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Acupuncture relieves back and pelvic pain during pregnancy, study suggests | Women’s health

Acupuncture can significantly relieve the lower back or pelvic pain frequently experienced by pregnant women, according to a new global data analysis of the available evidence.

There were no observable major side effects for babies whose mothers opted for the procedure, the findings suggest, although only a few of the studies evaluated outcomes. The meta analysis was published in the journal BMJ Open.

“Acupuncture significantly improved pain, functional status, and quality of life in women with [lower back/pelvic pain] during the pregnancy. Additionally, acupuncture had no observable severe adverse influences on the newborns,” the researchers concluded. “More large-scale and well-designed [randomised controlled trials] are still needed to further confirm these results.”

Acupuncture is emerging as a potential treatment for various different types of pain, largely because it does not involve the need for drugs and is considered safe, say the researchers.

Acupuncture is a treatment derived from ancient Chinese medicine. Fine needles are inserted at certain sites in the body for therapeutic or preventative purposes. It is already used in NHS GP surgeries, as well as in pain clinics and hospices across the UK.

Exactly how it might ease pain is not yet clear, but is thought to involve the release of the body’s innate “happy” chemicals – endorphins – plus increases in blood flow to local skin and muscle. The NHS says it is likely that these naturally released substances are responsible for the beneficial effects experienced with acupuncture.

But whether it can ease the debilitating lower back or pelvic pain experienced by as many as nine in 10 women during their pregnancy remains hotly contested.

To add to the evidence base, the team of Chinese researchers trawled research databases from around the world for relevant clinical trials that looked at the pain relief afforded to pregnant women given acupuncture, alone or when combined with other therapies, as well as the potential impact on their newborns.

The final analysis included 10 randomised controlled trials, involving more than 1,000 women. Every study was published between 2000 and 2020, and carried out variously in Sweden, the UK, the US, Spain and Brazil.

The mothers-to-be were all healthy, 17 to 30 weeks into their pregnancy on average, and had lower back or pelvic pain or both. Acupuncture was delivered either by trained acupuncturists, physiotherapists, or midwives. A total of seven trials described body acupuncture; three described auricular (ear lobe) acupuncture.

Pooled data analysis of the trial results for nine studies suggested that acupuncture significantly relieved pain during pregnancy. Of the four studies reporting on the potential of acupuncture to restore physical function, the results showed that this was significantly improved.

Quality of life was recorded in five studies. When the results of these were pooled, the findings suggested that acupuncture significantly improved this too.

The adjusted pooled data analysis also suggested that acupuncture was safe, and for the four studies reporting on it, that there was no significant difference in health scores of the babies when acupuncture was compared with other interventions, or none.

Seven studies recorded other expected minor side-effects for the mothers-to-be, such as pain, soreness and bleeding at the needle site, and drowsiness. Nevertheless, participants rated acupuncture favourably and most were willing to repeat it, if needed.

The researchers cautioned that the number of included studies was relatively small and their quality variable. The design, methodology, outcomes, and participant characteristics also differed substantially, they added.

Nevertheless, they concluded that acupuncture merits closer attention for its potential to ease pain at a time when it is preferable to avoid drugs because of the potential side-effects for mother and baby.

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Scientists develop first-of-its-kind implant that relieves pain without drugs

Researchers at the Northwestern University have developed a device that sounds straight out of science fiction: a small, soft, flexible first-of-its-kind implant that relieves pain on demand, without the use of drugs and dissolves.

The biocompatible, water-soluble device could provide a much-needed alternative to opioids and other highly addictive medications. As per the researchers, the device could be highly valuable for patients who undergo routine surgeries or amputations that most often need post-operative medications. Surgeons could implant the device during the procedure to ‘manage’ the patient’s post-operative pain.

The study published in the July 1 issue of the journal Science, describes the device’s design and demonstrates its efficacy in an animal model.

The devices employs a simple mechanism

“Although opioids are extremely effective, they also are extremely addictive,” said Northwestern’s John A. Rogers, who led the device’s development, in a press release. “As engineers, we are motivated by the idea of treating pain without drugs — in ways that can be turned on and off instantly, with user control over the intensity of relief. The technology reported here exploits the mechanism that causes your fingers to feel numbers when cold. Our implant demonstrates in animal model studies that this effect can be produced in a programmable way, directly and locally to targeted nerves, even those deep within surrounding soft tissues.”

So, how does it work?

The implant leverages a simple concept – evaporation. It contains a liquid coolant that is prompted to evaporate at the specific location of a sensory nerve. 

To elaborate, the device works by wrapping around nerves softly, to deliver precise and targeted cooling. This in turn numbs nerves and blocks pain signals to the brain. An external pump helps the user to remotely activate the device and control its intensity. Once the device is no longer required, it is naturally absorbed into the body — “bypassing the need for surgical extraction”.

At the thickness of a sheet of paper, the soft, elastic nerve cooling device is ideal for treating highly sensitive nerves.

Study co-author Dr. Matthew MacEwan of Washington University School of Medicine in St. Louis said that as nerves become cooler, the signals that travel through them become slower – eventually stopping completely. 

“We are specifically targeting peripheral nerves, which connect your brain and your spinal cord to the rest of your body. These are the nerves that communicate sensory stimuli, including pain. By delivering a cooling effect to just one or two targeted nerves, we can effectively modulate pain signals in one specific region of the body,” he said.

