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.
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
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.
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.
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
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
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.
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
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
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.”
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
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
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.
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.
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.
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.
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.
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.
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
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.”
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.
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.
For older adults, interpretation should consider general health, sleep, medication context, comorbidities, pain duration and activity level.
For youth clients, consider comprehension, assistance, family context and whether the measure is appropriate for the client’s age.
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.
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 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.
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
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 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
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.
The CSI measures symptoms commonly associated with central sensitisation and central sensitivity-related presentations.
Part A has 25 scored items. Part B asks about previously diagnosed related conditions.
Each Part A item is scored from 0 to 4. The total score ranges from 0 to 100.
A higher score indicates greater reported symptom burden associated with central sensitisation-related presentations.
No. The CSI is a screening questionnaire and does not diagnose central sensitisation on its own.
A cut-off of 40/100 is commonly cited, but it should be interpreted cautiously and not used as a definitive diagnosis.
No. It should be combined with history, symptoms, physical assessment, sleep, stress, activity exposure and professional judgement.
Yes, but score change should be interpreted alongside function, symptoms, goals and broader context.
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.
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
