSI score ≥40 was significantly associated with higher ASQoL score (mean 9.7 vs. 3.3), higher ASDAS_CRP (mean 2.6 vs. 1.7), female gender (60% vs. 29%) and more often entheseal involvement (61% vs. 26%). In univariable analysis, CSI score explained a large proportion of the variation in ASQoL (B = 0.06, 95%CI: 0.05-0.07; R²=0.46). This association remained significant after correction for ASDAS_CRP, gender, entheseal involvement, comorbidities, symptom duration, smoking status, BMI class and educational level (B = 0.04, 95%CI: 0.03-0.05).

CONCLUSION

CS is strongly related to patient-reported QoL in patients with axSpA independently from other patient- and disease-related aspects.

The Definition, Assessment, and Prevalence of (Human Assumed) Central Sensitisation in Patients with Chronic Low Back Pain: A Systematic Review

Central sensitisation is assumed to be one of the underlying mechanisms for chronic low back pain. Because central sensitisation is not directly assessable in humans, the term 'human assumed central sensitisation' (HACS) is suggested. The objectives were to investigate what definitions for HACS have been used, to evaluate the methods to assess HACS, to assess the validity of those methods, and to estimate the prevalence of HACS. Database search resulted in 34 included studies. Forty different definition references were used to define HACS. This review uncovered twenty quantitative methods to assess HACS, including four questionnaires and sixteen quantitative sensory testing measures. The prevalence of HACS in patients with chronic low back pain was estimated in three studies. The current systematic review highlights that multiple definitions, assessment methods, and prevalence estimates are stated in the literature regarding HACS in patients with chronic low back pain. Most of the assessment methods of HACS are not validated but have been tested for reliability and repeatability. Given the lack of a gold standard to assess HACS, an initial grading system is proposed to standardize clinical and research assessments of HACS in patients with a chronic low back.

Can Central Sensitization after injury persist as an autonomous pain generator? - A comprehensive search for evidence

OBJECTIVE

To conduct a comprehensive search for evidence whether Central Sensitization following an injury can act as a persistent autonomous pain generator after the inducing injury has healed.

METHODS

We searched Medline on PubMed and the Cochrane Library, screening 3,572 abstracts, from which 937 full text articles were obtained, with 186 of these discarded as irrelevant to the question being posed. The remaining 751 articles were studied for evidence.

RESULTS

Fourteen publications were judged to provide weak evidence for the hypothesis of central sensitization as a persisting autonomous pain generator, but none addressed the question directly. No strong evidence for the affirmative answer was found.Sixty-two publications were judged to provide weak evidence for a negative answer, and nine judged to provide strong evidence.Unexpectedly, serious weaknesses were discovered in the literature underpinning the validity of the clinical diagnosis of Central Sensitization in man:(i)  Inappropriate extrapolation, in many publications, of laboratory animal data to humans.(ii) Failure to demonstrate the absence of peripheral pain generators which might be perpetuating Central Sensitization.(iii) Many factors now shown to confound what is being measured by quantitative sensory testing, conditioned pain modulation, and Central Sensitization Inventory.

CONCLUSIONS

We found no evidence proving that central sensitization can persist as an autonomous pain generator after the initiating injury has healed.Our review has also shown that the evidential basis for the diagnosis of CS in individual patients is seriously in question.

Tests for central sensitization in general practice: a Delphi study

INTRODUCTION

Central sensitization (CS) may explain the persistence of symptoms in patients with chronic pain and persistent physical symptoms (PPS). There is a need for assessing CS in the consultation room. In a recently published systematic review, we made an inventory of tests for CS. In this study we aimed to assess which tests might have added value, might be feasible and thus be suitable for use in general practice.

METHODS

We conducted a Delphi study consisting of two e-mail rounds to reach consensus among experts in chronic pain and PPS. We invited 40 national and international experts on chronic pain and PPS, 27 agreed to participate. We selected 12 tests from our systematic review and additional searches; panellists added three more tests in the first round. We asked the panellists, both clinicians and researchers, to rate these 15 tests on technical feasibility for use in general practice, added value and to provide an overall judgement for suitability in general practice.

RESULTS

In two rounds the panellists reached consensus on 14 of the 15 tests: three were included, eleven excluded. Included were the Central Sensitization Inventory (CSI), pressure pain thresholds (PPTs) and monofilaments. No consensus was reached on the Sensory Hypersensitivity Scale.

