Neblett, Randy, Hartzell, Meredith M, Mayer, Tom G et al. · Pain practice : the official journal of World Institute of Pain · 2017 · DOI
Researchers created and tested a scoring system called the Central Sensitization Inventory (CSI) to help doctors identify when someone's symptoms may be caused by their nervous system being overly sensitive to pain signals. The study divided CSI scores into five levels—from subclinical to extreme—and confirmed that higher scores are associated with having more chronic conditions like fibromyalgia and ME/CFS, as well as higher levels of depression, sleep problems, and disability.
This study provides ME/CFS patients and clinicians with a standardized, validated tool to quantify central sensitization severity and track treatment response. For ME/CFS researchers, these severity levels enable consistent stratification and comparison across studies, improving our ability to identify and study central sensitization as a potential contributing mechanism in ME/CFS.
This study validates a screening tool and does not establish that central sensitization causes ME/CFS or other central sensitivity syndromes—only that the CSI score correlates with their presence. It does not clarify the biological mechanisms underlying central sensitization or whether these severity levels predict prognosis or guide specific treatment decisions. The cross-sectional design means causality cannot be inferred from the observed associations.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Neblett, Randy, Hartzell, Meredith M, Mayer, Tom G, Cohen, Howard, & Gatchel, Robert J (2017). Establishing Clinically Relevant Severity Levels for the Central Sensitization Inventory.. Pain practice : the official journal of World Institute of Pain. https://doi.org/10.1111/papr.12440
BibTeX
@article{mecfsatlas-neblett-2017-establishing-clinically,
author = {Neblett, Randy and Hartzell, Meredith M and Mayer, Tom G and Cohen, Howard and Gatchel, Robert J},
title = {Establishing Clinically Relevant Severity Levels for the Central Sensitization Inventory.},
journal = {Pain practice : the official journal of World Institute of Pain},
year = {2017},
doi = {10.1111/papr.12440},
note = {PubMed: 26989894},
url = {https://www.mecfsatlas.com/evidence/neblett-2017-establishing-clinically},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/neblett-2017-establishing-clinically
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