From the Personal Transformation Institute, an EMDRIA-approved provider of EMDR training and continuing education. Written for therapists and other clinicians who work with chronic pain.
Key takeaways
- The Central Sensitization Inventory (CSI) is a self-report questionnaire that screens for symptoms linked to central sensitization, where the nervous system amplifies pain and other signals.
- Part A has 25 items scored 0 to 4, for a total of 0 to 100. Part B lists prior diagnoses and is not scored.
- A score of 40 or higher is the commonly used cutoff, and published severity levels run from subclinical (0 to 29) to extreme (60 to 100).
- The CSI is a screening and tracking tool, not a diagnosis. It works best alongside a careful history.
What Is Central Sensitization?
Central sensitization describes a nervous system that has become more reactive over time. Pain and other body signals get turned up in the brain and spinal cord, so a person can hurt more, and in more places, than tissue damage alone would explain. The pain is real; the volume knob is set higher.
Central sensitization is thought to be part of what links a group of conditions sometimes called central sensitivity syndromes, including fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, migraine and tension headaches, temporomandibular joint disorder, restless legs syndrome and multiple chemical sensitivity. People often carry several of these at once.
What Is the Central Sensitization Inventory?
The CSI was developed and validated by Tom Mayer, Randy Neblett and colleagues (published in Pain Practice, 2012) to help clinicians identify patients whose symptoms may be driven by central sensitization. It is brief, self-administered and widely used in pain medicine, physical therapy and behavioral health.
It has two parts:
- Part A: 25 statements about current health symptoms. This is the scored part.
- Part B: whether the person has been diagnosed with any of 10 conditions (the central sensitivity syndromes above, plus neck injury, anxiety or panic attacks, and depression) and in what year. Part B adds clinical background but is not included in the score.
What Part A asks about
The 25 items cover symptoms that tend to cluster when the nervous system is sensitized:
- Sleep and energy: unrefreshing sleep, fatigue, low energy
- Pain and tension: widespread pain, stiff muscles, neck and shoulder tension, headaches, jaw pain and teeth clenching, pelvic pain
- Gut and bladder: bowel changes, bladder discomfort, frequent urination
- Sensory sensitivity: bright light, smells, restless legs, skin problems
- Mood and cognition: anxiety attacks, sadness, concentration and memory difficulties
- Stress and history: whether stress makes physical symptoms worse, and whether the person experienced trauma as a child
How to Score the CSI
Each Part A item is answered on a five-point scale:
| Never | Rarely | Sometimes | Often | Always |
|---|---|---|---|---|
| 0 | 1 | 2 | 3 | 4 |
Add the 25 item scores for a total between 0 and 100. Higher totals mean more symptoms associated with central sensitization. Ignore Part B when scoring.
CSI Score Interpretation and Severity Levels
Two published benchmarks guide interpretation. A cutoff of 40 was established for identifying people likely to have a central sensitivity syndrome (Neblett and colleagues, The Journal of Pain, 2013). Later research defined five severity levels (Neblett and colleagues, Pain Practice, 2017):
| CSI total (Part A) | Severity level |
|---|---|
| 0 to 29 | Subclinical |
| 30 to 39 | Mild |
| 40 to 49 | Moderate |
| 50 to 59 | Severe |
| 60 to 100 | Extreme |
Reading the score well
- Screen, don’t diagnose. A high score suggests central sensitization may be contributing. It does not rule out other medical causes, so stay within your scope and coordinate with the client’s medical providers.
- Look at the pattern, not just the total. Which items score highest tells you where the client’s system is most activated: sleep, gut, pain, mood or sensory load.
- Read Part B alongside it. Several prior diagnoses from the list, together with a high total, strengthen the picture.
- Repeat it. Because it is quick, the CSI is useful for tracking change across treatment.
Why the CSI Matters in Trauma Therapy
One of the 25 items asks directly about childhood trauma, and that is no accident. Early adverse experiences and attachment patterns shape how a nervous system learns to respond to threat, and persistent pain is often part of that learned response. In that sense, pain can be a symptom and an indicator of something deeper in the client’s system, the same way panic attacks or intrusive thoughts are.
For EMDR therapists, the CSI fits naturally into Phase 1 history taking. A high score points toward pain-informed history taking, pain education and somatic resourcing in Phase 2, and targeting the early experiences at the root of the pain in reprocessing. Watching the score come down over treatment is meaningful feedback for both therapist and client.
Looking for the CSI worksheet?
The full instrument appears in the original validation study (Mayer and colleagues, Pain Practice, 2012). PTI’s printable CSI worksheet with scoring guide, reprinted with permission, is included in the course materials for EMDR for Chronic Pain and Illness.
Frequently Asked Questions
Part A has 25 questions, each scored from 0 (never) to 4 (always). Part B asks about 10 prior diagnoses and is not scored.
Scores from 0 to 29 fall in the subclinical range. Scores of 30 to 39 are considered mild.
40 is the published cutoff for identifying people likely to have a central sensitivity syndrome. Scores of 40 to 49 are moderate, 50 to 59 severe, and 60 to 100 extreme.
No. It is a screening and tracking tool. A high score suggests central sensitization may be contributing to symptoms, and it should be read alongside a full clinical and medical history.
No. Part B records prior diagnoses such as fibromyalgia, IBS, migraine and TMJ disorder. It adds clinical background but is not included in the total.
References
- Mayer, T. G., Neblett, R., Cohen, H., et al. (2012). The development and psychometric validation of the Central Sensitization Inventory. Pain Practice, 12(4), 276-285.
- Neblett, R., Cohen, H., Choi, Y., et al. (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.
- Neblett, R., Hartzell, M. M., Mayer, T. G., Cohen, H., & Gatchel, R. J. (2017). Establishing clinically relevant severity levels for the Central Sensitization Inventory. Pain Practice, 17(2), 166-175.
Related Reading
- Persistent Pain as an “Answer”
- The 4 E’s of Resourcing: The S.A.F.E. Approach to Resourcing
- EMD and Restricted Processing (EMDr): When and How to Narrow EMDR
Go deeper
EMDR-trained? EMDR for Chronic Pain and Illness is a 6-hour, self-paced course (6 APA, NBCC and EMDRIA credits) on applying pain neuroscience to the EMDR model: pain-informed history taking, pain education and somatic resourcing, and reprocessing the early experiences at the root of persistent pain.
Not yet EMDR-trained? PTI’s EMDRIA-approved 6-Day EMDR Basic Training is the place to start.