The effect of traditional cupping on pain and mechanical thresholds in patients with chronic nonspecific neck pain: a randomised controlled pilot study

Romy Lauche, Holger Cramer, Claudia Hohmann, Kyung-Eun Choi, Thomas Rampp, Felix Joyonto Saha, Frauke Musial, Jost Langhorst, Gustav Dobos, Romy Lauche, Holger Cramer, Claudia Hohmann, Kyung-Eun Choi, Thomas Rampp, Felix Joyonto Saha, Frauke Musial, Jost Langhorst, Gustav Dobos

Abstract

Introduction. Cupping has been used since antiquity in the treatment of pain conditions. In this pilot study, we investigated the effect of traditional cupping therapy on chronic nonspecific neck pain (CNP) and mechanical sensory thresholds. Methods. Fifty CNP patients were randomly assigned to treatment (TG, n = 25) or waiting list control group (WL, n = 25). TG received a single cupping treatment. Pain at rest (PR), pain related to movement (PM), quality of life (SF-36), Neck Disability Index (NDI), mechanical detection (MDT), vibration detection (MDT), and pressure pain thresholds (PPT) were measured before and three days after a single cupping treatment. Patients also kept a pain and medication diary (PaDi, MeDi) during the study. Results. Baseline characteristics were similar in the two groups. After cupping TG reported significantly less pain (PR: -17.9 mm VAS, 95%CI -29.2 to -6.6; PM: -19.7, 95%CI -32.2 to -7.2; PaDi: -1.5 points on NRS, 95%CI -2.5 to -0.4; all P < 0.05) and higher quality of life than WL (SF-36, Physical Functioning: 7.5, 95%CI 1.4 to 13.5; Bodily Pain: 14.9, 95%CI 4.4 to 25.4; Physical Component Score: 5.0, 95%CI 1.4 to 8.5; all P < 0.05). No significant effect was found for NDI, MDT, or VDT, but TG showed significantly higher PPT at pain-areas than WL (in lg(kPa); pain-maximum: 0.088, 95%CI 0.029 to 0.148, pain-adjacent: 0.118, 95%CI 0.038 to 0.199; both P < 0.01). Conclusion. A single application of traditional cupping might be an effective treatment for improving pain, quality of life, and hyperalgesia in CNP.

Figures

Figure 1
Figure 1
Study design.
Figure 2
Figure 2
CONSORT flowchart of recruitment and study conditions.
Figure 3
Figure 3
Pain ratings (pain diary, NRS, mean ± SD) decreased in TG at the day after cupping. *P < 0.05.
Figure 4
Figure 4
Course of pressure pain thresholds at pain-maximum and pain-adjacent (mean ± SD) *P < 0.05.

