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2022 Dec 06


Do “Central Sensitisation” Questionnaires Reflect Measures of Nociceptive Sensitisation or Psychological Constructs? a Systematic Review and Meta-Analyses.


Adams GR, Gandhi W, Harrison R, van Reekum CM, Wood-Anderson D, Gilron I, Salomons TV
Pain. 2022 Dec 06.
PMID: 36729810.


Central sensitization (CS) is defined as an increased nociceptive responsiveness due to sensitization of neurons in the central nervous system, usually the result of prolonged nociceptive input or a disease state associated with noxious inputs (e.g., polyarthritis). The concept of CS has recently been adopted in clinical assessments of chronic pain, but its diagnosis in humans may now includes a wide range of hypervigilant responses. The purpose of this review is to ascertain whether self-report questionnaires linked with CS are associated with enhanced nociceptive responses, or whether they measure sensitivity in a broader sense (i.e., emotional responses).According to our published, PROSPERO-registered review protocol (CRD42021208731), a predefined search of studies that involve the Central Sensitization Inventory (CSI) and/or Pain Sensitivity Questionnaire (PSQ) correlated with either nociceptive sensory tests or emotional hypervigilance was conducted on MEDLINE, PsychINFO and Web of Science. Correlations between the CSI/PSQ with our primary outcomes were extracted and meta-analysed.A Review of 66 studies totalling 13,284 participants found that the CSI (but not the PSQ) strongly correlated with psychological constructs: Depression, anxiety, stress, pain catastrophising, sleep and kinesiophobia. The CSI and PSQ showed weak/no correlations with experimental measures of nociceptive sensitivity: pain thresholds, temporal summation or conditioned pain modulation. The PSQ did however correlate strongly with phasic heat and tonic cold pain tests.The studies reviewed did not provide sufficient evidence that self-report measures reflect a canonical understanding of CS. The CSI more closely reflects psychological hypervigilance than increased responsiveness of nociceptive neurons.