Studies on understanding and managing sleep, cognition, Autonomic and Physical function in patients with non-specific chronic low back pain

This study will be carried out at human performance laboratory and sleep laboratory .the patients with chronic low back pain will be recruited from out patient department, centre for physiotherapy and Rehabilitation Sciences (CPRS), Jamia Millia Islamia. Subjects  will be recruited on the basis of inclusion and exclusion criteria and informed about the study. Subject will be explained the purpose and the possible risks of the study. They will be given an informed consent explaining their rights as research subjects (According to Helsinki declaration,1964). All the patients will be examined for demographics and baseline measures including pain, cognition, subjective sleep parameters (sleep quality, sleep health, sleep hygiene, sleep-related quality of life), objective sleep parameter (polysomnography), autonomic function, physical function (muscle activation pattern and lumbar movement control) and psychosocial factors (fear avoidance, kinesiophobia and pain catastrophising) by using respective outcome measures. After assessing the baseline criterion measures, they shall further be randomly divided into three groups (two intervention and one control group). Group A will receive modern neuroscience approach (Pain neuroscience education and cognition targeted exercise therapy) along with interferential therapy (IFT) and hot pack. Group B will receive cranial 16 electrostimulation in addition to modern neuroscience approach along with IFT and hot pack and group C (control) will receive general trunk stabilization exercises along with IFT and hot pack. Assessment of criterion measures will be taken in 2 subsequent days. On day one, P300 evoked potentials, EMG, interleukin-6 biomarker (saliva) and other subjective parameters will be recorded and participants are requested to come to sleep lab in the night for polysomnography familiarization session. On day two, heart rate variability and also subjects will be asked to come to lab at around 9:30 pm, after having dinner, at their regular bed time for complete polysomnography recording using EEG, EOG and EMG electrodes for the whole night. Moreover, all the subjects will be asked to fill consensus sleep diary daily to get a clearer picture of their sleep/ wake cycle for the complete study duration. The interventions will be given three days per week for a period of eight weeks. After the completion of eight weeks of intervention period, assessment of the outcome variables will be carried out again post intervention. A follow up will be conducted after 12 weeks, assessing all the outcome measures except polysomnography.