CONCLUSION

In a Delphi study among an international panel of experts, three tests for measuring CS were considered to be suitable for use in general practice: the Central Sensitization Inventory (CSI), pressure pain thresholds (PPTs) and monofilaments.

Exploring multidimensional characteristics in cervicogenic headache: Relations between pain processing, lifestyle, and psychosocial factors

OBJECTIVE

Although multidimensional interventions including physiotherapy, psychology, and education are generally recommended in managing headache, and to prevent chronification, such approach is lacking in cervicogenic headache (CeH). Therefore, exploring CeH within a biopsychosocial framework is deemed an essential first step.

METHODS

Non-randomized cross-sectional design to compare pain processing, lifestyle, and psychosocial characteristics between 18 participants with CeH (CeH group) (40.2 ± 10.9 years) and 18 matched controls (control group) (39.2 ± 13.1 years). Pain processing characteristics included degree of central sensitization (Central Sensitization Inventory), and (extra)-cephalic pressure pain thresholds (kPa/cm²/s). Lifestyle characteristics included sleep quality (Pittsburgh Sleep Quality Index), physical activity, screen time, and sedentary time (hours a week). Psychosocial characteristics included degree of depression, anxiety and stress (Depression Anxiety Stress Scale-21), and quality of life (Headache Impact Test-6).

RESULTS

Pain processing characteristics: More (p = .04) participants in the CeH group showed higher degrees of central sensitization compared to the control group. Lower (p < .05) (extra)-cephalic pressure pain thresholds were revealed in the CeH group compared to the control group for each muscle. Lifestyle and psychosocial characteristics: Compared to the control group, sleep quality and headache-related quality of life were worse (p < .0001) in the CeH group. Severe to extreme stress was experienced by more participants in the CeH group (p = .02). Further, significant relations between pain processing and (1) lifestyle characteristics and (2) psychosocial characteristics were seen in the CeH group.

CONCLUSION

Exploring multidimensional characteristics in CeH exposed relations between pain processing, lifestyle, and psychosocial characteristics. These novel findings fill a gap in the current scientific literature, and highlight the need for outcome research targeting lifestyle and psychosocial factors.

Assessment of Central Sensitization in Breast Cancer Survivors: Convergent Validity and Use of the Central Sensitization Inventory (CSI) and Its Short-Form as a Clustering Tool

The Central Sensitization Inventory (CSI) measurement properties in patients having nonspecific, noncancer pain are well-established. However, studies examining the reliability and validity of either the CSI or the Central Sensitization Inventory short-form version (CSI-9) in breast cancer survivors (BCS) are scarce. The purpose was to evaluate convergent validity and internal consistency of the CSI and CSI-9. Additionally, the relevance of a new cluster calculator using the CSI was explored. The cross-sectional multi-center study included 65 BCS and 37 healthy volunteers. Patients filled out multiple questionnaires assessing pain, number of painful areas, anxiety, depression and quality of life. The relevance of a cluster calculator was explored by known-group comparisons and boxplot description. All hypotheses were formulated before data analysis. The majority of hypotheses on the correlations between the CSI or CSI-9 and other health outcomes were confirmed (22 out of 27). The CSI and CSI-9 have excellent (α = 0.92) and good (α = 0.86) internal consistency, respectively. The CSI cluster calculator might be an interesting tool to use to have a patient's overall condition snapshot. Generally, the study findings support the construct validity and internal consistency of the CSI, which underline the use of this self-reported instrument in BCS. The CSI-9 shows promising results, but should be further evaluated.

Cross-cultural adaptation and validation of the German Central Sensitization Inventory (CSI-GE)

BACKGROUND

The Central Sensitization Inventory (CSI) is a screening tool designed to detect symptoms related to Central Sensitization (CS) and Central Sensitivity Syndromes (CSS) by measuring the degree of related phenomena. The objective of this study was to create a German, culturally-adapted version of the CSI and to test its psychometric properties.

METHODS

A German version of the CSI (CSI-GE) was developed, culturally-adapted, and pretested for comprehensibility. The psychometric properties of the resulting version were validated in a clinical study with chronic pain and pain-free control subjects. To assess retest reliability, the CSI-GE was administered twice to a subgroup of patients. Structural validity was tested using factor analyses. To investigate construct validity a hypotheses testing approach was used, including (1) correlations between the CSI-GE and several other well-established questionnaires as well as (2) an investigation of the CSI-GE discriminative power between different subgroups of participants believed to have different degrees of CS.

