General Outcome Measurements: Central Sensitisation Inventory

Persistent pain can be influenced by many factors, including tissue sensitivity, nervous system processing, sleep, stress, mood, fatigue, previous injury, activity exposure and broader health context.

The Central Sensitisation Inventory was developed to help identify symptoms that may be associated with central sensitisation-related presentations. It is often used in persistent pain, widespread pain, fibromyalgia-related research, musculoskeletal pain and chronic pain screening contexts.

The CSI is useful because it captures a broader symptom profile rather than only pain intensity. A client may report pain alongside sleep disturbance, fatigue, sensitivity, concentration difficulties, headaches, stress-related symptoms or other body-system complaints.

The CSI should support assessment reasoning. It should not be used as a stand-alone diagnostic test.

Quick Summary

• Outcome measure: Central Sensitisation Inventory
• Abbreviation: CSI
• Category: Pain-related screening questionnaire
• Type: Client-reported screening measure
• Part A: 25 scored symptom items
• Part B: Previously diagnosed conditions associated with central sensitivity syndromes
• Score range: 0–100 for Part A
• Higher score means: Greater symptom burden associated with central sensitisation-related presentations
• Common cut-off: 40/100 is often cited, but should be interpreted cautiously
• Key limitation: CSI does not confirm central sensitisation or diagnose a pain condition

What Is the CSI?

The CSI is a two-part questionnaire.

Part A includes 25 items that ask about symptoms commonly reported in central sensitivity-related presentations. Each item is scored from 0 to 4.

Part B asks whether the client has previously been diagnosed with conditions commonly associated with central sensitivity syndromes.

Part A is the scored section used for the total CSI score.

The total Part A score ranges from 0 to 100.

Higher scores indicate a greater number or intensity of symptoms commonly associated with central sensitisation-related presentations.

Why It Is Used

The CSI is used because persistent pain can involve more than local tissue symptoms.

A client may report:

• widespread pain
• fatigue
• poor sleep
• sensitivity to physical or emotional stress
• headaches
• concentration difficulties
• heightened symptom response
• pain that appears disproportionate to local findings
• multiple overlapping symptoms

The CSI may help professionals:

• establish a baseline symptom profile
• identify broader symptom burden
• support pain education conversations
• monitor symptom change over time
• compare questionnaire findings with physical assessment
• guide referral or further assessment where appropriate
• avoid over-reliance on local tissue explanations

The score should be interpreted alongside history, symptom behaviour, physical assessment, sleep, stress, activity exposure, goals and professional judgement.

What It Measures

The CSI measures symptoms commonly associated with central sensitisation and central sensitivity syndromes.

It may provide insight into:

• pain sensitivity-related symptoms
• fatigue
• sleep disturbance
• concentration concerns
• headaches
• stress-related symptoms
• widespread symptom burden
• overlapping body-system symptoms
• general symptom severity

It does not directly measure:

• central sensitisation in the nervous system
• pain mechanism with certainty
• tissue damage
• injury severity
• diagnosis
• imaging findings
• psychological diagnosis
• treatment need
• sport or work readiness

Who It Is Useful For

The CSI may be useful for:

• exercise professionals
• rehabilitation practitioners
• allied health support teams
• pain-informed movement professionals
• strength and conditioning coaches working with persistent pain
• movement assessment professionals
• students learning pain-related outcome measures

It may be relevant for clients with:

• persistent pain
• widespread symptoms
• fibromyalgia-related presentations
• chronic low back pain
• chronic neck pain
• headache with broader symptom burden
• musculoskeletal pain that is difficult to explain by local findings alone
• multiple symptom areas
• high irritability or sensitivity

When to Use This Outcome Measure

Use the CSI when you want to understand whether a client reports a broader symptom profile that may be relevant to persistent pain or central sensitisation-related assessment reasoning.

It may be useful at:

• initial assessment
• baseline pain profiling
• persistent pain screening
• reassessment
• progress review
• education and goal-setting
• referral-support documentation where appropriate

The CSI is especially useful when pain intensity alone does not explain the client’s presentation.

When Not to Use or When to Be Cautious

Use caution when:

• the score is being used to diagnose central sensitisation
• the score is interpreted without physical assessment
• the client has new, severe or unexplained symptoms
• red flags are present
• the client cannot complete the questionnaire independently
• the wrong language version is used
• many items are missing
• psychological, medical or neurological concerns require referral

The CSI should not be used to:

• diagnose central sensitisation
• confirm a pain mechanism
• diagnose fibromyalgia
• diagnose psychological conditions
• identify tissue damage
• replace medical assessment
• clear someone for sport or work
• replace professional judgement

Equipment or Resources Required

You need:

• CSI questionnaire
• scoring instructions
• baseline and retest dates
• symptom notes
• pain history
• activity and sleep context

Optional related information may include:

• pain intensity ratings
• body chart
• sleep quality notes
• fatigue rating
• stress or recovery notes
• region-specific outcome measure
• physical function tests
• referral notes where appropriate

Administration Protocol / Practice

Setup

Explain the purpose of the questionnaire before the client completes it.

