Oral Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

Screening System for Assessing Suitability of Cognitive Behavioral Therapy for Chronic Low Back Pain (116104)

Keisuke KS Shimizu 1 2 , Kazuhide KI Inage 1 , Hiroto HC Chikubu 1 , Sumihisa SO Orita 1 3 , Shiga YS Yasuhiro 1 , Yawara YE Eguchi 1 , Masahiro MI Inoue 1 , Seiji SO Ohtori 1
  1. Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
  2. The Futuristic Medical Care Education and Research Organization, Chiba University, Chiba, Japan
  3. Center for Frontier Medical Engineering, Chiba University, Chiba University, Chiba, Japan

INTRODUCTION

An objective method to evaluate patient suitability for cognitive behavioral therapy (CBT) for chronic low back pain (LBP) is currently lacking[1]. Inappropriate application can result in prolonged hospital visits and increased medical costs. Therefore, identifying an objective biomarker for evaluating suitability is crucial.

This study focused on electroencephalogram (EEG) complexity as a potential biomarker for evaluating CBT suitability for chronic LBP, assessing its discriminative ability and identifying factors that impede treatment.　EEG complexity is an index of cognitive flexibility and synchronization. We hypothesized that EEG complexity would decrease in chronic low back pain, affecting the effectiveness of CBT.　Complexity was analyzed as multiscale fuzzy sample entropy (MFSE)[2]. This is a case-control study that focused on EEG complexity, IQ, and developmental disorder tendencies as neuropsychological markers to predict suitability for CBT in patients with chronic low back pain.

METHODS

This study included 50 patients with chronic LBP(Fig 1). All participants had no history of back surgery, who confirmed the absence of major organic factors contributing to their LBP symptoms

based on MRI images and neurological symptoms. Additionally, these patients had not benefited from standard orthopedic treatments. After 10 CBT sessions, patients were classified into responder and non-responder groups based on the rate of change from baseline in VAS scores, and the mean difference in MFSE between the two groups was evaluated using Repeated Measures ANOVA. This study used the wearable device Muse2 (InteraXon Inc., Toronto, Canada; https://choosemuse.com/muse-2/) to facilitate simple and clinical-grade EEG measurements. Intelligence quotient and tendency toward developmental disorders were evaluated using the WAIS-4 and AQ. 

RESULTS

Cognitive Abilities(Fig 2)

One-way ANOVA revealed VCI(Verbal Comprehension Index) of the non-responder group was 89.36 (7.04), significantly lower compared to the responder group (F(1,48)=51.65, p<.01). Also, significant differences were found in attention switching (F(1,48)=14.87, p<.01), local details (F(1,48)=17.87, p<.01) and imagination (F(1,48)=13.29, p<.01), indicating that the non-responder group had difficulty switching attention, stronger obsession to details and lower imagination.

EEG Complexity:MFSE(Fig3)

MFSE showed significant effects of scale factor [F(19,171)=14.82, p < .01, partial η2=0.622] and interaction between group and scale factor [F(38,171)=7.34, p < .01, partial η2=0.620]. The low-frequency band MFSE score had an odds ratio of 10.768 (95% confidence interval: 8.263–10.044, p < .001). The low-frequency band showed a high discriminative ability for suitability about CBT (area under the curve: 0.825), with a cut-off value of 1.25.

DISCUSSION

In this study, we focused on EEG complexity (MFSE) as an objective evaluation of CBT suitability for patients with chronic LBP and assessed its discriminative ability. Low-MFSE in the low-frequency band had the strongest influence on the presence or absence of CBT effects and could be used to evaluate CBT suitability with high sensitivity(Fig 4). Previously, no evidence-based evaluation criteria existed for CBT suitability, and evaluation required lengthy psychological tests and interviews. The method developed in this study allows for quicker evaluation in outpatient settings, reducing the burden on both patients and medical professionals and allowing for a more effective treatment. 

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