RESULTS

The CSI-GE showed excellent reliability, including high test-retest characteristics. Factor analyses confirmed a bi-factor dimensionality as has been determined previously. Analysing construct validity 6 out of 11 hypotheses (55%) were met. CSI-GE scores differentiated between subgroups according to expectations. Correlations between CSI-GE scores and other questionnaires suggested that none of the correlated constructs was identical, but there was overlap with other questionnaires based on symptom load. Several correlations did not fit with our current understanding of CS.

CONCLUSION

The CSI-GE appears to be a reliable tool for measuring CS/CSS-related symptomatology. Whether this implies that the CSI-GE measures the degree of CS within an individual subject remains unknown. The resulting score should be interpreted cautiously until further clarification of the construct.

Health-related quality of life deviations from population norms in patients with lumbar radiculopathy: associations with pain, pain cognitions, and endogenous nociceptive modulation

PURPOSE

The primary goal of this study was to compare the health-related quality of life (HRQoL) of people with lumbar radiculopathy to age- and sex-adjusted population norms. Additionally, it aimed to explore the associations between the HRQoL difference scores and measures related to pain cognitions, pain intensity, and endogenous nociceptive modulation.

METHODS

Using answers from the Short Form 36-item Health Survey and UK population norms, SF-6D difference scores were calculated. A one-sample t test was used to assess the SF-6D difference scores. Univariate and multivariate regression analyses were used to assess the associations between SF-6D difference scores and pain intensity [Visual Analogue Scale (VAS) for back and leg pain], pain cognitions [Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Pain Vigilance and Awareness Questionnaire (PVAQ)], and correlates for endogenous nociceptive modulation using quantitative sensory testing.

RESULTS

One hundred and twenty people with lumbar radiculopathy scheduled for surgery were included in this study. The mean SF-6D difference score of - 0.26 [SD = 0.09] was found to be significantly less than 0 [95%CI: - 0.27 to - 0.24]. Univariate analyses showed a significant influence from PCS, TSK, and PVAQ on the SF-6D difference scores. The final multivariate regression model included PCS and PVAQ, with only PCS maintaining a statistically significant regression coefficient [b = - 0.002; 95% CI: - 0.004 to - 0.001].

CONCLUSION

People diagnosed with lumbar radiculopathy report significantly lower HRQoL scores when compared with age- and sex-adjusted UK norm values. Even though all examined pain cognitions were found to have a significant association, pain catastrophizing showed the most significant relation to the SF-6D difference scores.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov Identifier No. NCT02630732. Date of registration: November 25, 2015.

Disability, burden, and symptoms related to sensitization in migraine patients associate with headache frequency

OBJECTIVES

This observational study aimed to assess the difference in disability, burden, and sensitization between migraine patients with low-frequency headache attack (1-8 headache days/month), high-frequency headache attack (9-14 headache days/months), and patients with chronic migraine (>14 headache days/months).

METHODS

Migraine patients with or without aura were divided into three groups according to headache frequency (low-frequency episodic migraine; high-frequency episodic migraine; chronic migraine). Questionnaires were used to assess the burden of headache, quality of life, phycological burden, and symptoms related to sensitization (estimated by the Central Sensitization Inventory). Differences among migraine groups were assessed using Chi-Quadro test, ANOVA, or Kruskal-Wallis as appropriate.

RESULTS

136 patients were included (68 low-frequency episodic migraine, 45 high-frequency episodic migraine, 23 chronic migraine). Patients with high frequency episodic migraine and chronic migraine differed from patients with low frequency episodic migraine showing a worse burden of headache (p=0.002; p=0.002), worse level of physical (p=0.001; p<0.001) and mental (p=0.002; p=0.001) quality of life, worse level of depression (p=0.008; p=0.003), and increase presence of symptoms related to sensitization (p<0.001; p=0.003). No differences were found in any variables between patients with high-frequency episodic migraine and patients with chronic migraine (p>0.05).

CONCLUSIONS

Patients with high-frequency episodic migraine and chronic migraine could be considered in the same segment of the migraine population, with similar degrees of disability and sensitization related symptoms.

