Central Sensitization as a Marker of Cognitive and Emotional Vulnerability in Chronic Low Back Pain

Background and Aim: Low back pain (LBP) represents an important public health issue, with approximately 20% of acute cases progressing to chronic low back pain (CLBP). In addition to pain, patients with CLBP also suffer from reduced cognitive performance, depressive symptoms and catastrophic thoughts. Central sensitization (CS) is considered a key point in pain persistence. This study examines CS and its impact on cognitive, emotional, and behavioral functioning in patients with CLBP. Methods: In this cross-sectional study, 67 patients with CLBP were classified using the Central Sensitization Inventory (CSI) into groups with (WCS, n = 32) and without central sensitization (WoCS, n = 35). Cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA), emotional functioning using the Center for Epidemiologic Studies Depression Scale (CES-D), and behavioral functioning using the Pain Catastrophizing Scale (PCS), including helplessness, rumination, and magnification domains. Normality was assessed using the Shapiro-Wilk test. Between-group comparisons were performed using Mann-Whitney U, chi-square, or Welch's t-tests. Multivariable linear regression analyses adjusted for age and gender were conducted. Results: Compared with the WoCS group, patients with central sensitization were older (median 58 vs. 50 years, p = 0.001) and more frequently female (71.9% vs. 40.0%, p = 0.018). The WCS group showed higher PCS total scores (31.8 ± 14.2 vs. 16.0 ± 11.9), higher helplessness (14.3 ± 6.1 vs. 6.9 ± 5.5), rumination (12.7 ± 6.2 vs. 7.0 ± 4.8), and magnification scores (4.8 ± 2.4 vs. 2.1 ± 2.1), higher CES-D scores (26.3 ± 10.4 vs. 11.7 ± 7.2), and lower MoCA scores (23.6 ± 3.0 vs. 26.1 ± 2.1) (all p < 0.001). All associations remained significant after adjustment for age and gender. Conclusions: Central sensitization in CLBP is independently associated with greater pain catastrophizing across all domains, increased depressive symptoms, and reduced cognitive performance, supporting its role as a multidimensional clinical phenotype.