Questionnaires Developed at PRIDE


Self-report questionnaires are often used for initial patient assessment and for measuring treatment effects and responsiveness. Three unique clinical questionnaires, the Pain Disability Questionnaire (PDQ), the Central Sensitization Inventory (CSI), and the Fear-Avoidance Components Scale (FACS) have been developed and validated at PRIDE. All patients who enter the PRIDE functional restoration program complete a comprehensive self-report test battery, including these three measures, at admission, and all those who finish the program complete an identical battery at discharge.

Pain Disability Questionnaire (PDQ)

The PDQ is a self-report questionnaire designed to measure functional disability in patients with pain disorders involving the neuromuscluloskeletal system. The PDQ has demonstrated excellent psychometric properties, including test-retest reliability coefficients ranging from 0.94 to 0.98 and a Cronbach’s alpha coefficient of 0.96. In fact, the PDQ has been shown to have better psychometric properties than other similar self-report disability questionnaires that have been reported in the literature. In addition, higher PDQ scores, both before and after functional restoration treatment, have been shown to be predictive of poorer socioeconomic outcomes one-year after treatment discharge, including poorer rates of work return and retention.

The PDQ uses a visual analog scale, scored from 0 to 10, for each of the 15 items. Add the items to determine a Total Functional Disability score, which ranges from 0 to 150. Five functional disability severity levels have been recommended to aid clinical interpretation: Mild = 1 – 40; Moderate = 41 -70; Severe = 71 – 100; Very Severe = 101 – 130; and Extreme = 131 – 150. Two subscale scores can also be determined. The score total from items 1, 2, 3, 4, 5, 6, 7, 12, 13 indicate a Functional Status Component (FSC), and the score total from items 8, 9, 10, 11, 14, and 15 indicate a Psychosocial Component (PC).

Supporting References:

  • Anagnostis C, Gatchel R, Mayer T. (2004). The Pain Disability Questionnaire: A New Psychometrically Sound Measure for Chronic Musculo-skeletal Disorders. SPINE. October; 29(20): 2290-2302.
  • Gatchel R, Mayer T, Theodore B. (2006). The Pain Disability Questionnaire: Relationship to One-Year Functional and Psychosocial Rehabilitation Outcomes. The Journal of Occupational Rehabilitation. March; 16(1): 75-94.

Central Sensitization Inventory (CSI)

Central Sensitization (CS) is a neurophysiological phenomenon in which central nervous system neurons become hyper-excitable, resulting in abnormal and intense enhancement of pain. Central Sensitivity Syndrome (CSS) is a newly proposed category for a group of inter-related disorders for which CS is a common etiology, including the following:


  • Fibromyalgia
  • Myofascial Pain Syndrome
  • Chronic Fatigue Syndrome
  • Temporomandibular Joint Disorder
  • Irritable Bowel Syndrome
  • Migraine/Tension Type Headaches
  • Restless Leg Syndrome
  • Multiple Chemical Sensitivity

The Central Sensitization Inventory (CSI) was developed to assess the overlapping health-related symptom dimensions of CS/CSSs. Part A has 25 items scored from 0 to 4. Total scores range from 0-100. Part B (which is not scored) asks if one has previously been diagnosed with one or more specific disorders, including seven separate CSSs and three CSS-related disorders. The CSI has now been translated, and psychometrically validated, in a number of different languages.

The CSI was initially introduced in 2012. In its initial psychometric evaluation, the CSI was found to have a high degree of test-retest reliability and internal consistency (Pearson’s r = .82; Cronbach’s alpha= .88). Subsequent validation studies revealed that CSI scores were highly correlated with the presence of one or more CSSs in patients referred to a psychiatric chronic pain management clinic. Additional analyses determined that a cut-off score of 40 out of 100 on the CSI produced good sensitivity (81%) in correctly identifying a group of CSS patients, and acceptable specificity (75%) in correctly identifying a group of non-patient comparison subjects. More recently, severity levels have been proposed, in order to provide more useful information to clinicians and researchers in assessing a patient’s CS/CSS-related symptoms and documenting meaningful clinical changes in response to treatment. The following severity ranges have been recommended: Subclinical = 0 to 29; Mild = 30 to 39; Moderate = 40 to 49; Severe = 50 to 59; and Extreme = 60 to 100.