Combination of Pain Location and Pain Duration is Associated with Central Sensitization-Related Symptoms in Patients with Musculoskeletal Disorders: A Cross-Sectional Study

OBJECTIVES

Increased evidence indicates that pain location affects central sensitization (CS)-related symptoms. In addition, pain location and pain duration may be intricately related to CS-related symptoms. However, these factors have been investigated separately. This study aimed to investigate the association between CS-related symptoms and pain location and/or pain duration in patients with musculoskeletal disorders.

METHODS

Six hundred thirty-five participants with musculoskeletal disorders were included in this cross-sectional study. All participants were assessed for pain location, pain duration, central sensitization inventory (CSI), EuroQol-5 dimension, and brief pain inventory. The participants were categorized into 3 groups based on pain location (spinal, limb, and both spinal and limb pain) and into 2 groups based on pain duration (acute and chronic pain).

RESULTS

The interaction between pain location and pain duration were not significant on CSI score (P > 0.05). The odds ratio for higher CSI score (≥ 40) in patients with both spinal and limb pain vs. those with spinal or limb pain was 2.64 (P < 0.01) and that in patients with chronic pain vs. those with acute pain was 1.31 (P = 0.52). In addition, the prevalence of higher CSI scores in the combination of chronic and "both spinal and limb" pain was high (23.1%, adjusted residual = 4.48).

CONCLUSIONS

Pain location independently influenced CSI scores, and the combination of both spinal and limb pain and chronic pain indicated high CSI scores. The combination of pain location and pain duration is an important clue that points to CS-related symptoms.

Cross-cultural adaptation and psychometric validation of the Persian version of the central sensitization inventory

BACKGROUND

The Central Sensitization Inventory (CSI) is a patient-reported tool to assess symptoms associated with central sensitization (CS). It consists of two parts: Part A assesses 25 somatic and emotional CS-related health symptoms, and part B asks if one has previously been diagnosed with a list of 10 Central Sensitivity Syndromes and related conditions.

OBJECTIVES

The aim of this study was to translate and cross-culturally adapt the CSI into Persian and to evaluate its psychometric properties.

DESIGN

Cross-sectional study.

METHOD

After completing the Persian translation, the psychometric properties of the Persian CSI (CSI-Per) were evaluated in 256 patients with chronic pain and 46 healthy subjects.

RESULTS

A confirmatory factor analysis confirmed a 1-factor model suggested in a large recent comprehensive multicountry study. Test-retest reliability (ICC = 0.934; P < 0.001) and the internal consistency (Cronbach's α = 0.87) were both good. After dividing the patient subjects into severity level subgroups, based on CSI-Per total scores, significant associations were found with the Persian version of the pain catastrophizing scale, pain duration, current pain intensity, maximum, minimum and average pain intensity in the past week and average pain intensity in the past month. In addition, total CSI-Per scores differentiated between patients and healthy subjects.

CONCLUSION

The CSI-Per demonstrated good validity and reliability to assess symptoms associated with CS in Persian-speaking patients with chronic pain.

Lack of correlation between central sensitization inventory and psychophysical measures of central sensitization in individuals with painful temporomandibular disorder

OBJECTIVE

To assess the correlation between the Central Sensitization Inventory (CSI) scores and the results of psychophysical tests and psychosocial questionnaires according to the presence of painful temporomandibular disorder (TMD).

DESIGN

It was a cross-sectional study involving 146 participants, aged 20-65 years. Painful TMD was classified using the Research Diagnostic Criteria for Temporomandibular Disorders. CSI was applied to assess "central sensitization-related symptoms", as has been suggested. Wind-up ratio, pressure pain threshold and conditioned pain modulation were used as psychophysical tests to evaluate signs and symptoms of central sensitization. Psychosocial factors were assessed by the presence of non-specific physical symptoms, depressive and anxiety symptoms. The sample was divided into two groups: Control (n = 31); Painful TMD (n = 115). Descriptive statistics characterized the sample. Correlation analysis were performed using Pearson's and Spearman's correlation coefficients (α = 5%).

RESULTS

Of the total sample, 78.8 % presented painful TMD, and the mean (standard deviation) age was 37.4 (±11.5) years. Anxiety symptoms (p = 0.028) and non-specific physical symptoms (p < 0.001) were more frequent in the painful TMD group than in controls. Painful TMD patients presented higher scores of the CSI (p < 0.001) and lower pressure pain thresholds (p ≤ 0.020) compared to controls. CSI scores were significantly correlated with psychosocial measures (p < 0.001) but not with psychophysical tests (p ≥ 0.089).

