Skip to content
Accessible Unlicensed Requires Authentication Published online by De Gruyter October 19, 2021

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

Liam Andrén Holm ORCID logo, Casper Glissmann Nim ORCID logo, Henrik Hein Lauridsen ORCID logo, Johanne Brinch Filtenborg ORCID logo and Søren Francis O’Neill ORCID logo

Abstract

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.


Corresponding author: Liam Andrén Holm, Medical Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Østre Hougvej 55, 5500 Middelfart, Denmark, Phone: +45 42487420, E-mail:

Acknowledgments

The authors thank the clinicians and data managers at the Spine Centre of Southern Denmark for assisting in recruitment of participants and data management, and Research Electronic Data Capture, Region of Southern Denmark for their assistance in data management. Furthermore, the authors thank all the translators; Eric Will (EW), Hanne Birgitte Hede Jørgensen (HBHJ), Gilles Ludger Fournier (GLF), as well as authors Henrik Hein Lauridsen (HHL) and Søren O’Neill (SON) for their involvement in the translation process and the cross-cultural adaption of the CSI.

  1. Research funding: At the time of data collection, Liam Holm (LH) was an undergraduate research student at the University of Southern Denmark and funded by the Foundation of Chiropractic Research and Postgraduate Education, Denmark. The conducted research was not preregistered in an institutional registry. Data is available upon reasonable request, contact .

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent and ethical approval: Oral and written consent was obtained in all cases. The study was approved by The Regional Committee on Health Research Ethics for Southern Denmark (ref. number S-20180098).

Appendix

Appendix 1 Overview of tests in experimental pain testing and the psychophysical variables obtained

QST test

Psychophysical variables
Test siteUnit of measurePressure intensityRepeated at intervals
Cuff algometry
Pressure pain thresholdLower legkPaIncreasing, 1 kPa/sNo
Pressure pain toleranceLower legkPaIncreasing, 1 kPa/sNo
Temporal summationLower legΔVAS100% of CPTTNo
Conditioned pain modulationLower legΔCPPT70% of CPTTNo
Weighted pinprick pressure
Pressure pain thresholdParaspinal muscleWeight, gFixed, 4–55 gx3
Pressure pain thresholdDorsum of thenar spaceWeight, gFixed, 4–55 gx3
Pressure algometry
Pressure pain thresholdParaspinal muscle masskPaIncreasing, 50 kPa/sX3
Pressure pain thresholdExtensors of forearmkPaIncreasing, 50 kPa/sx3
Spring-loaded pressure probe
Pressure pain thresholdParaspinal muscle masskgFixed, 1–10 kgx2
Pressure pain thresholdExtensors of forearmkgFixed, 1–10 kgx2
Pressure pain intensityParaspinal muscle massVASSPPT + 2 kgNo
Pressure pain intensityExtensors of forearmVASSPPT + 2 kgNo
Temporal summationParaspinal muscle massΔSPPIlower backSPPT + 1 kgNo
Temporal summationParaspinal muscle massΔSPPI lower backSPPT + 1 kgNo
Cold pressor test
Conditioned pain modulationParaspinal muscle massΔTSCold, 0–2 °CNo
Cold pain intensityHandVASCold, 0–2 °CNo
Time to maximum cold pain intensityHandTime, secCold, 0–2 °CNo
Area under the curveHandAreaCold, 0–2 °CNo

  1. kPa, kilopascal; ΔVAS, difference in VAS after a cuff algometry temporal summation protocol; CPPT, heterotopic pressure pain detection threshold; ΔCPPT, difference in pressure pain detection threshold before and after conditioning stimulus; ΔSPPI, difference in pressure pain intensity before and after a temporal summation protocol; ΔTS, difference in temporal summation before and after a conditioning stimulus in the cold pressor test; SPPT, pressure pain threshold.

