Cultural Validation of the Chinese Central Sensitization Inventory in Patients with Chronic Pain and its Predictive Ability of Comorbid Central Sensitivity Syndromes

Abstract

Background: Central sensitization (CS) is frequently reported in chronic pain, and the central sensitization inventory (CSI) is popularly used to assess CS. However, a validated Chinese CSI is lacking and its predictive ability for the comorbidity of central sensitivity syndromes (CSSs) remains unclear. Hence, this study aimed to generate the Chinese CSI (CSI-C) with cultural adaptation and examine its psychometric properties. Methods: The CSI-C was formulated through forward and backward translation, panel review and piloting and then validated among patients with chronic pain (n = 235). Its internal consistency, test-retest reliability, and concurrent validity were measured. An exploratory factor analysis (EFA) was performed for the construct validity. Receiver operating characteristic (ROC) analysis was employed to determine the discriminative ability in the presence of comorbidity of CSSs. Results: About 70% of the participants in the study experienced at least mild CS symptoms. CSI-C demonstrates a high internal consistency (Cronbach's alpha = 0.896) and excellent test-retest reliability (ICC = 0.932). CSI-C scoring was significantly correlated with pain intensity (r = 0.188), EQ-5D index (r = −0.375), anxiety (r=0.525), and depression (r = 0.467). The EFA generated a 5-factor model, including physical symptoms, emotional distress, hypersensitivity syndromes and so on. An CSI cutoff of 42 had a sensitivity of 71.4% and a specificity of 70% for identifying chronic pain patients with ≥2 CSSs. Conclusion:The CS manifestations are prevalent in those with persistent pain. CSI-C is a reliable and valid instrument for measuring CS. A CSI score ≥42 may predict the comorbidity of 2 or above CSSs in patients with chronic pain.

Adaptation and validation of the Chinese version of the Central Sensitisation Inventory in patients with chronic pain

“…16 The Hong Kong version correlated with pain intensity (r=0.188). 27 The Chinese CSI-25 score was not correlated with the duration of pain, which agrees with previous research. 18 19 27 The test-retest reliability of the Chinese CSI-25 was excellent in the overall population (ICC=0.975), which is consistent with previous evaluations of the English (ICC=0.817), 12 German (ICC=0.917), 13 Dutch (ICC=0.88-0.91), 14 Greek (ICC=0.991), 17 Japanese (ICC=0.85), 18 Hong Kong (ICC=0.932), 27 Nepali (ICC=0.98) 19 and Persian (ICC=0.934) 20 versions of the scale.…”

“…27 The Chinese CSI-25 score was not correlated with the duration of pain, which agrees with previous research. 18 19 27 The test-retest reliability of the Chinese CSI-25 was excellent in the overall population (ICC=0.975), which is consistent with previous evaluations of the English (ICC=0.817), 12 German (ICC=0.917), 13 Dutch (ICC=0.88-0.91), 14 Greek (ICC=0.991), 17 Japanese (ICC=0.85), 18 Hong Kong (ICC=0.932), 27 Nepali (ICC=0.98) 19 and Persian (ICC=0.934) 20 versions of the scale. Furthermore, the internal consistency of the Chinese CSI-25 was Cronbach's α=0.930 in the overall population and 0.882 in the chronic pain population, which compares with Cronbach's α values of 0.879 for the English version, 12 0.928 for the German version, 13 0.78 for the Dutch version, 14 0.872 for the Spanish version, 15 0.87 for the Italian version, 16 0.993 for the Greek version, 17 0.89 for the Japanese version, 18 0.896 for the Hong Kong version, 27 0.91 for the Nepali version 19 and 0.87 for the Persian version.…”

“…The new scale developed in this study could potentially be used as a tool to screen for CS in patients with chronic pain in China ( online supplemental material 3 ). During the preparation of the current manuscript, a study by Feng et al conducted in Hong Kong was published, 27 which also generated and validated a Chinese CSI. Nevertheless, Hong Kong differs greatly from mainland China with regard to culture, language and Chinese characters.…”

“…Our study was more rigorously designed with concurrent healthy controls and all-around evaluation indicators compared with the previous study, which recruited patients only and did not observe criterion validity, measurement error and floor and ceiling effects. 27 Liang Furthermore, both patients with musculoskeletal pain and fibromyalgia were included in this study, while Feng et al only enrolled patients with musculoskeletal pain. 27 The mean age of subjects in the Chinese version and the Hong Kong version was 44 and 64 years old, 27 respectively.…”

“…27 Liang Furthermore, both patients with musculoskeletal pain and fibromyalgia were included in this study, while Feng et al only enrolled patients with musculoskeletal pain. 27 The mean age of subjects in the Chinese version and the Hong Kong version was 44 and 64 years old, 27 respectively. Considering the strict design and the representativeness of subjects, the Chinese CSI-25 might provide a valid and accurate tool for clinicians and researchers to evaluate chronic pain and CS in Chinese patients.…”