CONCLUSION

The CSI scores did not correlate with psychophysical measures of central sensitization but were positively correlated with the results of psychosocial questionnaires.

Convergent Validity of the Central Sensitization Inventory in Chronic Whiplash-Associated Disorders; Associations with Quantitative Sensory Testing, Pain Intensity, Fatigue, and Psychosocial Factors

OBJECTIVE

Central sensitization is present in different pain conditions, including chronic whiplash-associated disorders. In the absence of a gold standard method of assessment to determine the presence of central sensitization, quantitative sensory testing is currently understood as an optimal proxy. Laboratory sensory testing is, however, not feasible in clinical practice, and the Central Sensitization Inventory was developed as an alternative. The aim of the current study was to evaluate the convergent validity of the Central Sensitization Inventory in chronic whiplash-associated patients by determining the association between the Central Sensitization Inventory and quantitative sensory testing, pain intensity, fatigue, and psychosocial factors.

METHODS

A total of 125 chronic whiplash-associated patients completed multiple questionnaires and were subjected to pressure pain thresholds and temporal summation.

RESULTS

. The Central Sensitization Inventory showed a strong association with constructs of general psychopathology, anxiety, distress, depression, and somatization in chronic whiplash-associated disorders. Moderate correlations were found with fatigue and intrusive and avoidant phenomena after a variety of traumatic events. No significant association was found between the Central Sensitization Inventory and pressure pain thresholds and temporal summation, nor between the Central Sensitization Inventory and other pain measurements.

CONCLUSIONS

Overall, we found that the Central Sensitization Inventory is better in identifying the psychosocial factors related to central sensitization in chronic whiplash-associated disorders than the central nervous system adaptations. Thus, the convergent validity of the Central Sensitization Inventory appears to be only partially present in chronic whiplash-associated disorders.

Central Sensitivity Is Associated with Poor Recovery of Pain: Prediction, Cluster, and Decision Tree Analyses

The process of pain recovery varies and can include the recovery, maintenance, or worsening of symptoms. Many cases of patients with pain show a tendency of recovering as predicted; however, some do not. The characteristics of cases that do not fit the prediction of pain recovery remain unclear. We performed cluster and decision tree analyses to reveal the characteristics in cases that do not fit the prediction of pain recovery. A total of 43 patients with musculoskeletal pain (nonoperative: 22 patients, operative: 13 patients) and central pain (brain disease: 5 patients, spinal cord disease: 3 patients) were included in this longitudinal study. Central sensitivity syndrome (CSS) outcome measures (Central Sensitisation Inventory), pain intensity-related outcome measures (Short-Form McGill Pain Questionnaire-2 (SFMPQ-2)), and cognitive-emotional outcome measures (Hospital Anxiety and Depression Scale and Pain Catastrophising Scale-4) of all patients were assessed at baseline and after 1-2 months. Regression analysis was used to calculate pain recovery prediction values. A hierarchical cluster analysis based on the predicted change of SFMPQ-2 and the observed change of SFMPQ-2 was used to extract subgroups that fit and those that do not fit pain recovery prediction. To extract the characteristics of subgroups that do not fit the prediction of pain recovery, a decision tree analysis was performed. The level of significance was set at 5%. In the results of cluster analysis, patients were classified into three subgroups. Cluster 1 was characterised by worse pain intensity from baseline, cluster 2 by pain, having recovered less and mildly than the predicted value, and Cluster 3 by a marked recovery of pain. In the results of the decision tree analysis, the CSI change was extracted as an indicator related to the classification of all clusters. Our findings suggest that the poor improvement of CSS is characteristic in cases that do not fit the prediction of pain recovery.

Symptoms of central sensitization in patients with inflammatory bowel diseases: a case-control study examining the role of musculoskeletal pain and psychological factors

OBJECTIVES

Musculoskeletal (MSK) pain is a common complaint in patients with inflammatory bowel diseases (IBD). MSK pain in IBD has previously demonstrated association with symptoms of central sensitization; however it is uncertain whether these symptoms are influenced simply by the presence of MSK pain and/or IBD. Primary aim of this study was to investigate whether symptoms of central sensitization differed across three groups: IBD patients with and without MSK pain and healthy controls. Secondary aim was to investigate between-group differences for measures of somatosensory functioning.

