Battlefield Acupuncture for Palliation of Periprocedural and Postprocedural Pain during Platelet-Rich Plasma Injections

Abstract

Platelet-rich plasma (PRP) is a biologic agent commonly used in sports medicine practice for a variety of injuries (1). The mechanism of PRP is based on the principle that inflammation is integral to healing activation and autologous activated platelets and their contents have an active role in this process (2). PRP injected directly at a site of joint injury (which may include tendinopathies and tears of muscles, ligaments, and tendons) induces a cascade of cytokines and chemokines that signal cellular proliferation, differentiation, and proteosynthesis (2,3). Platelets also upregulate receptors that mediate the inflammatory response by preventing excess leukocyte recruitment from anti-inflammatory cytokines (2).Since the PRP-induced healing process starts with inflammation, patients frequently experience pain during injection and in the days following the procedure. When considering the additional mechanical effects of targeted percutaneous tissue fenestration during concomitant PRP delivery, patient discomfort is a common, but undesired short-term effect. Procedural pain can be a source of distress for the patient and may even lead to temporal functional decline, despite the potential for longer-term therapeutic improvements in outcomes. While the astute sports medicine clinician will provide informed consent, patient-centered shared decision making,