Appendix 2 Distribution of experimental pain test variables in the Quantitative Sensory Pain Test protocol

nMedianMeanStandard deviation1st quartile3rd quartileInterquartile range
Cuff algometry
Pressure pain threshold14822.425.411.816.933.316.5
Pressure pain tolerance threshold14852.254.120.438.466.127.6
Pressure pain threshold14825.526.411.916.933.817.0
Pressure pain tolerance threshold14848.650.017.238.059.721.7
Temporal summation1481.11.21.40.22.01.8
Conditioned pain modulation1455.55.812.7−1.613.715.3
Weighted pinprick pressure
Pressure pain threshold1676.05.21.44.56.01.5
Pressure pain threshold1676.05.80.76.06.00.0
Pressure algometry
Pressure pain threshold167440.0452.4219.0282.3607.5325.2
Pressure pain threshold167288.3300.0130.9206.7380.7174.0
Spring-loaded probe
Pressure pain threshold1675.55.62.54.07.53.5
Pressure pain threshold1673.53.71.62.54.52.0
Pressure pain intensity16721.022.319.52.535.032.5
Pressure pain intensity16736.036.321.721.054.033.0
Temporal summation16716.017.518.15.029.024.0
Temporal summation1679.011.915.60.019.019.0
Cold pressor test
Conditioned pain modulation167−4.0−5.616.8−16.54.521.0
Cold pain intensity87.079.423.764.0100.036.0
Time to maximum cold pain intensity49.055.334.724.883.258.5
Area under the curve1673445.03916.12856.61404.06298.04894.0
Quantitative sensory test
Total score1420.50.50.10.40.60.1

Appendix 3 Correlation matrix showing significant correlations between Quantitative Sensory Pain test variables and psycho-social factors:

QST variablesPsycho-social factorsSpearman’s correlation coefficientp-value
SPPIlower backODI0.2170.012
SPPIlower backKEDS0.1920.013
SPPIlower backSocial isolation0.2210.008
SPPIlower backDepression0.2030.009
SPPIforearmODI0.1740.045
SPPIforearmDepression0.1550.045
TCPTWAI-10.1900.014
CCPMSocial isolation−0.1840.043
WPPThandFear-Avoidance−0.1730.025
APPTlower backODI−0.2190.011
APPTlower backKEDS−0.298<0.001
APPTlower backWAI-10.1800.020
APPTlower backDepression−0.1900.014
APPTforearmKEDS−0.1740.025
APPTforearmRisk of persistent pain−0.1670.048
APPTforearmDepression−0.1590.040
SPPTlower backODI−0.2850.001
SPPTlower backKEDS−0.278<0.001
SPPTlower backWAI-10.1880.015
SPPTlower backCatastrophizing−0.1600.039
SPPTlower backDepression−0.1800.020
TS2Risk of persistent pain−0.1790.034
TS2Catastrophizing−0.1690.029
CPMlower backCatastrophizing−0.1600.039

  1. ODI, oswestry disability index; KEDS, karolinska exhaustion disorder scale; WAI-1, work ability index: item one; SPPI, spring-loaded probe pressure pain intensity; TCPT, time to achieve maximum cold pain intensity in the cold pressor test; CCPM, cuff algometry conditioned pain modulation; WPPT, pinprick pain threshold; APPT, algometry pressure pain threshold; SPPT, spring-loaded probe pressure pain threshold; TS2, temporal summation after cold pressor test; CPMlower back, conditioned pain modulation in the cold pressor test.

Appendix 4 Correlations (Spearman’s Correlation Coefficients) of QST variables and psycho-social factors in the Low- and High-CSI-Score Groups (CSI Cut-off Score=40):

QST variablesPsycho-social factorsSpearman’s correlation coefficientp-value
High CSI group
CPTTnon-dominant legODI0.3960.0370
CPTTnon-dominant legWAI-1−0.3720.0232
CCPMDepression−0.3310.0484
WPPThandWAI-10.3580.0232
TS2Risk of persistent pain−0.4250.0136
Low CSI group
SPPIlower backODI0.2550.0098
SPPIlower backSocial isolation0.1960.0398
SPPIlower backDepression0.1960.0270
SPPIforearmODI0.3050.0018
SPPIforearmAnxiety0.1780.0458
CCPMRisk of persistent pain0.2290.0283
APPTforearmRisk of persistent pain−0.1940.0447
SPPTlower backODI−0.1950.0499
CPMlower backCatastrophizing−0.2050.0207

