The Mediating Effect of Central Sensitization on the Relation between Pain Intensity and Psychological Factors: A Cross-Sectional Study with Mediation Analysis

BACKGROUND: Central sensitization (CS) and psychological factors are associated with pain intensity; however, the mediating role of CS on the relation between psychological factors and pain intensity remains unclear. OBJECTIVES: We performed mediation analysis to investigate how CS mediates relation between psychological factors and pain intensity. METHODS: Twenty patients with musculoskeletal pain were included in this cross-sectional study. Central sensitization inventory (CSI), one pain intensity-related outcome measure (Short-Form McGill Pain Questionnaire 2 (SFMPQ2)), and three psychological outcome measures (Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale-4 (PCS), and Tampa Scale for Kinesiophobia-11 (TSK)) of all participants were assessed. The mediation analysis with a bootstrap sampling procedure was used to assess the indirect effects. The level of significance was set at 5%. RESULTS: Mediation analysis showed that the HADS-anxiety, HADS-depression, and PCS had significant indirect effects on the pain ratings of CSI. Additionally, the direct effect was significant only for PCS. CONCLUSIONS: The relationship among anxiety symptoms, depression symptoms, and pain intensity was completely mediated by CS. Furthermore, the relationship between catastrophic thinking and pain intensity was partially mediated by CS. Our findings suggest that CS mediates relation between psychological factors and pain intensity, and CS-focused intervention may be important.