Whiplash associated disorders remain the most common injury associated with motor vehicle accidents and a major cause of disability (Ritchie et al, 2013). The consequences for people suffering a whiplash injury can be substantial with an evidential impact on their daily living (Campbell et al, 2018). Still, the exact pathophysiology is not entirely clear. Even though, evidence is growing and suggests both physical, physiological, and social factors as prognostic factors (Walton & Elliot, 2017). Pain in Motion colleague Ward Willaert wrote in January 2020 an interesting blog with current facts. Readers interested in (chronic) whiplash associated disorders are advised to read this blog.
An aspect to be considered in chronic whiplash associated disorders is the presence of central sensitization (van Oosterwijck, 2013). The phenomenon involving an amplification of neural signalling within the central nervous system that results in pain hypersensitivity, is associated with several medical diagnoses including whiplash (Scerbo et al, 2018). It is a predominant pain mechanism in multiple chronic musculoskeletal pain disorders and is associated with poor outcomes (Clark et al, 2017).
If present, patients with signs of central sensitization need a different approach of treatment, suggested in a multidisciplinary manner (Ravn SL et al, 2020). Therefore, it is important that we are adequality equipped to assess the presence of central sensitization. Quantitative sensory testing is currently understood as an optimal proxy to determine the presence of central sensitization. Laboratory testing is however not feasible in clinical practice and as an alternative the Central Sensitization Inventory (CSI) was developed to assess and quantify key somatic and emotional symptoms associated with central sensitization (Mayer et al, 2012). The CSI is nowadays considered the leading self-report measure of central sensitization related symptoms worldwide (Cuesta-Vargas et al, 2018).
But, if we are using the CSI, it is important that the methodological properties are adequate. Since the development of the CSI, different studies have reported about this topic. Assessment of the published measurement studies of the CSI suggests that the tool generates reliable and valid data quantifying the severity of several symptoms of central sensitization (Scerbo et al, 2018).
Research conducted on the validity of the CSI in chronic whiplash associated disorders is however only carried out with small sample sizes. Kregel et al. (2018) published their findings concerning the comparison of the CSI, psychophysical pain measures, and the outcome of psychosocial and clinical features of central sensitization in chronic spinal pain patients, including a subgroup of 13 patients with chronic whiplash. The conclusion was a strong relationship between contributing factors and clinical features of central sensitization, underlying the use of the CSI in the clinical practice. The subgroup of chronic whiplash associated disorders was however too small to draw firm conclusions.
And as it is crucial to understand how well the CSI measures the supposed construct of key somatic and emotional symptoms associated with central sensitization in different chronic pain conditions, we assessed the convergent validity of the CSI in chronic whiplash associated disorders by determining the association with quantitative sensory testing, pain intensity, fatigue, and psychosocial factors in a sample of 125 participants.
We expect to be able to publish the results in the near future, which will support us in increasing our understanding of the methodological quality of the CSI. I invite you to take notice of this publication if you are interested.
To conclude, the CSI appears to be a useful tool to assess and quantify key somatic and emotional symptoms associated with central sensitization in different chronic pain conditions. By using it, it can help us profiling patients and thus improving our treatment management. Further research into specific patient populations can help us to gain insight whether we can generalize the methodological quality of the CSI or whether differences exist between subgroups.
Erwin Hendriks is a Master of Science in manual therapy and sports physiotherapy. He is part of the Pain in Motion International Research Group. Currently, he is working as a physiotherapist at the Erasmus medical centre in Rotterdam (Netherlands) and the Rehabilition Centre Drechtsteden in Dordrecht (Netherlands). Furthermore, he gives lectures at the Hogeschool Rotterdam.
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References and further reading:
Campbell, L., Smith, A., McGregor, L., & Sterling, M. (2018). Psychological Factors and the Development of Chronic Whiplash-associated Disorder(s): A Systematic Review. Clin J Pain, 34 (8), 755-768.
Clark J, Nijs J Yeowell G, Goodwin PC (2017). What are the predictors of altered pain modulation in chronic musculoskeletal pain populations? A systematic review. Pain Physician, 20 (6), 487-500.
Cuesta-Vargas AI, Neblett R, Chiarotto A, Kregel J, Nijs J, van Wilgen CP, Pitance L, Knezevic A, Gatchel RJ, Mayer TG, Viti C, Roldan-Jiménez C, Testa M, Caumo W, Jeremic-Knezevic M, Luciano JV (2018).
Dimensionality and reliability of the central sensitization inventory in a pooled multicountry sample. J Pain, 19 (3), 317-329.
Kregel J, Schumacher C, Dolphens M, Malfliet A, Goubert D, Lenoir D, Cagnie B, Meeus M, Coppieters I (2018). Convergent validity of the Dutch central sensitization inventory: associations with psychophysical pain measures, quality of life, disability, and pain cognitions in patients with chronic spinal pain. Pain Pract, 18 (6), 777-787.
Mayer TG, Neblett R, Cohen H, Howard KJ, Choi YH, Williams MJ, Perez Y, Gatchel RJ (2012). The development and psychometric validation of the central sensitization inventory. Pain Prac, 12 (4), 276-85.
Ravn SL, Eskildsen NB, Johnsen AT, Sterling M, Andersen TE (2020). There’s nothing broken. You’ve had a whiplash, that’s it: a qualitative study of comorbid posttraumatic stress disorder and whiplash associated disorders. Pain Med, Epub, ahead of print.
Ritchie, C., Hendrikz, J., Kenardy, J., & Sterling, M. (2013). Derivation of a clinical prediction rule to identify both chronic moderate/severe disability and full recovery following whiplash injury. Pain, 154 (10), 2198-2206.
Scerbo T, Colasurdo J, Dunn S, Unger J, Nijs J, Cook C (2018). Measurement properties of the central sensitization inventory: as systematic review. Pain Pract, 18 (4), 544-554.
Van Oosterwijck, J., Nijs, J., Meeus, M., & Paul, L. (2013). Evidence for central sensitization in chronic whiplash: a systematic literature review. Eur J Pain, 17 (3), 299-312.
Walton DM, Elliot JM (2017). An integrated model of chronic whiplash-associated disorder. J Orthop Sports Phys Ther, 47 (7), 462-471.