  1. CPTT, cuff algometry pressure pain tolerance threshold; CCPM, cuff algometry conditioned pain modulation; WPPT, pinprick pain threshold; SPPT, spring-loaded probe pressure pain threshold; TS2, temporal summation after cold pressor test; SPPI, spring-loaded probe pressure pain intensity; APPT, algometry pressure pain threshold; CPMlower back, conditioned pain modulation in the cold pressor test; ODI, oswestry disability index; WAI-1, work ability index: item 1.

QST variablesPsycho-social factorsSpearman’s correlation coefficientp-value
High CSI group
CPTTnon-dominant legKEDS0.4110.0414
CCPMODI0.4720.0478
CCPMKEDS0.4440.0298
WPPThandRisk of persistent pain−0.4820.0171
WPPThandWAI-10.3700.0482
SPPTlower backWAI-10.3740.0459
Low CSI group
SPPIlower backODI0.2350.0131
SPPIlower backSocial isolation0.1930.0358
SPPIlower backDepression0.2070.0147
SPPIforearmODI0.2960.0016
SPPIforearmDepression0.1730.0430
SPPIforearmAnxiety0.1700.0463
CPPTnon-dominant legRisk of persistent pain0.1970.0458
CCPMRisk of persistent pain0.1980.0474
CCPMRisk of persistent pain−0.2340.0181
WPPThandAnxiety−0.1870.0283
APPTforearmRisk of persistent pain−0.2050.0269
APPTforearmAnxiety−0.1740.0415
SPPTlower backODI−0.2170.0221
CPMlower backCatastrophizing−0.2160.0108
QST total scoreDepression0.1900.0394

  1. CPTT, cuff algometry pressure pain tolerance threshold; CCPM, cuff algometry conditioned pain modulation; WPPT, pinprick pain threshold; SPPT, spring-loaded probe pressure pain threshold; SPPI, spring-loaded probe pressure pain intensity; CPPT, cuff algometry pressure pain detection threshold; APPT, algometry pressure pain threshold; CPMlower back, conditioned pain modulation in the cold pressor test; KEDS, karolinska exhaustion disorder scale; ODI, oswestry disability index; WAI-1, work ability index: item 1.

References

1. IASP Terminology. IASP. Available from .Search in Google Scholar

2. Staud, R, Craggs, JG, Robinson, ME, Perlstein, WM, Price, DD. Brain activity related to temporal summation of C-fiber evoked pain. Pain 2007;129:130–42, https://doi.org/10.1016/j.pain.2006.10.010.Search in Google Scholar

3. Meeus, M, Nijs, J. Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome. Clin Rheumatol 2007;26:465–73, https://doi.org/10.1007/s10067-006-0433-9.Search in Google Scholar

4. Meeus, M, Nijs, J, Van de Wauwer, N, Toeback, L, Truijen, S. Diffuse noxious inhibitory control is delayed in chronic fatigue syndrome: an experimental study. Pain 2008;139:439–48, https://doi.org/10.1016/j.pain.2008.05.018.Search in Google Scholar

5. Giesecke, T, Gracely, RH, Grant, MAB, Nachemson, A, Petzke, F, Williams, DA, et al.. Evidence of augmented central pain processing in idiopathic chronic low back pain. Arthritis Rheum 2004;50:613–23, https://doi.org/10.1002/art.20063.Search in Google Scholar

6. O’Neill, S, Manniche, C, Graven-Nielsen, T, Arendt-Nielsen, L. Generalized deep-tissue hyperalgesia in patients with chronic low-back pain. Eur J Pain Lond Engl 2007;11:415–20, https://doi.org/10.1016/j.ejpain.2006.05.009.Search in Google Scholar

7. Laursen, BS, Bajaj, P, Olesen, AS, Delmar, C, Arendt-Nielsen, L. Health related quality of life and quantitative pain measurement in females with chronic non-malignant pain. Eur J Pain Lond Engl 2005;9:267–75, https://doi.org/10.1016/j.ejpain.2004.07.003.Search in Google Scholar