Ilustration of the implantable device inside an arm. The red oval indicates pain. Source: Northwestern University

Includes an integrated senor to monitor the temperature of the nerve

The device contains tiny microfluidic channels to induce the cooling effect. While one channel contains the liquid coolant perfluoropentane (which is already clinically approved), a second channel contains dry nitrogen. When the liquid and gas flow into a shared chamber, a reaction takes place causing the liquid to immediately evaporate. Concurrently, a tiny integrated sensor monitors the temperature of the nerve to ensure that it doesn’t get too cold, which could damage the tissue.

“By monitoring the temperature at the nerve, the flow rates can be adjusted automatically to set a point that blocks pain in a reversible, safe manner. On-going work seeks to define the full set of time and temperature thresholds below which the process remains fully reversible,” said Rogers.

Former cooling therapies and nerve blockers have limitations, which the new device overcomes. Cryotherapies, for example, approach large areas of tissue, which could lead to unwanted effects. Here, Northwestern’s tiny device is just five millimeters wide and precisely targets only the affected nerves. This spares surrounding areas from unnecessary cooling.

“You don’t want to inadvertently cool other nerves or the tissues that are unrelated to the nerve transmitting the painful stimuli,” said MacEwan. “We want to block the pain signals, not the nerves that control motor function and enable you to use your hand, for example.”

The final disappearing act

The device isn’t Rogers’ first attempt at a bioresorbable electronic one. 

The Rogers lab introduced the concept of transient electronics in 2012, and in 2018, Rogers, MacEwan, and colleagues demonstrated the world’s first bioresorbable electronic device — a biodegradable implant that speeds nerve regeneration. Then, in 2021, Rogers and colleagues introduced a transient pacemaker.

All components of the devices naturally absorb into the body’s biofluids over days or weeks, without requiring surgical extraction.

“If you think about soft tissues, fragile nerves, and a body that’s in constant motion, any interfacing device must have the ability to flex, bend, twist, and stretch easily and naturally,” Rogers said. “Furthermore, you would like the device to simply disappear after it is no longer needed, to avoid delicate and risky procedures for surgical removal.”



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Brain implant relieves patient’s severe depression in “landmark” US study

Malte Mueller | Getty Images

US researchers have successfully relieved a patient’s severe, long-term depression with an electronic implant that acts like a neural pacemaker, resetting the brain circuits associated with negative feelings.

The team at the University of California, San Francisco (UCSF) said the study was “a landmark success” in the scientific effort to treat psychiatric disorders through carefully targeted neural electronics. The study is published in the Nature Medicine journal.

“We’ve developed a precision medicine approach that has successfully managed our patient’s treatment-resistant depression by identifying and modulating the circuit in her brain that’s uniquely associated with her symptoms,” said Andrew Krystal, UCSF professor of psychiatry.

At a press teleconference ahead of the study’s publication, the 36-year-old patient, who asked just to be called Sarah, said the implant had transformed her life after five years of intense depression that would not respond to any drug combination or electroconvulsive therapy. “I felt tortured by suicidal thoughts every day,” she said. “I was at the end of the line.”

Almost immediately after being inserted deep into her brain, the device provided relief, which has so far lasted for a year. When it detects neural activity associated with irrational thoughts, which previously triggered depressive obsessions, its electrodes deliver a short, corrective electric pulse and “poof… the cycle stops,” as Sarah put it.

Deep brain stimulation (DBS) has recently become a routine treatment for epilepsy and Parkinson’s disease but has had limited success against depression, which affects 280 million people globally, according to the World Health Organization. As many as 30 percent of depressed patients do not respond well to existing treatments.

The problem with applying neuro-electronics to depression had been that scientists knew relatively little about the brain circuits associated with the condition. The UCSF team’s key discovery was a “biomarker” indicating the onset of depressive symptoms, a specific pattern of neural activity in the part of the brain called the amygdala that deals with responses to threats.

The DBS device used in the study was adapted from one used to treat epilepsy. When it detects the biomarker in the amygdala, it sends tiny electric pulses to another area, the ventral striatum, which is part of the brain’s reward and pleasure system. This immediately lifts the unwanted mood symptoms.

Sameer Sheth, a neurosurgeon at Baylor College of Medicine in Houston who was not involved in the UCSF research, is carrying out another trial of personalized implants to treat depression and is about to publish positive results. He said the two projects indicated a trend in research toward developing “a more individualized approach to psychiatric treatments,” based on stimulating specific brain circuits.

Although the approach was promising, Sarah was the first patient in the first published trial, UCSF assistant professor of psychiatry Katherine Scangos cautioned. Scangos has enrolled two more people with severe depression to take part in the research and aims for 12 patients altogether.

“We need to look at how these circuits vary across patients and repeat this work multiple times,” she said, “and we need to see whether an individual’s biomarker or brain circuit changes over time as the treatment continues.”

Attaching an implant under the skull with electrodes extending deep into the brain is an expensive, invasive, and potentially risky procedure. Once details of the brain circuits underlying depression are better understood, “we hope to find non-invasive biomarkers that can be used with non-invasive treatments,” Scangos said.

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