Highlights
- •Dimensionality and reliability of the Central Sensitization Inventory (CSI) was investigated.
- •After examining 1-factor and 4-factor solutions, a bifactor model was determined to be the best fit.
- •The general “CS-related symptoms“ factor was highly reliable.
- •The 4 specific CSI factors did not show enough reliability to be used as subscales.
- •It is recommended that only total CSI scores be used and reported.
Abstract
Central sensitization (CS) involves the amplification of neural signaling within the
central nervous system, which evokes pain hypersensitivity. The Central Sensitization
Inventory (CSI) assesses 25 overlapping health-related symptom dimensions that have
been reported to be associated with CS-related disorders. Previous studies have reported
satisfactory test-retest reliability and internal consistency, but factor analyses
have exhibited conflicting results in different language versions. The purpose of
this cross-sectional study was to thoroughly examine the dimensionality and reliability
of the CSI, with pooled data from 1,987 individuals, collected in several countries.
The principal component analysis suggested that 1 general factor of CS best described
the structure. A subsequent confirmatory factor analysis revealed that a bifactor
model, which accounted for the covariance among CSI items, with regard to 1 general
factor and 4 orthogonal factors, fit the CSI structure better than the unidimensional
and the 4-factor models. Additional analyses indicated substantial reliability for
the general factor (ie, Cronbach α = .92; ω = .95; and ω hierarchical = .89). Reliability
results for the 4 specific factors were considered too low to be used for subscales.
The results of this study clearly suggest that only total CSI scores should be used
and reported.
Perspective
As far as we know, this is the first study that has examined the factor structure
and reliability of the CSI in a large multicountry sample. The CSI is currently considered
the leading self-report measure of CS-related symptoms worldwide.
Key words
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References
- Psychosocial factors and central sensitivity syndromes.Curr Rheumatol Rev. 2015; 11: 96-108
- The association between clinical characteristics of migraine and brain GABA levels: An exploratory study.J Pain. 2016; 17: 1058-1067
- Weighted least squares estimation with missing data (Technical Report).(Available at:) (Accessed January 12, 2018)
- A note on the multiplying factors for various chi-square approximations.J R Stat Soc Series B. 1954; 16: 196-298
- Central sensitization inventory as a predictor of worse quality of life measures and increased length of stay following spinal fusion.World Neurosurg. 2017; 104: 594-600
- Central sensitization in chronic low back pain: A narrative review.Natl J Integr Res Med. 2016; 7: 114-123
- Content validity and test-retest reliability of the Gujarati version of the central sensitization inventory.Natl J Integr Res Med. 2016; 7: 18-24
- Three concerns with applying a bifactor model as a structure of psychopathology.Clin Psychol Sci. 2017; 5: 184-186
- A tutorial on hierarchically structured constructs.J Pers. 2012; 80: 796-846
- Reliability and Validity Assessment.Sage, Beverly Hills, CA1979
- The central sensitization inventory validated and adapted for a Brazilian population: Psychometric properties and its relationship with brain-derived neurotrophic factor.J Pain Res. 2017; 10: 2109-2122
- Pain sensitivity questionnaire differentiates individuals with shoulder pain who demonstrate widespread sensitivity with quantitative sensory testing.J Pain. 2014; 15: S21
- Discriminating between neuropathic pain and sensory hypersensitivity using the Chronic Pain Questions (CPQ).Postgrad Med. 2017; 129: 22-31
- Cross-cultural adaptation and validity of the Spanish central sensitization inventory.Springerplus. 2016; 5: 1837
- Classical test theory.Med Care. 2006; 44: S50-S59
- An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data.Psychol Methods. 2004; 9: 466-491
- Multi-factor modeling in individual differences research: Some recommendations and suggestions.Pers Individ Dif. 2007; 42: 37-48
- The temporal stability of the bifactor model of comorbidity: An examination of moderated continuity pathways.Compr Psychiatry. 2017; 72: 74-82
- An index of factorial simplicity.Psychometrika. 1974; 39: 31-36
- Influence of centrally mediated symptoms on postoperative pain in osteoarthritis patients undergoing total knee arthroplasty: A prospective observational evaluation.Pain Pract. 2015; 15: E46-E53
- Risk factors predicting the development of widespread pain from chronic back or neck pain.J Pain. 2010; 11: 1320-1328
Knezevic A., Neblett R., Jeremic-Knezevic M., Tomasevic-Todorovic S., Boskovic K., Colovic P., Cuesta-Vargas A.: Cross cultural adaptation and psychometric validation of the Serbian version of the central sensitization inventory (CSI). Pain Pract 2017 Aug 4; [Epub ahead of print].