8. Imamura, M, Chen, J, Matsubayashi, SR, Targino, RA, Alfieri, FM, Bueno, DK, et al.. Changes in pressure pain threshold in patients with chronic nonspecific low back pain. Spine 2013;38:2098–107, https://doi.org/10.1097/01.brs.0000435027.50317.d7.Search in Google Scholar

9. Woolf, CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain 2011;152:S2–15, https://doi.org/10.1016/j.pain.2010.09.030.Search in Google Scholar

10. Mücke, M, Cuhls, H, Radbruch, L, Baron, R, Maier, C, Tölle, T, et al.. Quantitative sensory testing. Schmerz 2014;28:635–48. .Search in Google Scholar

11. Arendt-Nielsen, L, Yarnitsky, D. Experimental and clinical applications of quantitative sensory testing applied to skin, muscles and viscera. J Pain 2009;10:556–72, https://doi.org/10.1016/j.jpain.2009.02.002.Search in Google Scholar

12. Arendt-Nielsen, L, Morlion, B, Perrot, S, Dahan, A, Dickenson, A, Kress, HG, et al.. Assessment and manifestation of central sensitisation across different chronic pain conditions. Eur J Pain 2018;22:216–41, https://doi.org/10.1002/ejp.1140.Search in Google Scholar

13. Latremoliere, A, Woolf, CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain 2009;10:895–926, https://doi.org/10.1016/j.jpain.2009.06.012.Search in Google Scholar

14. Lee, YC, Nassikas, NJ, Clauw, DJ. The role of the central nervous system in the generation and maintenance of chronic pain in rheumatoid arthritis, osteoarthritis and fibromyalgia. Arthritis Res Ther 2011;13:211, https://doi.org/10.1186/ar3306.Search in Google Scholar

15. Misha, BM“, Attal, N, Baron, R, Bouhassira, D, Drangholt, M, Dyck, PJ, et al.. Value of quantitative sensory testing in neurological and pain disorders: NeuPSIG consensus. Pain 2013;154:1807–19, https://doi.org/10.1016/j.pain.2013.05.047.Search in Google Scholar

16. Rolke, R, Baron, R, Maier, C, Tölle, TR, Treede, R-D, Beyer, A, et al.. Quantitative sensory testing in the German research network on neuropathic pain (DFNS): standardized protocol and reference values. Pain 2006;123:231–43, https://doi.org/10.1016/j.pain.2006.01.041.Search in Google Scholar

17. Mayer, TG, Neblett, R, Cohen, H, Howard, KJ, Choi, YH, Williams, MJ, et al.. The development and psychometric validation of the central sensitization inventory. Pain Pract. 2012;12:276–85, https://doi.org/10.1111/j.1533-2500.2011.00493.x.Search in Google Scholar

18. Coronado, RA, George, SZ. The central sensitization inventory and pain sensitivity questionnaire: an exploration of construct validity and associations with widespread pain sensitivity among individuals with shoulder pain. Musculoskelet Sci Pract 2018;36:61–7, https://doi.org/10.1016/j.msksp.2018.04.009.Search in Google Scholar

19. Cuesta-Vargas, AI, Neblett, R, Gatchel, RJ, Roldán-Jiménez, C. Cross-cultural adaptation and validity of the Spanish fear-avoidance components scale and clinical implications in primary care. BMC Fam Pract 2020;21:44, https://doi.org/10.1186/s12875-020-01116-x.Search in Google Scholar

20. Gervais-Hupé, J, Pollice, J, Sadi, J, Carlesso, LC. Validity of the central sensitization inventory with measures of sensitization in people with knee osteoarthritis. Clin Rheumatol 2018;37:3125–32, https://doi.org/10.1007/s10067-018-4279-8.Search in Google Scholar

