Autonomic status and pain profile in patients of chronic low back pain and following electro acupuncture therapy: a randomized control trial.

Pain is a syndrome characterized by several neurophysiological changes including that of the autonomic nervous system. Chronic low back pain (LBP) is a major health problem and is a frequent reason for using unconventional therapies especially acupuncture. This study was conducted to evaluate the autonomic status and pain profile in chronic LBP patients and to observe the effect of electro acupuncture therapy. Chronic LBP patients (n=60) were recruited from the Department of Orthopaedics, GTB Hospital, Delhi. Age and sex matched healthy volunteers were selected as controls (n=30). Following a written consent, LBP patients were randomly allocated into two study groups - Group A received 10 sittings of electro acupuncture, on alternate days, at GB and UB points selected for back pain, while the Group B received a conventional drug therapy in the form of oral Valdecoxib together with supervised physiotherapy. Controls were assessed once while the patients were assessed twice, before and after completion of the treatment program (3 weeks). The autonomic status was studied with non-invasive cardiovascular autonomic function tests which included E: I ratio, 30:15 ratio, postural challenge test and sustained handgrip test. Pain intensity was measured with the visual analogue scale (VAS) and the global perceived effect (GPE). Statistical analysis was performed using repeated measure's ANOVA with Tukey's test. Pain patients showed a significantly reduced vagal tone and increased sympathetic activity as compared to the controls (P<0.05 to P<0.001 in different variables). Following treatment, both the study groups showed a reduction in vagal tone together with a decrease in the sympathetic activity. There was also a considerable relief of pain in both groups, however, the acupuncture group showed a better response (P<0.01). We conclude that there is autonomic dysfunction in chronic LBP patients. Acupuncture effectively relieves the pain and improves the autonomic status and hence can be used as an alternative/additive treatment modality in these cases.

Introducing problem-based learning in physiology in the conventional Indian medical curriculum.

BACKGROUND: Problem-based learning (PBL) is a widely acclaimed student-centred learning method. However, there are few reports of its use in the traditional lecture-practical-tutorial model of learning. We used PBL for teaching one module of Physiology to first-year medical undergraduate students who had no prior exposure to PBL. METHODS: One hundred first-year medical undergraduates enrolled in a medical college, which follows the traditional teaching-learning methods, participated in the exercise. The scheduled classes on 'Physiology of the thyroid gland' were converted into a PBL block to be covered over a week. An orientation of the teachers and students to PBL was done, clinical cases selected and tutor guides prepared before the actual PBL week. During the PBL week, students were exposed to small group discussions and Interactive resource sessions, and were given time for self-study. The PBL week concluded with a review session and evaluation of the PBL block using questionnaires. RESULTS: A comparison of the pre- and post-PBL questionnaire showed a clear preference for PBL over the conventional curriculum for the interactive resource sessions and group discussions. Both students and teachers found PBL rewarding. CONCLUSION: Implementation of PBL is feasible even in a traditional set-up despite limited resources, rigid time schedules and little interaction among various disciplines. We hope our experience would encourage other teachers to introduce appropriately modified PBL in their ongoing curriculum.