School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom.
Department of Psychology, Queen's University, Kingston, ON, Canada.
Pain. 2023 Jun 1;164(6):1222-1239. doi: 10.1097/j.pain.0000000000002830. Epub 2022 Nov 29.
Central sensitization (CS) is defined as an increased nociceptive responsiveness due to sensitization of neurons in the central nervous system, usually the result of prolonged nociceptive input or a disease state associated with noxious inputs (eg, polyarthritis). The concept of CS has recently been adopted in clinical assessments of chronic pain, but its diagnosis in humans may now include a wide range of hypervigilant responses. The purpose of this review is to ascertain whether self-report questionnaires linked with CS are associated with enhanced nociceptive responses or whether they measure sensitivity in a broader sense (ie, emotional responses). According to our published, PROSPERO-registered review protocol (CRD42021208731), a predefined search of studies that involve the Central Sensitization Inventory (CSI) or Pain Sensitivity Questionnaire (PSQ), correlated with either nociceptive sensory tests or emotional hypervigilance was conducted on MEDLINE, PsycINFO, and Web of Science. Correlations between the CSI or PSQ with our primary outcomes were extracted and meta-analysed. A review of 66 studies totalling 13,284 participants found that the CSI (but not the PSQ) strongly correlated with psychological constructs: depression, anxiety, stress, pain catastrophising, sleep, and kinesiophobia. The CSI and PSQ showed weak or no correlations with experimental measures of nociceptive sensitivity: pain thresholds, temporal summation, or conditioned pain modulation. The PSQ did, however, correlate strongly with phasic heat and tonic cold pain tests. The studies reviewed did not provide sufficient evidence that self-report measures reflect a canonical understanding of CS. The CSI more closely reflects psychological hypervigilance than increased responsiveness of nociceptive neurons.
中枢敏化（CS）被定义为由于中枢神经系统神经元的敏化导致的痛觉反应性增加，通常是由于长时间的痛觉输入或与有害输入相关的疾病状态（例如，多关节炎）所致。CS 的概念最近已被用于慢性疼痛的临床评估，但人类 CS 的诊断现在可能包括广泛的高度警觉反应。本综述的目的是确定与 CS 相关的自我报告问卷是否与增强的痛觉反应相关，或者它们是否在更广泛的意义上测量敏感性（即情绪反应）。根据我们已发表的、在 PROSPERO 注册的综述方案（CRD42021208731），对涉及中枢敏化量表（CSI）或疼痛敏感问卷（PSQ）的研究进行了预先设定的检索，这些研究与痛觉感觉测试或情绪高度警觉相关，在 MEDLINE、PsycINFO 和 Web of Science 上进行了检索。提取并对 CSI 或 PSQ 与我们主要结局的相关性进行了荟萃分析。对 66 项总计 13284 名参与者的研究进行了综述，发现 CSI（但不是 PSQ）与心理结构强烈相关：抑郁、焦虑、压力、疼痛灾难化、睡眠和运动恐惧。CSI 和 PSQ 与痛觉敏感性的实验测量呈弱相关或无相关性：疼痛阈值、时间总和或条件性疼痛调制。然而，PSQ 与相位热和持续冷痛测试强烈相关。综述的研究没有提供足够的证据表明自我报告的测量反映了对 CS 的经典理解。CSI 更能反映心理高度警觉，而不是痛觉神经元的反应性增加。
