Prevalence of central sensitisation associated symptoms and associations with treatment outcomes in surgical, interventional and injection-based treatment for patients with chronic spinal pain

TL;DR

This study found that central sensitisation symptoms are common in chronic spinal pain patients and linked to worse treatment outcomes.

Contribution

The study identifies central sensitisation as a significant predictor of poor treatment satisfaction in spinal pain patients.

Findings

49.9% of patients had high central sensitisation scores (CSI ≥40).

Higher CSI scores correlated with lower treatment satisfaction (r = -0.69).

Patients with high CSI scores were less likely to achieve meaningful improvement after treatment.

Abstract

This study aimed to assess the prevalence of symptoms potentially related to central sensitisation (CS) in patients with spinal pain and explore its association with patient-reported treatment outcomes.

This study was designed as a single-centre prospective cohort study evaluating 496 patients undergoing surgical and non-surgical management for spinal pain between 2020 and 2023. Patients with symptoms lasting more than three months were assessed for symptoms associated with CS using the validated Central Sensitisation Inventory (CSI) before treatment. Treatment satisfaction was then assessed using a 5-point Likert scale. Complete data on patient demographics were available for 492 patients.

The prevalence of a CSI score of 40+ was 49.9%. Non-surgical patients had a higher median CSI score (42, IQR: 32–49) compared to surgical patients (34.5, IQR: 24–48) (p = 0.001). A moderate negative correlation was found between CSI scores and Likert scores (r = −0.69, p < 0.001). Multiple regression analysis showed that both treatment type and CSI scoring significantly impacted satisfaction scores (p < 0.001). Logistic regression revealed that higher CSI scores (40+) decreased treatment satisfaction (OR = 0.09) (p < 0.001). Where post-treatment patient-reported outcome scores were available, the cohort of patients with CSI⩾40 compared to the <40 cohort had a lower proportion of patients who achieved minimum clinically important difference and patient acceptable symptom state for both Neck Disability Index and Oswestry Disability Index (p < 0.05).

Overall, high CSI scores were common in patients with chronic spinal pain and were significantly associated with treatment dissatisfaction. Higher CSI scores should be considered when selecting treatment and managing patient expectations.

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