Supporting References:

English version (CSI-En):

  • Mayer TG, Neblett R, Cohen H, Howard KJ, Choi YH, Williams MJ, Perez Y, Gatchel RJ. (2012). The development and psychometric validation of the central sensitization inventory. Pain Practice. April; 12(4):276-85.
  • Neblett, R, Choi, Y, Hartzell, M, Williams, M, Cohen, H, Mayer, TG, Gatchel, RJ (2013). Establishing clinically relevant cutoff scores for the Central Sensitization Inventory (CSI). The Journal of Pain. May; 14(5): 438-445.
  • Neblett R, Hartzell M, Cohen H, Mayer T, Williams M, Choi Y, Gatchel R. (2015). Ability of the Central Sensitization Inventory to Identify Central Sensitivity Syndromes in an Outpatient Chronic Pain Sample. Clinical Journal of Pain. April; 31(4): 323-332.
  • Neblett R; Hartzell M; Mayer TG; Cohen H; Gatchel RJ. (2016). Establishing Clinically Relevant Severity Levels for the Central Sensitization Inventory. Pain Practice: The Official Journal Of World Institute Of Pain. Feb;17(2):166-175.
  • Neblett R, Hartzell MM, Williams M, Bevers KR, Mayer TG, Gatchel RJ (2017). Use of the central sensitization inventory (CSI) as a treatment outcome measure for chronic spinal pain disorder patients in a functional restoration program. Accepted for publication in The Spine Journal.

Mexican/Central American Spanish CSI:

Developed at PRIDE (2012)

European Spanish (CSI-Sp):

Developed by Antonio I Cuesta-Vargas, PhD, and colleagues, Cátedra de Fisioterapia, Departamento de Fisioterapia, Universidad de Malaga, Andalucia Tech, Instituto Investigacion de Biomédica de Malaga (IBIMA) Grupo de Clinimetria (F-14). Av/ Arquitecto Peñalosa s/n (Teatinos Campus Expansion) 29009 Malaga (Spain)

Cuesta-Vargas AI, Roldan-Jimenez C, Neblett R, Gatchel RJ. (2016) Cross-cultural adaptation and validity of the Spanish central sensitization inventory. Springerplus. Oct 21;5(1):1837.

French (CSI-Fr):

Developed by Laurent Pitance, PhD, and colleagues, Clinical research institute (IREC), Université Catholique de Louvain, Oral and maxillo-facial Surgery Department and Cliniques Universitaires Saint-Luc, Brussels

Pitance, L., Piraux, E., Lannoy, B., Meeus, M., Berquin, A., Eeckhout, C., … & Roussel, N. (2016). Cross cultural adaptation, reliability and validity of the French version of the central sensitization inventory. Manual Therapy, 25, e83-e84.

Dutch (CSI-D):

Developed by Professor C.Paul van Wilgen, PT, PhD. Vrije Universiteit Brussel · Faculty of Physical Education and Physiotherapy; Jeroen Kregel, MSc, PhD Student Ghent University, Gent · Department of Rehabilitation Sciences and Physiotherapy; Professor Jo Nijs, PT, MT, PhD Vrije Universiteit Brussel, Brussels · Physiotherapy, Human Physiology & Anatomy (KIMA); and colleagues.

Kregel J, Vuijk PJ, Descheemaeker F, Keizer, D., van der Noord, R., Nijs, J., … & van Wilgen, P. (2016).The Dutch Central Sensitization Inventory (CSI): Factor Analysis, Discriminative Power and Test-Retest Reliability. Clin J Pain. Jul;32(7):624-30.

Gujarati (CSI-G):

Developed by Dr. Dibyendunarayan Bid, PT, and colleagues, The Sarvajanik College of Physiotherapy, Rampura, Surat

Bid Dibyendunarayan D, Soni Neela C, Rathod Priyanshu V, Thangamani Ramalingam A. Content Validity and Test-Retest Reliability of the Gujarati Version of the Central Sensitization Inventory. NJIRM 2016;7(5):18-24.