Example wording:

“This questionnaire asks about symptoms that can be associated with persistent pain and increased nervous system sensitivity. It does not diagnose the cause of pain, but it helps us understand your broader symptom profile.”

Format

The CSI can be completed:

• on paper
• digitally
• independently
• verbally if assistance is required
• before a session
• during reassessment
• as part of persistent pain monitoring

Client Instructions

Ask the client to:

• answer based on their usual experience
• choose the option that best reflects them
• answer every item where possible
• avoid overthinking each question
• ask for clarification if they do not understand an item
• complete the same version at retest

Scoring Process

Part A includes 25 scored items.

Each item is scored:

• 0 = Never
• 1 = Rarely
• 2 = Sometimes
• 3 = Often
• 4 = Always

The total Part A score ranges from 0 to 100.

Higher scores indicate greater symptom burden associated with central sensitisation-related presentations.

Retesting Considerations

Retest at meaningful time points, such as:

• baseline
• after a pain education block
• after a training or rehabilitation block
• after a flare-up
• after changes in sleep, stress or workload
• progress review
• follow-up review

For consistency, record the same version, date, current symptom status, flare-ups, sleep, stress and activity exposure.

Safety Notes

The CSI is a self-report questionnaire, so it does not create physical testing risk.

However, high scores, worsening symptoms or complex presentations may support further assessment, referral or multidisciplinary input where appropriate.

Scoring and Interpretation

The CSI Part A score ranges from 0 to 100.

Higher scores indicate greater symptom burden associated with central sensitisation-related presentations.

Lower scores indicate lower reported symptom burden.

A commonly cited cut-off is 40/100, but this should not be interpreted as a definitive diagnostic threshold.

What a High Score May Suggest

A higher CSI score may suggest:

• broader symptom burden
• higher sensitivity-related symptom reporting
• persistent pain complexity
• sleep, fatigue or stress-related symptom contribution
• need for broader assessment beyond local tissue findings
• possible need for education, monitoring or referral

A high score does not prove central sensitisation.

What a Low Score May Suggest

A lower CSI score may suggest:

• fewer symptoms commonly associated with central sensitisation-related presentations
• lower reported widespread symptom burden
• symptoms may be more region-specific or mechanically influenced

A low score does not exclude nervous system sensitivity, persistent pain complexity or other contributors.

What the Score Does Not Prove

A CSI score does not prove:

• central sensitisation
• diagnosis
• pain mechanism
• fibromyalgia
• tissue damage
• psychological disorder
• severity of injury
• sport readiness
• work readiness
• whether one intervention caused the change

How to Explain the Result Safely

Example wording:

“Your CSI score gives us a broader view of symptoms that can be associated with persistent pain and sensitivity. We will interpret it alongside your history, symptoms, goals, physical findings, sleep, stress and activity context.”

What the Score May Mean in Different Client Populations

General Fitness Clients

For general fitness clients, the CSI may help identify whether symptoms are broader than one local painful area.

Interpretation should consider training load, sleep, stress, recovery and activity confidence.

Sport and Performance Clients

For sport and performance clients, a higher CSI score may suggest that load progression should consider recovery, fatigue, sleep and symptom irritability.

It should not be used to clear or restrict sport on its own.

Older Adults

For older adults, interpretation should consider general health, sleep, medication context, comorbidities, pain duration and activity level.

Youth Clients

For youth clients, consider comprehension, assistance, family context and whether the measure is appropriate for the client’s age.

Clients With Persistent Pain

The CSI may be particularly useful when pain is persistent, widespread, variable or difficult to explain by local findings alone.

It can help frame symptom burden without suggesting that symptoms are “not real” or purely psychological.

Clients With Multiple Symptom Areas

CSI may help document broader symptom load across several body regions or systems, but further assessment is required to understand the full context.

Meaningful Change, MCID, MDC and Responsiveness

Meaningful change helps determine whether a score change is likely to matter.

High-quality, universally applicable MCID or MDC values for every CSI population are limited.

CSI score change should be interpreted with:

• baseline comparison
• repeated measurement
• symptom change
• sleep and fatigue changes
• activity exposure
• pain intensity
• function change
• client goals
• professional judgement

Because the CSI reflects a broad symptom profile, a score change may not always map directly to pain intensity or function.

Avoid over-interpreting small changes unless they are consistent with the client’s broader presentation.

Normative Data, Reference Values or Comparative Data

CSI values vary across pain conditions, languages, cultures and populations.

