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Use of the central sensitization inventory (CSI) as a treatment outcome measure for chronic spinal pain disorder patients in a functional restoration program.

Spine J. 2017 Jun 12;:

Authors: Neblett R, Hartzell MM, Williams M, Bevers KR, Mayer TG, Gatchel RJ

BACKGROUND CONTEXT: The Central Sensitization Inventory (CSI) is a valid and reliable patient-reported instrument designed to identify patients whose presenting symptoms may be related to Central Sensitization (CS). Part A of the CSI measures a full array of 25 somatic and emotional symptoms associated with CS, and Part B asks if patients have previously been diagnosed with one or more specific Central Sensitivity Syndromes (CSSs) and related disorders. The CSI has previously been validated in a group of chronic pain patients who were screened by a trained psychiatrist for specific CSS diagnoses. It is currently unknown if the CSI can be a useful treatment-outcome assessment tool for chronic spinal pain disorder (CSPD) patients who are not screened for comorbid CSSs. It is known, however, that previous studies have identified CS-related symptoms, and comorbid CSSs, in subsets of patients with CSPDs. Studies have also shown that CS-related symptoms can be influenced by cognitive and psychosocial factors, including abuse history in both childhood and adulthood, sleep disturbance, catastrophic and fear-avoidant cognitions, and symptoms of depression and anxiety.
PURPOSE: To evaluate CSI scores, and their associations with other clinically-relevant psychosocial variables, in a cohort of CSPD patients who entered and completed a functional restoration program.
STUDY DESIGN/SETTING: A retrospective study of prospectively-collected data from a cohort study of CSPD patients who completed the CSI at admission to, and discharge from, an interdisciplinary function restoration program (FRP).
PATIENT SAMPLE: A cohort of 763 CSPD patients OUTCOME MEASURES: Clinical interviews evaluated mood disorders and abuse history. A series of self-reported measures evaluated comorbid psychosocial symptoms, including pain intensity, pain-related anxiety, depressive symptoms, somatization symptoms, perceived disability, and sleep disturbance, at FRP admission and discharge.
METHODS: Patients were grouped into five severity level groups, from Mild-to-Extreme, based on total CSI scores, at FRP admission, and then again at discharge. The FRP included a quantitatively-directed and medically-supervised exercise process, as well as a multimodal psychosocial disability management component.
RESULTS: The CSI severity groups were strongly associated with Major Depressive Disorder and previous abuse history (p < .01), which are known risk factors for CS-related symptoms and diagnoses. CSI scores were also strongly associated with patient-reported CSS diagnoses on CSI Part B. The percentage of patients who reported a comorbid CSS diagnosis increased in each higher CSI-severity group, from 11% in the Subclinical group, to 56% in the Extreme group. The CSI severity groups were significantly related to other CS-related patient-reported symptoms, including pain intensity, pain-related anxiety, depressive symptoms, somatization symptoms, perceived disability, and sleep disturbance (ps < .001). CSI scores, along with all other psychosocial measures, decreased at treatment discharge.
CONCLUSIONS: In the present study, admission CSI scores were highly associated with previous CSS diagnoses, CS-related symptoms, and clinically relevant patient-reported psychosocial variables. All psychosocial variables, as well as scores on the CSI, were significantly improved at FRP discharge. The CSI may be have important clinical utility, as a screener and as a treatment outcome measure, for CSPD patients participating in an interdisciplinary FRP.

PMID: 28619687 [PubMed – as supplied by publisher]