What central sensitization means
Endometriosis can send strong pain signals from the pelvis. Over time, the brain and spinal cord may become extra sensitive, like a pain alarm set too high. The pain is real; the nervous system is amplifying it.
Central Sensitization Inventory
CSI-9 patient score
0
/ 36
Answer the 9 items to calculate a complete result.
Screening result pending
Select a response for each item. Higher CSI-9 scores indicate more frequent symptoms associated with central sensitization-related presentations.
Clinical note
The CSI-9 is a screening questionnaire, not a diagnosis. Results should be interpreted with the patient history, examination, and clinical judgment.
Cutoff reference: Tanaka et al., Pain Practice, 2020. A score of 20 was reported as useful for identifying central sensitization-related symptoms when comparing fibromyalgia and musculoskeletal disorder groups.
Patient questionnaire
Rate each statement
0 Never · 1 Rarely · 2 Sometimes · 3 Often · 4 Always
Patient explanation
Why pain can persist after treating endometriosis
Pain input
Endometriosis lesions, scarring, or organ-specific pain
Nervous system
Brain and spinal cord turn the volume up
Pain experience
Pain may spread, flare more easily, or persist
How the CSI-9 score is used
A higher CSI-9 score suggests the nervous system may be more sensitized. This does not mean surgery cannot help. It means treatment planning may need to address both the pain source and the pain amplifier.
Remove ongoing pain triggers
Targets endometriosis lesions, scarring, and bladder, bowel, pelvic floor, or other organ contributors.
Examples: excision surgery and treatment of specific pelvic pain contributors.Calm the pain amplifier
Targets overactive pain pathways, muscle guarding, fear, poor sleep, and activity sensitivity.
Examples: pelvic floor physical therapy, CBT or pain reprocessing, graded activity, sleep plan, and selected medications.The goal is better function and less pain by treating both sides of the problem: reducing ongoing pain triggers and helping the nervous system become less reactive. Discuss the individual plan with the clinician.