The 40/100 cut-off is commonly cited, but newer research has questioned whether one universal cut-off is appropriate for all populations and pain conditions.

Practical comparison guidance:

• compare the client with their own baseline
• use the same version at retest
• interpret score change with symptom and function changes
• avoid treating 40/100 as a diagnosis
• consider condition-specific evidence where available
• combine results with history and physical assessment

Reliability and Validity

Original validation evidence reported good internal consistency and test–retest reliability.

The CSI has been translated and studied across multiple populations and languages.

Reliability and validity are strongest when:

• the correct version is used
• the same version is repeated
• the client understands the items
• all items are completed
• the result is interpreted in a relevant pain population
• score interpretation is combined with broader assessment

Validity is limited by the fact that central sensitisation cannot be directly confirmed in humans by questionnaire alone, and there is no single gold-standard questionnaire diagnosis for central sensitisation.

Common Errors and Limitations

Common errors include:

• treating CSI as a diagnosis
• saying the score proves central sensitisation
• using 40/100 as a rigid cut-off
• ignoring red flags or medical concerns
• ignoring sleep, stress and activity exposure
• over-interpreting small score changes
• using the score without broader physical assessment
• implying symptoms are psychological or not real

Limitations include:

• self-report can be influenced by mood, sleep, stress and symptom flare-ups
• it does not identify the cause of pain
• it does not directly measure nervous system processing
• cut-offs vary by population
• symptoms overlap with many health conditions
• it should not replace medical or multidisciplinary assessment where needed

Practical Applications

The CSI may help professionals:

• document baseline symptom burden
• identify broader persistent pain features
• guide pain education discussions
• monitor symptom change over time
• support referral decisions where appropriate
• avoid over-focusing on one tissue source
• compare symptom burden with function and activity exposure

For active clients, it may help identify whether training progression should consider sleep, recovery, fatigue and symptom irritability.

For persistent pain clients, it can support a broader, more person-centred understanding of symptoms.

FAQs

What does the CSI measure?

The CSI measures symptoms commonly associated with central sensitisation and central sensitivity-related presentations.

How many items are in the CSI?

Part A has 25 scored items. Part B asks about previously diagnosed related conditions.

How is the CSI scored?

Each Part A item is scored from 0 to 4. The total score ranges from 0 to 100.

What does a higher CSI score mean?

A higher score indicates greater reported symptom burden associated with central sensitisation-related presentations.

Does the CSI diagnose central sensitisation?

No. The CSI is a screening questionnaire and does not diagnose central sensitisation on its own.

What is the CSI cut-off?

A cut-off of 40/100 is commonly cited, but it should be interpreted cautiously and not used as a definitive diagnosis.

Should CSI be used alone?

No. It should be combined with history, symptoms, physical assessment, sleep, stress, activity exposure and professional judgement.

Can CSI be used for progress tracking?

Yes, but score change should be interpreted alongside function, symptoms, goals and broader context.

Key Takeaways

• CSI is a 25-item screening questionnaire scored from 0 to 100.
• Higher scores indicate greater symptom burden associated with central sensitisation-related presentations.
• A 40/100 cut-off is commonly cited but should not be treated as diagnostic.
• CSI does not prove central sensitisation or identify the cause of pain.
• It is most useful in persistent pain and complex symptom presentations.
• Interpretation is strongest when combined with history, physical assessment, sleep, stress, activity exposure and goals.

References

Mayer, T. G., Neblett, R., Cohen, H., Howard, K. J., Choi, Y. H., Williams, M. J., Perez, Y., & Gatchel, R. J. (2012). The development and psychometric validation of the Central Sensitization Inventory. Pain Practice, 12(4), 276–285. https://doi.org/10.1111/j.1533-2500.2011.00493.x

Neblett, R., Cohen, H., Choi, Y., Hartzell, M. M., Williams, M., Mayer, T. G., & Gatchel, R. J. (2013). The Central Sensitization Inventory (CSI): Establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. The Journal of Pain, 14(5), 438–445. https://doi.org/10.1016/j.jpain.2012.11.012

Schuttert, I., Timmerman, H., Petersen, K. K., McPhee, M. E., Arendt-Nielsen, L., Reneman, M. F., & Wolff, A. P. (2021). The definition, assessment, and prevalence of human assumed central sensitisation in patients with chronic low back pain: A systematic review. Journal of Clinical Medicine, 10(24), 5931. https://doi.org/10.3390/jcm10245931

Serrano-Ibáñez, E. R., López-Martínez, A. E., Ramírez-Maestre, C., Ruiz-Párraga, G. T., & Esteve, R. (2018). Confirmatory factor analysis of the Central Sensitization Inventory in people with chronic pain. Pain Practice, 18(4), 486–495. https://doi.org/10.1111/papr.12638