DRY NEEDLING VS. CUPPING THERAPY IN MPS

COMPARISON OF THE EFFECTIVENESS OF DRY NEEDLING AND CUPPING THERAPY IN PATIENTS WITH MYOFASCIAL PAIN SYNDROME: A RANDOMIZED TRIAL

This study aimed to compare the effectiveness of dry needling and cupping therapy in patients diagnosed with myofascial pain syndrome involving the trapezius, supraspinatus, infraspinatus, and levator scapulae muscles. Treatment efficacy was evaluated using the visual analog scale (VAS), the number of trigger points, the Likert satisfaction scale, and the multidimensional quality of life scale.

Study Overview

• Status: Completed
• Conditions: Myofascial Pain Syndrome (MPS)
• Intervention / Treatment: Procedure: Cupping therapy; Procedure: Dry needling

Detailed Description

This study evaluated the effectiveness of dry needling (DN) and cupping therapy in 92 patients with chronic myofascial pain syndrome. Participants were randomly divided into two groups: one receiving a 10-session cupping regimen and the other undergoing a three-session dry needling protocol, with both groups performing home-based exercises.

Results showed that both treatments significantly reduced pain and improved patient outcomes over three months. When compared directly, cupping therapy was more effective at reducing trigger points and improving overall quality of life. Conversely, dry needling resulted in higher levels of patient satisfaction. In conclusion, both methods are valuable tools for managing myofascial pain, and the choice of treatment may depend on whether the clinical priority is physical symptom relief or patient preference. Further research is recommended to better define the specific long-term applications of these therapies.

• Study Type: Interventional
• Enrollment (Actual): 92
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Erzurum, Turkey (Türkiye), 25240
    • Ataturk University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Back pain lasting more than three months
• At least one palpable myofascial TN in the trapezius, supraspinatus, infraspinatus, and/or levator scapulae muscles
• Written informed consent

Exclusion Criteria:

• Prior dry needling treatment
• Prior cupping therapy
• Severe cognitive dysfunction
• Spinal fracture
• Infection
• Malignancy
• Ankylosing spondylitis
• Central nervous system injury
• Psychiatric disorder
• Diseases causing tissue degeneration
• Conditions associated with spasticity or cerebrovascular disease
• Cervical radiculopathy due to structural abnormalities
• Muscle or tendon injuries of the shoulder or neck
• Fibromyalgia or other conditions presenting with symptoms similar to myofascial pain syndrome
• Use of anticoagulant or antiplatelet therapy
• Thrombocytopenia or hemorrhagic disorders
• A history of surgery or blood donation within the previous three months
• Pregnancy
• Breastfeeding
• Presence of renal, hepatic, or severe cardiovascular disease

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Cupping therapy arm; Dry cupping was conducted 3 times per week for 9 sessions, followed by one session of wet cupping at the tenth session.	Procedure: Cupping therapy; In the tenth session, wet cupping was performed directly over the patients' TNs. In addition to the TNs, wet cupping was also applied at the Dazhui DU-14 point in all patients. Before initiating the procedure, the treatment area was disinfected with alcohol. Sterile single-use cups numbered 5 and 6 were applied to the treatment area. After 3 to 5 minutes, the cups were removed one at a time. After the area was cleaned, a No. 15 scalpel blade was used to make shallow vertical cuts at the cupping site. Afterward, the cups were returned to the same places. The procedure was performed three times without making any new cuts. The blood was drained, and the cups were put back on. The entire procedure lasted approximately 20 min. The cups were removed at the end of the procedure, and the area that had been treated was cleaned and covered properly.
Active Comparator: Dry needling arm; Participants in this arm received three sessions of dry needling, administered once per week.	Procedure: Dry needling; Needling was performed while the TNs in the levator scapulae, supraspinatus, and upper part of the trapezius muscles were sitting. Patients were placed in the prone position for the middle and lower parts of the trapezius and infraspinatus muscles. To increase the accuracy of localization and minimize the risk of injury to nearby structures, needling was performed under ultrasound guidance. We used the Esaote MyLab 60 ultrasound machine that we have in our clinic for this. Standard single-use sterile acupuncture needles (0.25 mm × 25 mm) were used.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual analog scale	The VAS score was used to measure pain intensity in each patient. Patients were told to rate their pain on a 10-cm horizontal line for the VAS test. A score of 0 indicated no pain, a score of 5 indicated moderate pain, and a score of 10 indicated the worst pain.	From enrollment to the end of the first month
Trigger points count	Trigger points were identified in the trapezius, levator scapulae, supraspinatus, and infraspinatus muscles by the presence of a hypersensitive spot within a palpable taut band, accompanied by a visible or palpable LTR and/or reproduction of referred pain upon palpation of the sensitive point.	From enrollment to the end of the first month
Multidimensional quality of life score	The multidimensional quality of life scale includes a total of 35 items and assesses nine subdomains, each with four items. The overall score is obtained by summing the responses to all the items. Each item is given a score from 1 to 7, with a total score of 35 to 245. Higher scores indicate better functional status.	From enrollment to the end of the first month
Likert satisfaction scale	Patient satisfaction was assessed using a Likert scale, where participants were asked to rate their experience by selecting one of the following options: none, mild, moderately good, good, or very good.	From enrollment to the end of the first month

