WWA AND PRP
Description
Wrist-ankle acupuncture for pain relief during panretinal photocoagulation in patients with proliferative diabetic retinopathy: a retrospective self-controlled study Lu Lixin1, Liu Lin2, Zhang Meng2, Zhao Meng2, Shi Xiujuan2, Yu Jing2, Li Jipeng, Li Wang2, Chen Liyun2,* 1Department of Nursing, Beijing Tongren Hospital, Capital Medical University, Beijing, China 2Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China *Correspondence: Chen Liyun, Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China. Email: [to be added before submission] Author note: Zhang Meng and Zhao Meng are two distinct authors; please retain both names as listed. Running title: Wrist-ankle acupuncture for PRP pain Abstract Background: Panretinal photocoagulation (PRP) remains a core treatment for proliferative diabetic retinopathy (PDR), but procedural pain can impair cooperation, completion, and return for repeated sessions. Wrist-ankle acupuncture (WAA) may provide a low-burden adjunctive analgesic option in outpatient retinal laser care. Methods: This single-center retrospective self-controlled study reviewed routine clinical records of newly diagnosed PDR patients who initiated full-course PRP at a tertiary eye hospital between December 2021 and March 2025. Eligible patients had two comparable PRP sessions, one with adjunctive WAA and one without WAA. The primary outcome was immediate post-PRP Numerical Rating Scale (NRS) pain score. Secondary outcomes were worst NRS pain within 24 h, intolerable pain button-press episodes, rescue oral analgesic use within 24 h, willingness to continue WAA, and adverse events. Paired analyses were used. Results: Among 120 screened records, 111 paired patient records were included. WAA-assisted sessions had lower immediate post-PRP NRS than control sessions (2.6 ± 1.2 vs 4.3 ± 1.7; mean paired difference, −1.71; 95% CI, −1.95 to −1.47; P<0.001; Cohen’s dz=−1.34). WAA-assisted sessions also had lower worst NRS within 24 h (1.8 ± 0.9 vs 2.9 ± 1.3; mean paired difference, −1.15; 95% CI, −1.37 to −0.94; P<0.001), fewer intolerable pain episodes (median 4 [IQR 2,6] vs 8 [IQR 2,10]; P=0.033), and lower rescue oral analgesic use (9.0% vs 20.7%; P=0.0106). At the third PRP visit, 102/111 patients (91.9%) were willing to continue WAA. No needling-related safety signal or PRP interruption was recorded. Conclusions: In this retrospective self-controlled analysis, WAA was associated with clinically relevant reductions in PRP-associated pain, lower rescue analgesic use, high patient acceptance, and no recorded safety signal. Because treatment allocation was not randomized and no sham control was used, these findings are hypothesis-generating and require confirmation in prospective sham-controlled studies.