Psychometric validation of the Polish version of the Central Sensitization Inventory in subjects with chronic spinal pain

Background Central sensitization is an amplification of neuronal signaling within the central nervous system. The Central Sensitization Inventory was introduced in 2012. A Polish version of the CSI (CSI-Pol) was developed in 2019, but it was not psychometrically validated. The aim of this study was to validate the CSI-Pol in a sample of Polish-speaking patients with chronic spinal pain and compare them with a group of healthy control subjects. Methods The CSI-Pol was administered to 151 patients with chronic spinal pain recruited from two centers. It was re-administered 7 days later. The psychometric properties were then evaluated, including test-retest reliability, construct validity, factor structure and internal consistency. We correlated the CSI-Pol with functional scales, depression and social support scales and compared CSI-Pol scores in the clinical subjects with 30 healthy control subjects recruited from medical staff and their families. Results The CSI-Pol demonstrated excellent internal consistency (Cronbach’s α =0,933) and test-retest reliability (Intraclass Correlation Coefficients - ICC =0.96), as well as significant positive associations with other patient-reported scales, including the Neck Disability Index (r = 0.593), Revised Oswestry Low Back Pain Disability Questionnaire (r = 0.422), and other measures of functional and depressive states. An exploratory factor analysis resulted in a 4-factor model. CSI-Pol scores in the clinical sample (35.27 ± 17.25) were significantly higher than the control sample (23.3 ± 8.9). Conclusion The results of this study suggest that the CSI-Pol may be a useful clinical tool for assessing central sensitization related symptoms and guiding appropriate treatment in Polish-speaking patients with spinal pain.

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.

“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.

Validity and reliability of the Turkish version of the central sensitization inventory

Objectives: The aim of this study was to translate the Central Sensitization Inventory (CSI) into the Turkish language, to perform a psychometric validation, and to investigate its reliability in patients with chronic spinal pain with an organic origin, patients with fibromyalgia, and pain-free control individuals. Patients and methods: Between April 2016 and February 2017, the translation of the original English version of the CSI into Turkish was performed using the forward-backward translation method. A total of 100 fibromyalgia patients (6 males, 94 females; mean age: 45.0±8.4 years; range, 25 to 60 years), 100 patients with chronic spinal pain with an identified organic origin (CSPO), (10 males, 90 females; mean age: 43.8±9.7 years; range, 21 to 60 years), and 100 healthy controls (8 males, 92 females; mean age: 35.8±10.1 years; range, 25 to 55 years) were included in the study. Demographic characteristics were collected. Test-retest reliability was determined by re-administering the CSI-Turkish (CSI-Turk) two weeks after the first application. Results: The internal consistency (Cronbach's alpha) was found to be 0.92 and the intraclass correlation coefficient was 0.93. Patients with fibromyalgia, a very common central sensitivity syndrome (CSS), had the highest mean CSI-Turk scores, and healthy controls had the lowest. Using the recommended cut-off score of 40 resulted in 87% sensitivity and 90% specificity in distinguishing between fibromyalgia and control individuals. Conclusion: This study suggests that the CSI-Turk can be effectively used as a screening tool to elucidate CS-related symptomology among patients with chronic pain with a high internal consistency, test-retest reliability, sensitivity, and specificity.

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.