21. Huysmans, E, Ickmans, K, Van Dyck, D, Nijs, J, Gidron, Y, Roussel, N, et al.. Association between symptoms of central sensitization and cognitive behavioral factors in people with chronic nonspecific low back pain: a cross-sectional study. J Manip Physiol Ther 2018;41:92–101, https://doi.org/10.1016/j.jmpt.2017.08.007.Search in Google Scholar

22. van Wilgen, CP, Vuijk, PJ, Kregel, J, Voogt, L, Meeus, M, Descheemaeker, F, et al.. Psychological distress and widespread pain contribute to the variance of the central sensitization inventory: a cross-sectional study in patients with chronic pain. Pain Pract. 2018;18:239–46, https://doi.org/10.1111/papr.12600.Search in Google Scholar

23. Kregel, J, Schumacher, C, Dolphens, M, Malfliet, A, Goubert, D, Lenoir, D, et al.. 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. Pain Pract. 2018;18:777–87, https://doi.org/10.1111/papr.12672.Search in Google Scholar

24. Mibu, A, Nishigami, T, Tanaka, K, Manfuku, M, Yono, S. Difference in the impact of central sensitization on pain-related symptoms between patients with chronic low back pain and knee osteoarthritis. J Pain Res 2019;12:1757–65, https://doi.org/10.2147/jpr.s200723.Search in Google Scholar

25. Zafereo, J, Wang-Price, S, Kandil, E. Quantitative sensory testing discriminates central sensitization inventory scores in participants with chronic musculoskeletal pain: an exploratory study. Pain Pract. 2021;21:547–56, https://doi.org/10.1111/papr.12990.Search in Google Scholar

26. Kent, P, Kongsted, A, Jensen, TS, Albert, HB, Schiøttz-Christensen, B, Manniche, C. SpineData—a Danish clinical registry of people with chronic back pain. Clin Epidemiol 2015;7:369–80, https://doi.org/10.2147/clep.s83830.Search in Google Scholar

27. Neblett, R, Cohen, H, Choi, Y, Hartzell, MM, Williams, M, Mayer, TG, et al.. The Central Sensitization Inventory (CSI): establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. J Pain 2013;14:438–45, https://doi.org/10.1016/j.jpain.2012.11.012.Search in Google Scholar

28. Neblett, R, Hartzell, MM, Cohen, H, Mayer, TG, Williams, M, Choi, Y, et al.. Ability of the central sensitization inventory to identify central sensitivity syndromes in an outpatient chronic pain sample. Clin J Pain 2015;31:323–32, https://doi.org/10.1097/ajp.0000000000000113.Search in Google Scholar

29. Nijs, J, Apeldoorn, A, Hallegraeff, H, Clark, J, Smeets, R, Malfliet, A, et al.. Low back pain: guidelines for the clinical classification of predominant neuropathic, nociceptive, or central sensitization pain. Pain Physician 2015;18:E333–346, https://doi.org/10.36076/ppj.2015/18/e333.Search in Google Scholar

30. Beaton, DE, Bombardier, C, Guillemin, F, Ferraz, MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 2000;25:3186–91, https://doi.org/10.1097/00007632-200012150-00014.Search in Google Scholar

31. Terwee, CB, Prinsen, CAC, Chiarotto, A, Westerman, MJ, Patrick, DL, Alonso, J, et al.. COSMIN methodology for evaluating the content validity of patient-reported outcome measures: a Delphi study. Qual Life Res 2018;27:1159–70. .Search in Google Scholar

32. Cuesta-Vargas, AI, Roldan-Jimenez, C, Neblett, R, Gatchel, RJ. Cross-cultural adaptation and validity of the Spanish central sensitization inventory. SpringerPlus 2016;5:1837, https://doi.org/10.1186/s40064-016-3515-4.Search in Google Scholar

33. Chiarotto, A, Viti, C, Sulli, A, Cutolo, M, Testa, M, Piscitelli, D. Cross-cultural adaptation and validity of the Italian version of the central sensitization inventory. Musculoskelet Sci Pract 2018;37:20–8, https://doi.org/10.1016/j.msksp.2018.06.005.Search in Google Scholar

