The Development and Psychometric Validation of the Central Sensitization Inventory (CSI), 2013, Mayer et al

Andy

Andy

Retired committee member
Abstract

Central Sensitization (CS) has been proposed as a common pathophysiological mechanism to explain related syndromes for which no specific organic cause can be found. The term Central Sensitivity Syndrome (CSS) has been proposed to describe these poorly understood disorders related to CS.

The goal of this investigation was to develop the Central Sensitization Inventory (CSI), which identifies key symptoms associated with CSSs, and quantifies the degree of these symptoms. The utility of the CSI, to differentiate among different types of chronic pain patients that presumably have different levels of CS impairment, was then evaluated.

Study 1 demonstrated strong psychometric properties (test-retest reliability = 0.817; Cronbach's alpha = 0.879) of the CSI in a cohort of normative subjects. A factor analysis (including both normative and chronic pain subjects) yielded 4 major factors (all related to somatic and emotional symptoms), accounting for 53.4% of the variance in the dataset.

In Study 2, the CSI was administered to four groups: fibromyalgia (FM); chronic widespread pain (CWP) without FM; work-related regional chronic low back pain (CLBP); and normative control group. Analyses revealed that the FM patients reported the highest CSI scores, and the normative population the lowest (p<.05). Analyses also demonstrated that the prevalence of previously diagnosed CSSs and related disorders was highest in the FM group and lowest in the normative group (p<.001).

Taken together, these two studies demonstrate the psychometric strength, clinical utility, and the initial construct validity of the CSI in evaluating CS-related clinical symptoms in chronic pain populations.

Paragraph breaks added for easier reading.

Open access, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248986/
 
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When a questionnaire includes, and adds together scores for, things as diverse as childhood trauma, sensitivity to smells, and dry skin, I think they have taken leave of their senses. How can this possibly be 'measuring' anything?
 
Trish said:
When a questionnaire includes, and adds together scores for, things as diverse as childhood trauma, sensitivity to smells, and dry skin, I think they have taken leave of their senses. How can this possibly be 'measuring' anything?
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Absolutely. It reeks of the totally inept deluding themselves they have done something very clever.

I would like to see some study investigate the nuts and bolts of this crass approach that so many of these questionnaires seem to utilise (adding things that literally don't add up), and so many studies pin their supposed outcomes onto. Much of it is completely nonsensical. In fact it probably would not need too much to prove its stupidity in principle, though more rigour and depth for such proof to stand up to scientific scrutiny. It is a much used tool in psych studies, and I think much abused.

I can already see the various investigators lining up to give the same stock answer as always "we do it this way because it is the best we have". I think it is about time the serious weaknesses of this were investigated, and to see if a better tool could be considered.

ETA: The fact that these investigators even use such tools to arrive at outcomes by, is a clear indication of what little grasp they seem to have on reality, what little basic common sense they have.
 
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These questionnaires are just lists of all the things they believe are caused by central sensitization then asking if people have them.

You could do the same for the presence of individual guardian angels -

Have you ever experienced a near miss of an accident?
Have you had second thoughts about something and been right to do so?
Do you sometimes have a comforting dream?
 
As @Mithriel says ‘this just lists all the things that people believe are caused by central sensitisation’, but this does enable wonderfully circular research in that you can then administer the inventory to people who experience these things and ‘prove’ they have central sensitisation. These researchers do need classes in basic logic.

It is interesting that this approach is popular with advocates of lumping together disparate diagnoses under catch all diagnoses such as MUS and treating them with psychological/behavioural interventions. Is this because their CBT works so well for such disparate patients that a common mechanism underlying them is the only explanation or is it that as evidence for the effectiveness of CBT in narrow clinical groups such as ME is challenged its advocates need to shift the ground?

It feels this is just a repeat of what we saw in relation to the deconditioning model of ME, where proponents of GET/CBT developed a methodology that ‘proved’ their preferred interventions worked and just repeated the same experiments over and over again without examining any evidence that related to their actual explanation of the pathology.
 
Given the proponents of central sensitisation fail to define exactly what is meant by this at a neurological level, for example is it that neurons’ firing threshold is lowered or their conductivity is somehow speeded up, are they doing anything more than asserting a personality type.

Without proposing an actual mechanism for such sensitisation and then demonstrating that it actually occurs, this approach is hypothesising some mysterious quality of some brains (and/or central nervous systems) that are in some unspecified way substandard, ‘she’s over sensitive’ or ‘he has an artistic temperament’, which in scientific terms has no more validity that ascribing ‘hysteria’ to a wandering womb.
 
Claiming that the CSI predicts CWP and FM caseness, therefore it has "construct validity" is nonsense, it is circular logic.

For them to claim construct validity, they have to demonstrate a high sensitivity and specificity for predicting objective pain related phenomena (eg actually measure spinal temporal summation directly).
 
I find trying to latch onto what CSS is, is like clutching at smoke.

If I understand correctly, CSS is a theory collecting syndromes under its umbrella, to prove that it is valid, or real.

This reminds me of studying, and dissecting "I think, therefore I am."

The circles make me dizzy.
 
Sean said:
So it's pathophysiological now, not pathopsychological?

Which explains why they treat it with psychological therapies. Makes perfect sense. :rolleyes:

...has yet been found.

*sigh*
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Re: "...for which no specific organic cause can be found."

Thank you for your correction to: "has yet been found."

I have a sneaking hunch some would like to "correct" that statement to read, "can never be found."
 
Snow Leopard said:
Claiming that the CSI predicts CWP and FM caseness, therefore it has "construct validity" is nonsense, it is circular logic.

For them to claim construct validity, they have to demonstrate a high sensitivity and specificity for predicting objective pain related phenomena (eg actually measure spinal temporal summation directly).
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Hey! The celestial spheres, invented to explain the movement of solar system objects, do indeed look like they explain the thing they were invented to look like they explain. Blaspheme!
 
sad to see this (CSI) appears to have been accepted as a valid measurement for central sensitization in research.
You would think there would be a more robust means of validating any kind of measurement scale before it was widely used.
 
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