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

Adams, Greig; Gandhi, Wiebke; Harrison, Richard; Reekum, Carien M. van; Wood-Anderson, Desmond; Gilron, Ian; Salomons, Tim V.

doi:10.1097/j.pain.0000000000002830

Cited by 34 publications

(24 citation statements)

References 145 publications

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“…The correlation found between depressive symptoms and the CSI has been consistently reported in the literature 56,72–75 and may not be surprising, since the CSI explores psychological constructs such as feeling sad or depressed. The association of the CSI with depressive symptoms but not with CPM supports the conclusions obtained in a recent meta‐analysis which suggests that this questionnaire is able to identify psychological vulnerability that is associated with pain but not the presence of CS determined with QST 56 …”

Section: Discussionsupporting

confidence: 62%

“…Part A evaluates a total of 25 symptoms on a 5‐point Likert scale with total score ranging from 0 to 100. Its result has been shown to be more associated with the presence of pain‐related psychological symptoms than with pain sensitivity 56 . It was found to have high reliability and validity (test–retest reliability = 0.82; Cronbach's alpha = 0.88) 57 …”

Section: Methodsmentioning

confidence: 99%

“…The association of the CSI with depressive symptoms but not with CPM supports the conclusions obtained in a recent meta-analysis which suggests that this questionnaire is able to identify psychological vulnerability that is associated with pain but not the presence of CS determined with QST. 56…”

Section: Correlations Between Psychological Factors and Pain Characte...mentioning

confidence: 99%

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Conditioned pain modulation and psychological factors in young adults with recurrent or chronic neck pain

Arribas‐Romano,

Fernández‐Carnero,

González‐Zamorano

et al. 2023

Pain Practice

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BackgroundControversy exists with the presence of alterations in descending pain inhibition mechanisms in patients with non‐specific neck pain (NSNP). The aim of the present study was to evaluate the status of conditioned pain modulation CPM, remote pressure pain thresholds (PPT), and psychological factors in a specific subgroup of patients with NSNP such as young adult students. In addition, possible associations between CPM, psychological factors, and pain characteristics were analyzed.MethodsThirty students with recurrent or chronic NSNP and 30 pain‐free students were included in this cross‐sectional study. The following measures were assessed: CPM, remote PPT, psychological factors (depression, anxiety, pain catastrophizing, and kinesiophobia), pain characteristics (duration, intensity, severity of chronic pain, interference with daily life), and central sensitization inventory (CSI).ResultsNo significant differences were found in the efficacy of CPM between students with chronic or recurrent NSNP and pain‐free students (β coefficient = −0.67; 95% CI = −1.54, 0.20). However, students with pain showed a significantly higher remote PPT (mean difference = −1.94; 95% CI = −2.71, −1.18). and a greater presence of anxious (mean difference = 6; 95% CI = 2, 9) and depressive symptoms (mean difference = 8.57; 95% CI = 3.97, 13.16). In addition, significant moderate or strong correlations were found between CPM and pain intensity (partial r = 0.41), pain catastrophizing and mean pain intensity (r = 0.37), grade (r = 0.50), and interference of pain (r = 0.57), kinesiophobia and disability (r = 0.38), and depression and CSI (r = 0.39).ConclusionsYoung adult students with chronic or recurrent NSNP present remote hyperalgesia and symptoms of depression and anxiety but not dysfunctional CPM.

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Section: Discussionsupporting

confidence: 62%

Section: Methodsmentioning

confidence: 99%

Section: Correlations Between Psychological Factors and Pain Characte...mentioning

confidence: 99%

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Conditioned pain modulation and psychological factors in young adults with recurrent or chronic neck pain

Arribas‐Romano,

Fernández‐Carnero,

González‐Zamorano

et al. 2023

Pain Practice

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“…Previously, higher scores of CSI have shown weak or no associations between objective other measures of nociceptive sensitivity of pain threshold, heat pain threshold, conditioned pain modulation, and temporal summation. 62 The recent high-quality study demonstrated a similar lack of significant HRV findings with pain intensity. 63 Hence, our findings challenge the use of HRV measurements as an objective outcome measurement in future clinical trials related to CMP conditions, because there is only little association with the subjective core outcome measures of pain intensity, disability, and quality of life.…”

Section: Discussionmentioning

confidence: 87%

“…Clinically, this was the most pertinent finding because the associations between subjective central sensitization and HRV had not been studied before. Previously, higher scores of CSI have shown weak or no associations between objective other measures of nociceptive sensitivity of pain threshold, heat pain threshold, conditioned pain modulation, and temporal summation 62 …”

Section: Discussionmentioning

confidence: 98%

To what degree patient‐reported symptoms of central sensitization, kinesiophobia, disability, sleep, and life quality associated with 24‐h heart rate variability and actigraphy measurements?