34. Bilika, P, Neblett, R, Georgoudis, G, Dimitriadis, Z, Fandridis, E, Strimpakos, N, et al.. Cross-cultural adaptation and psychometric properties of the Greek version of the central sensitization inventory. Pain Pract. 2020;20:188–96, https://doi.org/10.1111/papr.12843.Search in Google Scholar

35. Turczyn, P, Kosińska, B, Janikowska-Hołoweńko, D, Malec-Milewska, M, Marszalec, N, Maleszka, P, et al.. Translation and cross-cultural adaptation of the polish central sensitization inventory. Reumatologia 2019;57:129–34, https://doi.org/10.5114/reum.2019.86422.Search in Google Scholar

36. Pitance, L, Piraux, E, Lannoy, B, Meeus, M, Berquin, A, Eeckhout, C, et al.. Cross cultural adaptation, reliability and validity of the French version of the central sensitization inventory. Man Ther 2016;25:e83–4, https://doi.org/10.1016/j.math.2016.05.139.Search in Google Scholar

37. Scerbo, T, Colasurdo, J, Dunn, S, Unger, J, Nijs, J, Cook, C. Measurement properties of the central sensitization inventory: a systematic review. Pain Pract. 2018;18:544–54, https://doi.org/10.1111/papr.12636.Search in Google Scholar

38. Kent, P, Mirkhil, S, Keating, J, Buchbinder, R, Manniche, C, Albert, HB. The concurrent validity of brief screening questions for anxiety, depression, social isolation, catastrophization, and fear of movement in people with low back pain. Clin J Pain 2014;30:479–89, https://doi.org/10.1097/ajp.0000000000000010.Search in Google Scholar

39. Hart, DL, Werneke, MW, George, SZ, Matheson, JW, Wang, Y-C, Cook, KF, et al.. Screening for elevated levels of fear-avoidance beliefs regarding work or physical activities in people receiving outpatient therapy. Phys Ther 2009;89:770–85, https://doi.org/10.2522/ptj.20080227.Search in Google Scholar

40. Hawthorne, G. Measuring social isolation in older adults: development and initial validation of the friendship scale. Soc Indic Res 2006;77:521–48, https://doi.org/10.1007/s11205-005-7746-y.Search in Google Scholar

41. Jensen, MP, Keefe, FJ, Lefebvre, JC, Romano, JM, Turner, JA. One- and two-item measures of pain beliefs and coping strategies. Pain 2003;104:453–69, https://doi.org/10.1016/s0304-3959(03)00076-9.Search in Google Scholar

42. Kroenke, K, Spitzer, RL, Williams, JBW. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 2003;41:1284–92, https://doi.org/10.1097/01.mlr.0000093487.78664.3c.Search in Google Scholar

43. Waddell, G, Newton, M, Henderson, I, Somerville, D, Main, CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 1993;52:157–68, https://doi.org/10.1016/0304-3959(93)90127-b.Search in Google Scholar

44. Fairbank, JC, Pynsent, PB. The oswestry disability index. Spine 2000;25:2940–52. discussion 2952, https://doi.org/10.1097/00007632-200011150-00017.Search in Google Scholar

45. Besèr, A, Sorjonen, K, Wahlberg, K, Peterson, U, Nygren, A, Asberg, M. Construction and evaluation of a self rating scale for stress-induced exhaustion disorder, the Karolinska Exhaustion Disorder Scale. Scand J Psychol 2014;55:72–82, https://doi.org/10.1111/sjop.12088.Search in Google Scholar

46. Ebener, M, Hasselhorn, HM. Validation of short measures of work ability for research and employee surveys. Int J Environ Res Public Health 2019;16, https://doi.org/10.3390/ijerph16183386.Search in Google Scholar

47. Graven-Nielsen, T, Vaegter, HB, Finocchietti, S, Handberg, G, Arendt-Nielsen, L. Assessment of musculoskeletal pain sensitivity and temporal summation by cuff pressure algometry: a reliability study. Pain 2015;156:2193–202, https://doi.org/10.1097/j.pain.0000000000000294.Search in Google Scholar

