Lifting capacity is associated with central sensitization and non-organic signs in patients with chronic back pain, 2020, Echieta et al

[Andy]

Purpose: To analyze the associations between lifting capacity, and central sensitization (CS) and non-organic signs (NOS) in patients with chronic back pain (CBP) attending vocational rehabilitation.

Materials and methods: Cross-sectional observational multicenter study among patients with CBP undergoing a return to work assessment within care as usual. Main analyses: step 1: partial correlation between lifting capacity, and CS, NOS, and additional variables; step 2: multiple regression in stepwise forward method for dependent variable lifting capacity, and for independent variables CS and NOS, and additional variables significant (p < 0.05) at step 1. All analyses were controlled for sex.

Results: Fifty-six patients of mean age 42.5 years and 59% women participated in the study. Correlations between lifting capacity and CS and NOS were r = –0.53 and r = –0.50, respectively. CS and NOS, as well as age and sex, contributed significantly to the final regression model, which explained 57.6% of variance.

Conclusions: After controlling for confounders, CS and NOS were negatively associated with lifting capacity in patients with CBP. Explained variance was substantially higher than previously reported studies.

• Implications for Rehabilitation
• The identification of central sensitization and non-organic signs (NOS) in patients with chronic back pain can alert clinicians about central nervous system being in a hypersensitive state and about pain behavior.
  
  
• Central sensitization and NOS are relevant determinants of lifting capacity.
  
  
• Better understanding of the factors affecting lifting capacity lead to better design and tailoring of interventions, resulting in optimized vocational rehabilitation programs and faster return to work.
  

Open access, https://www.tandfonline.com/doi/full/10.1080/09638288.2020.1752318

 

[Hutan]

Central Sensitisation Inventory
A score of 40 or more on this questionnaire:

A 2014 study by Neblett et al found the CSI accurately identified 82.8% of participants as having CSS whereas 54.8% participants were correctly identified as not having CSS.

For goodness sake - if I'm interpreting that statement correctly, the Neblett et al study found that 45% of participants who presumably had some well documented physical reason for their pain were labelled as having central sensitisation syndrome using this CSI Inventory. Does that not give anyone pause for thought before using the CSI?

The authors of the study that is the subject of this thread said this about the CSI:

The Dutch translation of the CSI has shown to reveal four distinguishable domains, good discriminative power, excellent test–retest reliability, and good internal consistency for three out of the four domains

 

[James Morris-Lent]

As we can see from the use of this 'CSI' there is no attempt to scientifically measure 'Central Sensitization'. From looking at the questions I don't see how this questionnaire could distinguish the supposed CSS diseases from many other significant chronic conditions when untreated/having poor treatment options. For instance, someone with untreated or refractory chronic acid reflux could score quite high on this form. People having to take medications despite side effects could score high.

I think all the number can say is that people who score higher are subjectively sicker - in other words a totally degenerate diagnostic tool.


Here is the paper that first presented the CSI. I browsed through it but there isn't too much to say. It's not a BPS dogma paper. It's just pointless in my opinion. It seems that some BPS people simply happen to have found the terminology appealing and have adapted it to fit their own purposes.
Link to the original paper for the CSI

 

[Trish]

That questionnaire is nonsense. How can it 'measure' anything?

I suspect it's a result of backwards logic. Take all your patients who have symptoms that you can't find an organic cause for (MUS). Attribute all those symptoms to and invented concept 'central sensitisation', then list them in a questionnaire and bingo, all the patients you can't diagnose, now have CS.

 

[Wonko]

Finally, a BPS questionnaire that I don't win a meaningless diagnosis with.

I'm not sure 'exactly' what my score was (memory problem with keeping a running tally, and I'm far to 'lazy' to use a pen and paper for such a pointless task) but I think it was low 30's, definitely not above 40

 

[Snow Leopard]

Does that not give anyone pause for thought before using the CSI?

I guess they don't want to admit they screwed up in their choice of measures.

This is the study in question:
https://www.ncbi.nlm.nih.gov/pubmed/24806467

Patients from a psychiatric medical practice (N=161), which specialized in the assessment and treatment of complex pain and psychophysiological disorders, were assessed for the presence of a CSS

The "54.8% participants were correctly identified as not having CSS." claim refers to other psychological disorders.

As such, it was not compared to other medical illnesses, but it is quite clear that given the above study that this questionnaire has poor discriminant validity.

One issue that many researchers fail to consider/discuss is that tests of discriminant validity can easily be biased by the social contexts of the study - how the participants are recruited, their knowledge of the study (Hawthorne effects and the like) as well as the wider societal social contexts that bias the questionnaire answering behaviour of the groups in question.

 

[James Morris-Lent]

That questionnaire is nonsense. How can it 'measure' anything?

I suspect it's a result of backwards logic. Take all your patients who have symptoms that you can't find an organic cause for (MUS). Attribute all those symptoms to and invented concept 'central sensitisation', then list them in a questionnaire and bingo, all the patients you can't diagnose, now have CS.

It doesn't seem to make much sense to lump in say, ME, IBS, and chronic 'functional' pain as being part of the same 'central sensitization'. There is no necessary overlap in the core symptoms of these syndromes.

Maybe there is some meaningfully similar underlying process, but we would need the actual physiological mechanism(s). It reminds me of the Cell Danger Response. A unifying biological-sounding theory that is just a speculative combination of words and arrows on paper hoping for some biology to back up the concepts. Sounds backwards to me, too.

 

[Sean]

That questionnaire is nonsense. How can it 'measure' anything?

I suspect it's a result of backwards logic. Take all your patients who have symptoms that you can't find an organic cause for (MUS). Attribute all those symptoms to and invented concept 'central sensitisation', then list them in a questionnaire and bingo, all the patients you can't diagnose, now have CS.

That is literally all there is to it. Circular definition-based reasoning.

And they wonder why we get a bit peeved at them?

 

[rvallee]

Step 1: put stuff in a box
Step 2: slap a label on the box
Step 3: marvel at the fact that you "discovered" that the stuff is labeled, thus confirming your labeling of said stuff

One remarkable thing is that this questionnaire essentially asks people to rate their frequency (not severity though, apparently that's not important) of illness, and equates it as meaning this is proof they are differently sick. Or something. It's all so damn random. Grinding your teeth? The hell would that even have with the concept of CSS even if it were true? Dry skin? Childhood trauma?

Honestly if this were deliberate satire of bad science nobody could tell the difference. These people are completely delusional.

As large differences exist in lifting capacity between men and women [5–7], all correlations and regression analyses were performed controlling for sex.

They "controlled" for sex but not for mass? There is a huge range of lifting capacity depending on body mass. And of course individual pain level is likely the single biggest factor and it's impossible to measure so can't be controlled for. Come on, this isn't serious. Freaking amateurs.