Nerve Sensitization Symptom Evaluator
Author: Shana L Johnson MD, AskDrShana
Signs that pain is related to nerve sensitization (nociplastic pain) includes long-standing symptoms symptoms (> 3 months), spread of symptoms beyond the boundary of the injury area, marked increased sensitivity to painful stimuli, and non-pain symptoms that cause system-wide symptoms like severe fatigue, disrupted sleep, and brain fog.
Common symptoms seen with sensitization have been collected and made into a clinical tool, a symptom evaluator, for assessment. The clinical tool is called the central sensitization inventory (CSI). The tool asks about common sensitization symptoms, non-pain symptoms, and associated mental health conditions.
About the CSI
The measure includes 25 statements. About half of them refer to symptoms of common sensitization syndromes, such as headaches and stiff and achy muscles. The other questions are used to gather information about the non-pain symptoms, such as sleep issues and fatigue. As well as commonly associated factors, such as associations with stress, mental health, and prior trauma. The CSI looks at whether stress makes physical symptoms worse. It asks about anxiety attacks, feeling sad, and about any trauma suffered as a child. All are additional factors in the development or worsening of sensitization syndromes.
How to Check
After reading a statement, a numerical score is given based on the response.
Never=0, Rarely=1, Sometimes=2, Often=3, Always=4.
After responding to all the statements, the score is added up. The total score ranges from 0 to 100, with higher scores suggesting more sensitization. A score of 40 or higher is suggestive of significant symptoms from sensitization.
The questionnaire is provided below and freely available at pridedallas.com.
The main usefulness of this tool is developing awareness of potential sensitization symptoms. The measure is not meant as a self-diagnostic tool since diagnosis requires consideration of other factors not included in it.
Central Sensitization Inventory
Please circle the best response to the right of each statement. | ||||||
1 | I feel tired and unrefreshed when I wake from sleeping. | Never | Rarely | Sometimes | Often | Always |
2 | My muscles feel stiff and achy. | Never | Rarely | Sometimes | Often | Always |
3 | I have anxiety attacks. | Never | Rarely | Sometimes | Often | Always |
4 | I grind or clench my teeth. | Never | Rarely | Sometimes | Often | Always |
5 | I have problems with diarrhea and/or constipation. | Never | Rarely | Sometimes | Often | Always |
6 | I need help in performing my daily activities. | Never | Rarely | Sometimes | Often | Always |
7 | I am sensitive to bright lights. | Never | Rarely | Sometimes | Often | Always |
8 | I get tired very easily when I am physically active. | Never | Rarely | Sometimes | Often | Always |
9 | I feel pain all over my body. | Never | Rarely | Sometimes | Often | Always |
10 | I have headaches. | Never | Rarely | Sometimes | Often | Always |
11 | I feel discomfort in my bladder and/or burning when I urinate. | Never | Rarely | Sometimes | Often | Always |
12 | I do not sleep well. | Never | Rarely | Sometimes | Often | Always |
13 | I have difficulty concentrating. | Never | Rarely | Sometimes | Often | Always |
14 | I have skin problems such as dryness, itchiness, or rashes. | Never | Rarely | Sometimes | Often | Always |
15 | Stress makes my physical symptoms get worse. | Never | Rarely | Sometimes | Often | Always |
16 | I feel sad or depressed. | Never | Rarely | Sometimes | Often | Always |
17 | I have low energy. | Never | Rarely | Sometimes | Often | Always |
18 | I have muscle tension in my neck and shoulders. | Never | Rarely | Sometimes | Often | Always |
19 | I have pain in my jaw. | Never | Rarely | Sometimes | Often | Always |
20 | Certain smells, such as perfumes, make me feel dizzy and nauseated. | Never | Rarely | Sometimes | Often | Always |
21 | I have to urinate frequently. | Never | Rarely | Sometimes | Often | Always |
22 | My legs feel uncomfortable and restless when I am trying to go to sleep at night. | Never | Rarely | Sometimes | Often | Always |
23 | I have difficulty remembering things. | Never | Rarely | Sometimes | Often | Always |
24 | I suffered trauma as a child. | Never | Rarely | Sometimes | Often | Always |
25 | I have pain in my pelvic area. | Never | Rarely | Sometimes | Often | Always |
Total= |
Mayer TG, et al. The development and psychometric validation of the Central Sensitization Inventory (CSI). Pain Pract. 2012; 12(4):276-285.
The inventory is a useful list of all the different symptoms sensitization of the nervous system can cause! The knowledge can raise awareness of potential neural sensitization symptoms to people who are either suffering unnecessarily or know someone who is. Remember that diagnosis of sensitization syndrome is best done by a licensed medical provider. You could have an undiagnosed medical condition along with neural sensitization. This list is helpful but doesn’t evaluate for the possibility of overlapping medical conditions that could cause the same symptoms. For example, low thyroid can cause many of the symptoms listed here, such as fatigue, sadness, and digestive changes. And, of course, you can have both at once. Due to the complicated nature of the diagnosis, be sure to seek a qualified provider for an evaluation.
As basic as it sounds, simply understanding sensitization and its contribution to symptoms is an important step! Understanding what is happening and why returns a sense of control and an improved ability to manage the symptoms. Knowing you are going to be ok and not in danger is a big relief! The emotional centers of the brain that latch onto fear and turn up the discomfort volume won’t be triggered as often when you have peace of mind. You can maintain control and self-management better.