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Visual analog scale	The VAS score was used to measure pain intensity in each patient. Patients were told to rate their pain on a 10-cm horizontal line for the VAS test. A score of 0 indicated no pain, a score of 5 indicated moderate pain, and a score of 10 indicated the worst pain.	From enrollment to the end of the third month
Trigger points count	Trigger points were identified in the trapezius, levator scapulae, supraspinatus, and infraspinatus muscles by the presence of a hypersensitive spot within a palpable taut band, accompanied by a visible or palpable LTR and/or reproduction of referred pain upon palpation of the sensitive point.	From enrollment to the end of the third month
Multidimensional quality of life score	The multidimensional quality of life scale includes a total of 35 items and assesses nine subdomains, each with four items. The overall score is obtained by summing the responses to all the items. Each item is given a score from 1 to 7, with a total score of 35 to 245. Higher scores indicate better functional status.	From enrollment to the end of the third month
Likert satisfaction scale	Patient satisfaction was assessed using a Likert scale, where participants were asked to rate their experience by selecting one of the following options: none, mild, moderately good, good, or very good.	From enrollment to the end of the third month

Collaborators and Investigators

• Sponsor: Turkish League Against Rheumatism
• Collaborators: Atatürk University Scientific Research Projects Coordination Unit
• Investigators: Study Director: Fatih Baygutalp, Medical doctor, Department of Physical Medicine and Rehabilitation, Ataturk University Faculty of Medicine

Study record dates

Study Major Dates

• Study Start (Actual): March 15, 2022
• Primary Completion (Actual): June 30, 2024
• Study Completion (Actual): August 29, 2025

Study Registration Dates

• First Submitted: June 30, 2026
• First Submitted That Met QC Criteria: June 30, 2026
• First Posted (Actual): July 7, 2026

Study Record Updates

• Last Update Posted (Actual): July 7, 2026
• Last Update Submitted That Met QC Criteria: June 30, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Dry needling; Trigger point; Myofascial pain syndrome; Wet cupping therapy; Dry cupping therapy
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Muscular Diseases; Myofascial Pain Syndromes; Therapeutics; Complementary Therapies; Physical Therapy Modalities; Dry Needling; Cupping Therapy
• Other Study ID Numbers: B.30.2.ATA.0.01.00/286

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: All the patients' demographic characteristics, including age, sex, educational level, occupation, height and weight
• IPD Sharing Time Frame: Beginning 1 year after publication with no end date
• IPD Sharing Access Criteria: Access to individual participant data (IPD) and supporting documentation is provided to the principal investigators and the designated research team. Additionally, access may be granted to journal editors and peer reviewers upon request for the purposes of data verification and manuscript evaluation. All shared information consists exclusively of de-identified, anonymized raw data to ensure participant privacy. Access is managed on a request-only basis, ensuring that data is shared securely and in accordance with ethical standards and institutional guidelines.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No