48. Larsen, JB, Madeleine, P, Arendt-Nielsen, L. Development of a new bed-side-test assessing conditioned pain modulation: a test-retest reliability study. Scand J Pain 2019;19:565–74, https://doi.org/10.1515/sjpain-2018-0353.Search in Google Scholar

49. O’Neill, S, O’Neill, L. Improving QST reliability--more raters, tests, or occasions? A multivariate generalizability study. J Pain 2015;16:454–62.Search in Google Scholar

50. Vaegter, HB, Petersen, KK, Mørch, CD, Imai, Y, Arendt-Nielsen, L. Assessment of CPM reliability: quantification of the within-subject reliability of 10 different protocols. Scand J Pain 2018;18:729–37, https://doi.org/10.1515/sjpain-2018-0087.Search in Google Scholar

51. O’Neill, S, Manniche, C, Graven-Nielsen, T, Arendt-Nielsen, L. Association between a composite score of pain sensitivity and clinical parameters in low-back pain. Clin J Pain 2014;30:831–8, https://doi.org/10.1097/AJP.0000000000000042.Search in Google Scholar

52. Cohen, J. Statistical power analysis for the behavioral sciences. Hillsdale, N.J.: L. Erlbaum Associates; 1988.Search in Google Scholar

53. Kregel, J, Vuijk, PJ, Descheemaeker, F, Keizer, D, van der Noord, R, Nijs, J, et al.. The Dutch central sensitization inventory (CSI): factor Analysis, discriminative power, and test-retest reliability. Clin J Pain 2016;32:624–30, https://doi.org/10.1097/ajp.0000000000000306.Search in Google Scholar

54. Farrar, JT, Portenoy, RK, Berlin, JA, Kinman, JL, Strom, BL. Defining the clinically important difference in pain outcome measures. Pain 2000;88:287–94, https://doi.org/10.1016/s0304-3959(00)00339-0.Search in Google Scholar

55. Roussel, NA, Nijs, J, Meeus, M, Mylius, V, Fayt, C, Oostendorp, R. Central sensitization and altered central pain processing in chronic low back pain: fact or myth? Clin J Pain 2013;29:625–38, https://doi.org/10.1097/ajp.0b013e31826f9a71.Search in Google Scholar

56. Neblett, R. The central sensitization inventory: a user’s manual. J Appl Biobehav Res 2018;23, https://doi.org/10.1111/jabr.12123.Search in Google Scholar

57. Neziri, AY, Curatolo, M, Nüesch, E, Scaramozzino, P, Andersen, OK, Arendt-Nielsen, L, et al.. Factor analysis of responses to thermal, electrical, and mechanical painful stimuli supports the importance of multi-modal pain assessment. Pain. 2011;152:1146–55, https://doi.org/10.1016/j.pain.2011.01.047.Search in Google Scholar

58. Gwilym, SE, Keltner, JR, Warnaby, CE, Carr, AJ, Chizh, B, Chessell, I, et al.. Psychophysical and functional imaging evidence supporting the presence of central sensitization in a cohort of osteoarthritis patients. Arthritis Rheum 2009;61:1226–34, https://doi.org/10.1002/art.24837.Search in Google Scholar

59. Kleinböhl, D, Hölzl, R, Möltner, A, Rommel, C, Weber, C, Osswald, PM. Psychophysical measures of sensitization to tonic heat discriminate chronic pain patients. Pain 1999;81:35–43, https://doi.org/10.1016/s0304-3959(98)00266-8.Search in Google Scholar

60. Arendt-Nielsen, L, Larsen, JB, Rasmussen, S, Krogh, M, Borg, L, Madeleine, P. A novel clinical applicable bed-side tool for assessing conditioning pain modulation: proof-of-concept. Scand J Pain 2020;20:801–7, https://doi.org/10.1515/sjpain-2020-0033.Search in Google Scholar

Received: 2021-05-25
Accepted: 2021-09-21
Published Online: 2021-10-19

© 2021 Walter de Gruyter GmbH, Berlin/Boston