Brazilian Portuguese (CSI-BP):

Developed by Wolnei Caumo M.D. PhD, and colleagues, Post-graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA), Laboratory of Pain and Neuromodulation at UFRGS,Porto Alegre, Brazil; and Surgery Department, School of Medicine, UFRGS, Porto Alegre, Brazil.

Caumo W, Ruehlman LS, Karoly P, et al. (2017). Cross-Cultural Adaptation and Validation of the Central Sensitization Inventory for a Brazilian Population and its relationship with the function of descending pain modulatory system and with the serum BDNF. Accepted for publication in the Journal of Pain Research.

Serbian (CSI-Serb):

Developed by Aleksandar Knezevic, MD, PhD, and colleagues, Faculty of Medicine, University of Novi Sad, Serbia and Medical Rehabilitation Clinic, Clinical Centre of Vojvodina, Novi Sad, Serbia.

Knezevic A, Neblett R, Jeremic-Knezevic M, et al. (2017). Cross cultural adaptation and psychometric validation of the Serbian version of the central sensitization inventory (CSI). Accepted for publication in Pain Practice: The Official Journal of World Institute of Pain.

Japanese (CSI-J):

Developed by Tomohiko Nishigami, PT, PhD, and colleagues, The Sansom Institute for Health Research, The University of South Australia, School of Health Sciences, City East Campus, Adelaide, SA

(Psychometric validation is currently in progress)

Italian (CSI-I):

Developed by Alessandro Chiarotto, MSc, and colleagues, Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam; The Netherlands and Department of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit, Amsterdam, The Netherlands; and Amsterdam Public Health, Amsterdam, The Netherlands

(Psychometric validation is currently in progress)

Fear Avoidance Components Scale (FACS)

Pain-related avoidance of activities, due to fear of increased pain or (re)injury, is a common problem for people with painful medical conditions. Fear-avoidance (FA) can lead to decreased functioning and to disability from activities of daily living. Though other self-report measures of FA are available, they have been criticized for not adequately evaluating all important components of FA. The Fear-Avoidance Components Scale (FACS), originally introduced in 2015, is a new measure of FA that attempts to improve on these earlier instruments by comprehensively evaluating important cognitive, behavioral, and affective components of FA in patients with painful medical conditions.

The FACS has 20 items, scored on a 6-point Likert scale, for a total score range of 0 to 100. Total scores indicate one of the following severity levels: Subclinical (0-20); Mild (21-40); Moderate (41-60); Severe (61-80); and Extreme (81-100). In its initial published validation study, the FACS demonstrated strong test-retest reliability (Pearson r between .9 and .94) and internal consistency (Cronbach’s alpha between .89 and .92). The FACS severity levels corresponded well with score distributions from different subject populations with painful medical conditions. Subjects with the highest level of functioning, and presumably the lowest disability and FA, scored in the lower FACS severity levels. Subjects with the lowest levels of functioning, and presumably the highest disability and FA, scored in the higher FACS severity levels. In addition, strong associations were found among FACS scores and other FA-related psychosocial patient-reported outcome variables and objective lifting performance variables in a chronic musculoskeletal pain disorder population admitted to an interdisciplinary functional restoration program.

Supporting References:

Neblett R, Mayer TG, Hartzell MM, Williams MJ, Gatchel RJ. The fear-avoidance components scale (FACS): Development and psychometric evaluation of a new measure of pain-related fear avoidance. Pain Practice: The Official Journal Of World Institute Of Pain. 2016 Apr; 16 (4):435-50.

Neblett R, Mayer TG, Williams M, Asih S, Cuesta-Vargas AI, Hartzell MM, Gatchel RJ. (2017). The fear-avoidance components scale (FACS): Responsiveness and functional restoration treatment outcomes in a chronic musculoskeletal pain disorder (CMPD) population. Accepted for publication in the Clinical Journal of Pain.