Establishing Clinically Relevant Severity Levels for the Central Sensitization Inventory

Randy Neblett, Meredith M. Hartzell, Tom G. Mayer, Howard Cohen, Robert Joseph Gatchel

Research output: Contribution to journalArticleResearchpeer-review

28 Citations (Scopus)

Abstract

Objectives: The aim of this study was to create and validate severity levels for the central sensitization inventory (CSI), a valid and reliable patient-reported outcome instrument designed to identify patients whose presenting symptoms may be related to a central sensitivity syndrome (CSS; eg, fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome), with a proposed common etiology of central sensitization (CS). Methods: Based on CSI score means and standard deviations from previously published subject samples, the following CSI severity levels were established: subclinical = 0 to 29; mild = 30 to 39; moderate = 40 to 49; severe = 50 to 59; and extreme = 60 to 100. The concurrent validity of the CSI severity levels was then confirmed in a separate chronic pain patient sample (58% with a CSS diagnosis and 42% without) by demonstrating associations between CSI scores and (1) the number of physician-diagnosed CSSs; (2) CSI score distributions in both CSS and non-CSS patient samples; (3) patient-reported history of CSSs; and (4) patient-reported psychosocial measures, which are known to be associated with CSSs. Results: Compared to the non-CSS patient subsample, the score distribution of the CSS patient subsample was skewed toward the higher severity ranges. CSI mean scores moved into higher severity levels as the number of individual CSS diagnoses increased. Patients who scored in the extreme CSI severity level were more likely to report previous diagnoses of fibromyalgia, chronic fatigue syndrome, temporomandibular joint disorder, tension/migraine headaches, and anxiety or panic attacks (P < 0.01). CSI severity levels were also associated with patient-reported depressive symptoms, perceived disability, sleep disturbance, and pain intensity (P ≤ 0.02). Conclusion: This study provides support for these CSI severity levels as a guideline for healthcare providers and researchers in interpreting CSI scores and evaluating treatment responsiveness.

Original languageEnglish
Pages (from-to)166-175
Number of pages10
JournalPain Practice
Volume17
Issue number2
DOIs
StatePublished - 1 Feb 2017

Fingerprint

Central Nervous System Sensitization
Equipment and Supplies
Chronic Fatigue Syndrome
Tension-Type Headache
Temporomandibular Joint Disorders
Irritable Bowel Syndrome
Panic Disorder
Migraine Disorders
Chronic Pain
Health Personnel
Sleep

Keywords

  • central sensitivity syndrome
  • central sensitization
  • central sensitization inventory
  • chronic pain

Cite this

Neblett, R., Hartzell, M. M., Mayer, T. G., Cohen, H., & Gatchel, R. J. (2017). Establishing Clinically Relevant Severity Levels for the Central Sensitization Inventory. Pain Practice, 17(2), 166-175. https://doi.org/10.1111/papr.12440
Neblett, Randy ; Hartzell, Meredith M. ; Mayer, Tom G. ; Cohen, Howard ; Gatchel, Robert Joseph. / Establishing Clinically Relevant Severity Levels for the Central Sensitization Inventory. In: Pain Practice. 2017 ; Vol. 17, No. 2. pp. 166-175.
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abstract = "Objectives: The aim of this study was to create and validate severity levels for the central sensitization inventory (CSI), a valid and reliable patient-reported outcome instrument designed to identify patients whose presenting symptoms may be related to a central sensitivity syndrome (CSS; eg, fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome), with a proposed common etiology of central sensitization (CS). Methods: Based on CSI score means and standard deviations from previously published subject samples, the following CSI severity levels were established: subclinical = 0 to 29; mild = 30 to 39; moderate = 40 to 49; severe = 50 to 59; and extreme = 60 to 100. The concurrent validity of the CSI severity levels was then confirmed in a separate chronic pain patient sample (58{\%} with a CSS diagnosis and 42{\%} without) by demonstrating associations between CSI scores and (1) the number of physician-diagnosed CSSs; (2) CSI score distributions in both CSS and non-CSS patient samples; (3) patient-reported history of CSSs; and (4) patient-reported psychosocial measures, which are known to be associated with CSSs. Results: Compared to the non-CSS patient subsample, the score distribution of the CSS patient subsample was skewed toward the higher severity ranges. CSI mean scores moved into higher severity levels as the number of individual CSS diagnoses increased. Patients who scored in the extreme CSI severity level were more likely to report previous diagnoses of fibromyalgia, chronic fatigue syndrome, temporomandibular joint disorder, tension/migraine headaches, and anxiety or panic attacks (P < 0.01). CSI severity levels were also associated with patient-reported depressive symptoms, perceived disability, sleep disturbance, and pain intensity (P ≤ 0.02). Conclusion: This study provides support for these CSI severity levels as a guideline for healthcare providers and researchers in interpreting CSI scores and evaluating treatment responsiveness.",
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Neblett, R, Hartzell, MM, Mayer, TG, Cohen, H & Gatchel, RJ 2017, 'Establishing Clinically Relevant Severity Levels for the Central Sensitization Inventory', Pain Practice, vol. 17, no. 2, pp. 166-175. https://doi.org/10.1111/papr.12440

Establishing Clinically Relevant Severity Levels for the Central Sensitization Inventory. / Neblett, Randy; Hartzell, Meredith M.; Mayer, Tom G.; Cohen, Howard; Gatchel, Robert Joseph.

In: Pain Practice, Vol. 17, No. 2, 01.02.2017, p. 166-175.

Research output: Contribution to journalArticleResearchpeer-review

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