Use of the central sensitization inventory (CSI) as a treatment outcome measure for chronic spinal pain disorder patients in a functional restoration program

Publication date: Available online 12 June 2017
Source:The Spine Journal
Author(s): Randy Neblett, Meredith M. Hartzell, Mark Williams, Kelley R. Bevers, Tom G. Mayer, Robert J. Gatchel
Background ContextThe Central Sensitization Inventory (CSI) is a valid and reliable patient-reported instrument designed to identify patients whose presenting symptoms may be related to Central Sensitization (CS). Part A of the CSI measures a full array of 25 somatic and emotional symptoms associated with CS, and Part B asks if patients have previously been diagnosed with one or more specific Central Sensitivity Syndromes (CSSs) and related disorders. The CSI has previously been validated in a group of chronic pain patients who were screened by a trained psychiatrist for specific CSS diagnoses. It is currently unknown if the CSI can be a useful treatment-outcome assessment tool for chronic spinal pain disorder (CSPD) patients who are not screened for comorbid CSSs. It is known, however, that previous studies have identified CS-related symptoms, and comorbid CSSs, in subsets of patients with CSPDs. Studies have also shown that CS-related symptoms can be influenced by cognitive and psychosocial factors, including abuse history in both childhood and adulthood, sleep disturbance, catastrophic and fear-avoidant cognitions, and symptoms of depression and anxiety.PurposeTo evaluate CSI scores, and their associations with other clinically-relevant psychosocial variables, in a cohort of CSPD patients who entered and completed a functional restoration program.Study Design/SettingA retrospective study of prospectively-collected data from a cohort study of CSPD patients who completed the CSI at admission to, and discharge from, an interdisciplinary function restoration program (FRP).Patient SampleA cohort of 763 CSPD patientsOutcome MeasuresClinical interviews evaluated mood disorders and abuse history. A series of self-reported measures evaluated comorbid psychosocial symptoms, including pain intensity, pain-related anxiety, depressive symptoms, somatization symptoms, perceived disability, and sleep disturbance, at FRP admission and discharge.MethodsPatients were grouped into five severity level groups, from Mild-to-Extreme, based on total CSI scores, at FRP admission, and then again at discharge. The FRP included a quantitatively-directed and medically-supervised exercise process, as well as a multimodal psychosocial disability management component.ResultsThe CSI severity groups were strongly associated with Major Depressive Disorder and previous abuse history (p < .01), which are known risk factors for CS-related symptoms and diagnoses. CSI scores were also strongly associated with patient-reported CSS diagnoses on CSI Part B. The percentage of patients who reported a comorbid CSS diagnosis increased in each higher CSI-severity group, from 11% in the Subclinical group, to 56% in the Extreme group. The CSI severity groups were significantly related to other CS-related patient-reported symptoms, including pain intensity, pain-related anxiety, depressive symptoms, somatization symptoms, perceived disability, and sleep disturbance (ps < .001). CSI scores, along with all other psychosocial measures, decreased at treatment discharge.ConclusionsIn the present study, admission CSI scores were highly associated with previous CSS diagnoses, CS-related symptoms, and clinically relevant patient-reported psychosocial variables. All psychosocial variables, as well as scores on the CSI, were significantly improved at FRP discharge. The CSI may be have important clinical utility, as a screener and as a treatment outcome measure, for CSPD patients participating in an interdisciplinary FRP.



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