Background & Aims
In clinical practice, the Central Sensitization Inventory (CSI) is used to identify patients with suspected human assumed central sensitization (HACS). However, in research settings psychophysical measures are preferred to assess HACS, such as measures assessing pain sensitivity and functionality of endogenous pain modulation. Previous research in individuals with HACS, such as fibromyalgia patients, has demonstrated pro-nociceptive pain modulation, as evidenced by less efficient conditioned pain modulation (CPM) and exercise-induced hypoalgesia (EIH) [1,2]. Therefore, a moderate-to-strong association between the CSI and psychophysical measures of HACS would be expected. Yet, the evidence for this is ambiguous. Therefore, this cross-sectional study aimed to explore the convergent validity of the CSI in fibromyalgia by examining the relation between CSI scores and the outcomes of psychophysical pain measures of endogenous pain modulation used to assess CPM and EIH.
Methods
Fifty-five individuals (54 women, 1 man; mean age 49.2±13.10y) diagnosed with fibromyalgia participated in this cross-sectional study. The CSI was administered, along with questionnaires of illness perception (i.e., Illness Perception Questionnaire (IPQ)), anxiety and depression (i.e., Hospital Anxiety and Depression Scale (HADS)), and health-related quality of life (i.e., Research And Development-36 (RAND-36)). To examine endogenous pain modulation, pressure pain sensitivity, CPM, and EIH were assessed. For CPM, the test stimulus existed of pain pressure threshold (PPT) assessment using manual algometry which was performed prior to, during and following conditioning stimulation existing of hot water immersion (45.5°C) of the non-dominant hand. EIH was determined by PPT assessment prior to, and following a submaximal bicycle exercise test (Aerobic Power Index). CPM and EIH were calculated as change scores and percentage change in PPT.
Results
Only a small positive correlation between the CSI and parallel % CPM was found (r=0.307, p=0.025), indicating that a higher CSI score is associated with less efficient CPM. No other correlations between CSI and CPM or EIH were found. Small positive correlations were observed between the CSI and the HADS depression subscale (r=0.316, p=0.019), and the IPQ total score (r=0.406, p=0.002), and a moderate positive correlation with the HADS anxiety subscale (r=0.510, p<0.001). Small negative correlations were found between the CSI and all but one of the RAND-36 subscales (“physical functioning” (r=-0.339, p=0.011), “social functioning” (r=-0.436, p<0.001), “role limitations due to physical functioning” (r=-0.287, p=0.034), “emotional wellbeing” (r=-0.426, p=0.001), “energy/fatigue” (r=-0.460, p<0.001), “pain” (r=-0.489, p<0.001), “general health” (r=-0.488, p<0.001), and “health change” (r=-0.296, p=0.028)). These findings suggest that the CSI is related to psychological constructs.
Conclusions
The results of the present study add to the growing body of literature on the lack of an association between the CSI and psychophysical measures of HACS, and that the CSI mainly reflects the cognitive-emotional aspects of HACS.
References
[1] Lannersten, L., & Kosek, E. (2010). Dysfunction of endogenous pain inhibition during exercise with painful muscles in patients with shoulder myalgia and fibromyalgia. Pain, 151(1), 77–86. https://doi.org/10.1016/j.pain.2010.06.021
[2] O’Brien, A. T., Deitos, A., Triñanes Pego, Y., Fregni, F., & Carrillo-de-la-Peña, M. T. (2018). Defective Endogenous Pain Modulation in Fibromyalgia: A Meta-Analysis of Temporal Summation and Conditioned Pain Modulation Paradigms. In Journal of Pain (Vol. 19, Issue 8, pp. 819–836). Churchill Livingstone Inc. https://doi.org/10.1016/j.jpain.2018.01.010
Presenting Author
Rob JEM Smeets
Poster Authors
Amber Billens
MSc
Ghent University, Pain in Motion international research group
Lead Author
Sophie Van Oosterwijck
MSc
Ghent University, Pain in Motion international research group, Research Foundation – Flanders (FWO)
Lead Author
Mira Meeus
PhD
University of Antwerp
Lead Author
Laura MWE Beckers
PhD
Maastricht University
Lead Author
Adri T Apeldoorn
PhD
Noordwest Ziekenhuisgroep, Breederode Hogeschool
Lead Author
Rene Oosterwijk
MD
CIR Revalidatie
Lead Author
Jo Nijs
PhD
Vrije Universiteit Brussel
Lead Author
Jessica Van Oosterwijck
PhD
Ghent University, Pain in Motion international research group
Lead Author
Robert Smeets
Maastricht University, School for Public Health and Primary Care, Department
Lead Author
Topics
- Assessment and Diagnosis