- The Dutch Central Sensitization Inventory (CSI): Factor analysis, discriminative power, and test-retest reliability.Clin J Pain. 2016; 32: 624-630
- Expanded distribution of pain as a sign of central sensitization in individuals with symptomatic knee osteoarthritis.Phys Ther. 2016; 96: 1196-1207
- Bifactor analysis and construct validity of the HADS: A cross-sectional and longitudinal study in fibromyalgia patients.Psychol Assess. 2014; 26: 395-406
- The development and psychometric validation of the central sensitization inventory.Pain Pract. 2012; 12: 276-285
- The Central Sensitization Inventory (CSI): Establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample.J Pain. 2013; 14: 438-445
- Establishing clinically relevant severity levels for the central sensitization inventory.Pain Pract. 2017; 17: 166-175
- Is the central sensitization inventory (CSI) a useful outcome measure for chronic spinal pain disorder patients in a functional restoration program?.Spine J. 2017; 17: 1819-1829
- Low back pain: Guidelines for the clinical classification of predominant neuropathic, nociceptive, or central sensitization pain.Pain Physician. 2015; 18: E333-E346
- Treatment of central sensitization in patients with ‘unexplained’ chronic pain: An update.Expert Opin Pharmacother. 2014; 15: 1671-1683
- Applying modern pain neuroscience in clinical practice: Criteria for the classification of central sensitization pain.Pain Physician. 2014; 17: 447-457
- Cross cultural adaptation, reliability and validity of the French version of the central sensitization inventory.Man Ther. 2016; 25: e83-e84
- Psychometric evaluation and calibration of health-related quality of life item banks: Plans for the Patient-Reported Outcomes Measurement Information System (PROMIS).Med Care. 2007; 45: S22-S31
- Scoring and modeling psychological measures in the presence of multidimensionality.J Pers Assess. 2013; 95: 129-140
- Does central sensitization help explain idiopathic overactive bladder?.Nat Rev Urol. 2016; 13: 481-491
- Applying bifactor statistical indices in the evaluation of psychological measures.J Pers Assess. 2016; 98: 223-237
- Evaluating bifactor models: Calculating and interpreting statistical indices.Psychol Methods. 2016; 21: 137-150
- Central sensitization in chronic low back pain: A narrative review.J Back Musculoskeletal Rehabil. 2016; 29: 625-633
Scerbo T., Colasurdo J., Dunn S., Unger J., Nijs J., Cook C.: Measurement properties of the central sensitization inventory: A systematic review. Pain Pract 2017 Aug 29; [Epub ahead of print].
- Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures.Methods Psychol Res Online. 2003; 8: 23-74
- A Beginner's Guide to Structural Equation Modeling.3rd ed. Lawrence Erlbaum Associates, Mahwah2010
- Reliability.in: Cooper H. APA Handbook of Research Methods in Psychology: Foundations, Planning, Measures, and Psychometrics. American Psychological Association, Washington, DC2012: 643-660
- Starting at the beginning: An introduction to coefficient alpha and internal consistency.J Pers Assess. 2003; 80: 99-103
- Using Multivariate Statistics.5th ed. Pearson Education, Boston2007
- The value of item response theory in clinical assessment: A review.Assessment. 2011; 18: 291-307
van Wilgen C., Vuijk P., Kregel J., Voogt L., Meeus M., Descheemaker F., Keizer D., Nijs J.: 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 2017 Apr 27; [Epub ahead of print].
- Evidence for central sensitization in chronic whiplash: A systematic literature review.Eur J Pain. 2013; 17: 299-312
- Structural equation models with non-normal variables: Problems and remedies.in: Hoyle R.H. Structural Equation Modeling: Concepts, Issues and Applications. Sage, Newbury Park, CA1995: 56-75
- Clarifying the latent structure and correlates of somatic symptom distress: A bifactor model approach.Psychol Assess. 2016; 28: 109-115
- Central sensitization: Implications for the diagnosis and treatment of pain.Pain. 2011; 152: S2-S15
- Positive and negative relationship between anxiety and depression of patients in pain: A bifactor model analysis.PLoS One. 2012; 7 (e47577)
- Fibromyalgia and overlapping disorders: The unifying concept of central sensitivity syndromes.Semin Arthritis Rheum. 2007; 36: 339-356
- Editorial review: An update on central sensitivity syndromes and the issues of nosology and psychobiology.Curr Rheumatol Rev. 2015; 11: 70-85
- Cronbach's α, Revelle's β, and Mcdonald's ω H : Their relations with each other and two alternative conceptualizations of reliability.Psychometrika. 2005; 70: 123-133
- Central sensitivity syndromes: mounting pathophysiologic evidence to link fibromyalgia with other common chronic pain disorders.Pain Management Nursing. 2011; 12: 15-24
Article info
Publication history
Published online: November 30, 2017
Accepted:
November 9,
2017
Received in revised form:
November 4,
2017
Received:
May 22,
2017
Footnotes
This project was funded in part by the Instituto de Salud Carlos III through the Network for Prevention and Health Promotion in Primary Care (RD16/0007/0012). J.V.L. has a “Miguel Servet” research contract from the Instituto de Salud Carlos III (CP14/00087).
The authors have no conflicts of interest to declare.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
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© 2017 by the American Pain Society