METHODS

Cross-sectional study was performed on adults with IBD. Assessments included: central sensitization inventory (CSI), pressure pain threshold, temporal summation, conditioned pain modulation, perceived stress, affect style, anxiety, depression, and pain catastrophizing. One-way analyses of variance and covariance were used to investigate between-group differences for measures of central sensitization and potential confounding by psychological factors.

RESULTS

Study participants (n=66) were age/gender matched across three study groups. Between-group differences were solely demonstrated for CSI scores [F(2,63)=19.835, p<0.001, r=0.62], with IBD patients with MSK pain demonstrating the highest CSI scores and healthy controls the lowest. After controlling for individual psychological features, post hoc comparisons indicated that CSI scores were significantly different between-groups (p≤0.025) after controlling for most psychological variables, with the exception of perceived stress (p=0.063) and pain catastrophizing (p=0.593).

CONCLUSIONS

IBD patients as a whole demonstrated significantly greater symptoms of central sensitization compared to healthy controls. However, IBD patients with persistent MSK pain demonstrated the greatest symptoms of central sensitization compared to patients without MSK pain and healthy controls. Between-group differences for CSI in IBD patients with MSK were not confounded by psychological features.

IMPLICATIONS

Study results indicate that persistent MSK pain in IBD represents patients with greater central sensitization symptomology. This increased symptomology is suggestive of underlying mechanisms related to central sensitization, highlighting patient potentially at risk for worse pain experiences.

Evaluation of the Central Sensitization Inventory Score in elderly adults with musculoskeletal examination

OBJECTIVES

The present study aimed to conduct an epidemiological survey of Central Sensitization Inventory (CSI) scores in an older adult population and to investigate the association between the CSI scores, age, sex, pain intensity, site of pain, and health-related quality of life (QOL).

METHODS

Participants were 373 Japanese adults aged ≥ 50 years who underwent a health checkup in 2018. We collected demographic data and clinical characteristics along with the CSI scores, QOL questionnaire, site of pain (neck, lower back, upper limb, and lower limb) and pain severity. We performed an epidemiological survey of the CSI scores and investigated the gender difference in CSI scores and the relationship between the CSI scores, site of pain, and QOL.

RESULTS

The prevalence of low back pain was the highest (67.6%). The average CSI score was 14.2 points; 8% of volunteers had a high (> 30) CSI score. The CSI scores among women were significantly higher than those among men (p = .016). The CSI scores had a significantly moderate correlation with the numerical rating scale and QOL scores (all p < .001). Volunteers with neck pain showed the highest CSI scores (average 22.4 points).

CONCLUSIONS

The CSI total score showed sex differences and had a significant correlation with pain severity and QOL.

STUDY DESIGN

Cross-sectional study.

The moderating effects of pain catastrophizing on the relationship between illness perceptions and self-reported signs of central sensitization in patients with persistent pain

Two factors related to the continuation of persistent pain are pain catastrophizing and illness perceptions. Pain neuroscience education is known to positively influence both in patients with persistent pain. As the integration of pain neuroscience education in monodisciplinary physiotherapy treatments is effective, integration in transdisciplinary cognitive-behavioral treatments seems recommendable. When doing so, the moderating effect of pain catastrophizing and perceptions on treatment results have to be examined, as these provide valuable information under which conditions treatment works. A bottom-up retrospective observational study evaluated the changes in clinical outcomes, and relationships between clinical outcomes and cognitive and emotional factors in patients with persistent pain. Multiple regression analysis, PROCESS macro, explored the moderating effects of pain catastrophizing on the relationship between illness perceptions and self-reported symptoms of central sensitization. In total, 78 patients were included in the study. A correlation between pretreatment scores and change scores in illness perceptions and self-reported symptoms of central sensitization following treatment were found (resp. R-sq 0.407, F(10,99) = 0.638, P = 0.000; R-sq 0.361, F(5, 54) = 0.609, P = 0.000; and R-sq 0.314, F(4,55) = 0.560, P = 0.00), however, moderation of pain catastrophizing scores on these correlations was not found. Even though an association between changes in pain catastrophizing and illness perceptions in patients with persistent pain was found, the direction or strength between the changes in illness perceptions and changes in self-reported symptoms of central sensitization was not influenced by pretreatment scores of pain catastrophizing.