Mikkonen,

Kupari,

Tarvainen

et al. 2023

Pain Practice

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ObjectivesChronic musculoskeletal pain is associated with decreased parasympathetic and increased sympathetic activity in the autonomic nervous system. The objective of this study was to determine the associations between objective measures of heart rate variability (a measure of autonomic nervous system function), actigraphy (a measure of activity and sleep quality), respiration rates, and subjective patient‐reported outcome measures (PROMs) of central sensitization, kinesiophobia, disability, the effect of pain on sleep, and life quality.MethodsThirty‐eight study subjects were divided into two subgroups, including low symptoms of central sensitization (n = 18) and high symptoms of central sensitization (n = 20), based on patient‐reported scores on the Central Sensitization Inventory (CSI). Heart rate variability (HRV) and actigraphy measurements were carried out simultaneously in 24 h measurement during wakefulness and sleep.ResultsA decrease in HRV during the first 2 h of sleep was stronger in the low CSI subgroup compared to the high CSI subgroup. Otherwise, all other HRV and actigraphy parameters and subjective measures of central sensitization, disability, kinesiophobia, the effect of pain on sleep, and quality of life showed only little associations.DiscussionThe high CSI subgroup reported significantly more severe symptoms of disability, kinesiophobia, sleep, and quality of life compared to the low CSI subgroup. However, there were only small and nonsignificant trend in increased sympathetic nervous system activity and poorer sleep quality on the high central sensitization subgroup. Moreover, very little differences in respiratory rates were found between the groups.

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Central sensitization inventory is associated with psychological functioning but not with psychophysical assessment of pain amplification

Salbego,

Conti,

Soares

et al. 2024

European Journal of Pain

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BackgroundThe central sensitization inventory (CSI) is a questionnaire that has been widely used as a tool for assessing symptoms associated with sensitization. However, its ability to identify individuals with this phenomenon has recently been questioned. The aim of this study was to assess the correlation of CSI with psychosocial and psychophysical factors in patients with painful TMD diagnosed according to diagnostic criteria for temporomandibular disorders (DC/TMD) and asymptomatic controls, as well as to determine the influence of these variables on the CSI scores variations.MethodsThis cross‐sectional study with 77 patients diagnosed with painful TMD according to DC/TMD and 101 asymptomatic controls realized correlations between CSI, WUR, PPT, CPM and psychosocial questionnaires (HADS, PSQI, PCS and PSS). In cases where significant correlations existed, the potential influence of these variables on CSI variation was explored through linear regression analysis.ResultsIt has been found that the CSI correlates with psychosocial variables (anxiety, depression, catastrophizing, sleep and stress) (p < 0.0006) regardless of the presence of TMD, and that 68.9% of the variation in CSI scores can be influenced by all these variables (except stress). On the contrary, the CSI does not correlate with psychophysical parameters indicative of pain amplification (wind‐up ratio and conditioned pain modulation) (p > 0.320).ConclusionCSI is more associated with psychosocial factors than with more robust indicators of probable central sensitization (CS), thus limiting its utility in detecting this phenomenon both in TMD patients and healthy individuals.Significance StatementThe research highlights a noteworthy relationship between the central sensitization inventory and psychological factors, emphasizing their substantial influence on inventory values. This correlation offers crucial insights into mental health markers within the questionnaire. Additionally, the lack of connection with pain amplification implies a necessary re‐evaluation of the inventory's diagnostic suitability, especially in cases of painful temporomandibular disorders. Thus, caution is urged in its application for identifying CS in these individuals.

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

Cited by 34 publications

References 145 publications

Conditioned pain modulation and psychological factors in young adults with recurrent or chronic neck pain

Conditioned pain modulation and psychological factors in young adults with recurrent or chronic neck pain

To what degree patient‐reported symptoms of central sensitization, kinesiophobia, disability, sleep, and life quality associated with 24‐h heart rate variability and actigraphy measurements?

Central sensitization inventory is associated with psychological functioning but not with psychophysical assessment of pain amplification

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