References

    1. Merskey H, Bogduk N. Classification of Chronic Pain: Description Of Chronic Pain Syndromes and Definitions of Pain Terms. Seattle, Wash, USA: IASP Press ; 1994.
    1. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. European Spine Journal. 2006;15(6):834–848.
    1. Binder A. The diagnosis and treatment of nonspecific neck pain and whiplash. Europa Medicophysica. 2007;43(1):79–89.
    1. Skov T, Borg V, Ørhede E. Psychosocial and physical risk factors for musculoskeletal disorders of the neck, shoulders, and lower back in salespeople. Occupational and Environmental Medicine. 1996;53(5):351–356.
    1. Linton SJ. A review of psychological risk factors in back and neck pain. Spine. 2000;25(9):1148–1156.
    1. Karjalainen K, Malmivaara A, van Tulder M, et al. Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults. Cochrane Database of Systematic Reviews. 2003;(2) Article ID CD002194.
    1. Siivola SM, Levoska S, Latvala K, Hoskio E, Vanharanta H, Keinänen-Kiukaanniemi S. Predictive factors for neck and shoulder pain: a longitudinal study in young adults. Spine. 2004;29(15):1662–1669.
    1. Hogg-Johnson S, van der Velde G, Carroll LJ, et al. The burden and determinants of neck pain in the general population. Results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders. Journal of Manipulative and Physiological Therapeutics. 2009;32(2):S46–S60.
    1. McLean SM, May S, Klaber-Moffett J, Sharp DM, Gardiner E. Risk factors for the onset of non-specific neck pain: a systematic review. Journal of Epidemiology and Community Health. 2010;64(7):565–572.
    1. Schoffermann JA, Koestler ME. Whiplash and neck pain-related disability. In: Schultz IZ, Gatchel RJ, editors. Handbook of Complex Occupational Disability Claims: Early Risk Identification, Intervention and Prevention. New York, NY, USA: Springer; 2005. pp. 203–216.
    1. Jensen I, Harms-Ringdahl K. Strategies for prevention and management of musculoskeletal conditions. Neck pain. Best Practice and Research: Clinical Rheumatology. 2007;21:93–108.
    1. Larsson R, Öberg PA, Larsson SE. Changes of trapezius muscle blood flow and electromyography in chronic neck pain due to trapezius myalgia. Pain. 1999;79(1):45–50.
    1. Strøm V, Røe C, Knardahl S. Work-induced pain, trapezius blood flux, and muscle activity in workers with chronic shoulder and neck pain. Pain. 2009;144(1-2):147–155.
    1. Falla D. Unravelling the complexity of muscle impairment in chronic neck pain. Manual Therapy. 2004;9(3):125–133.
    1. Scott D, Jull G, Sterling M. Widespread sensory hypersensitivity is a feature of chronic whiplash-associated disorder but not chronic idiopathic neck pain. Clinical Journal of Pain. 2005;21(2):175–181.
    1. La Touche R, Fernández-de-las-Peñas C, Fernández-Carnero J, Díaz-Parreño S, Paris-Alemany A, Arendt-Nielsen L. Bilateral mechanical-pain sensitivity over the trigeminal region in patients with chronic mechanical neck pain. Journal of Pain. 2010;11(3):256–263.
    1. Jänig W. Grundlagen von reflextherapien. In: Bühring M, Kremer FH, editors. Naturheilverfahren und Unkonventionelle Medizinische Richtungen. Berlin, Germany: Springer; 2005. pp. 1–104.
    1. Fernández-de-las-Peñas C, Alonso-Blanco C, Miangolarra JC. Myofascial trigger points in subjects presenting with mechanical neck pain: a blinded, controlled study. Manual Therapy. 2007;12(1):29–33.
    1. Javanshir K, Ortega-Santiago R, Mohseni-Bandpei MA, Miangolarra-Page JC, Fernández-De-Las-Peñas C. Exploration of somatosensory impairments in subjects with mechanical idiopathic neck pain: a preliminary study. Journal of Manipulative and Physiological Therapeutics. 2010;33(7):493–499.
    1. Peloso PM, Gross A, Haines T, Trinh K, Goldsmith CH, Burnie S. Medicinal and injection therapies for mechanical neck disorders. Cochrane Database of Systematic Reviews. 2007;(3) Article ID CD000319.
    1. Ezzo J, Haraldsson BG, Gross AR, et al. Massage for mechanical neck disorders: a systematic review. Spine. 2007;32(3):353–362.
    1. Gross AR, Kay T, Hondras M, et al. Manual therapy for mechanical neck disorders: a systematic review. Manual Therapy. 2002;7(3):131–149.
    1. Kay TM, Gross A, Goldsmith C, Santaguida PL, Hoving J, Bronfort G. Exercises for mechanical neck disorders. Cochrane Database of Systematic Reviews. 2005;(3) Article ID CD004250.
    1. Ylinen J. Physical exercises and functional rehabilitation for the management of chronic neck pain. Europa Medicophysica. 2007;43(1):119–132.
    1. Tugwell P. Philadelphia panel evidence-based clinical practice guidelines on selected rehabilitation interventions for neck pain. Physical Therapy. 2001;81(10):1701–1717.
    1. Gross A, Miller J, D’Sylva J, et al. Manipulation or mobilisation for neck pain: a Cochrane Review. Manual Therapy. 2010;15(4):315–333.
    1. Ndao-Brumblay SK, Green CR. Predictors of complementary and alternative medicine use in chronic pain patients. Pain Medicine. 2010;11(1):16–24.
    1. Sherman KJ, Cherkin DC, Hogeboom CJ. The diagnosis and treatment of patients with chronic low-back pain by Traditional Chinese Medical acupuncturists. Journal of Alternative and Complementary Medicine. 2001;7(6):641–650.
    1. Kanodia AK, Legedza ATR, Davis RB, Eisenberg DM, Phillips RS. Perceived benefit of Complementary and Alternative Medicine (CAM) for back pain: a national survey. Journal of the American Board of Family Medicine. 2010;23(3):354–362.
    1. Chirali I. Traditional Chinese Medicine Cupping Therapy. Philadelphia, Pa, USA: Elsevier Churchill Livingston; 2007.
    1. Manz A. The Art of Cupping. Stuttgart, Germany: Thieme; 2009.
    1. Ahmadi A, Schwebel DC, Rezaei M. The efficacy of wet-cupping in the treatment of tension and migraine headache. American Journal of Chinese Medicine. 2008;36(1):37–44.
    1. Cao H, Liu J, Lewith GT. Traditional Chinese medicine for treatment of fibromyalgia: a systematic review of randomized controlled trials. Journal of Alternative and Complementary Medicine. 2010;16(4):397–409.
    1. Farhadi K, Schwebel DC, Saeb M, Choubsaz M, Mohammadi R, Ahmadi A. The effectiveness of wet-cupping for nonspecific low back pain in Iran: a randomized controlled trial. Complementary Therapies in Medicine. 2009;17(1):9–15.
    1. Kim JI, Lee MS, Lee DH, Boddy K, Ernst E. Cupping for treating pain: a systematic review. Evidence-Based Complementary and Alternative Medicine. 2011;2011:7 pages. Article ID 467014.
    1. Lüdtke R, Albrecht U, Stange R, Uehleke B. Brachialgia paraesthetica nocturna can be relieved by “wet cupping”—results of a randomised pilot study. Complementary Therapies in Medicine. 2006;14(4):247–253.
    1. Michalsen A, Bock S, Lüdtke R, et al. Effects of traditional cupping therapy in patients with carpal tunnel syndrome: a randomized controlled trial. Journal of Pain. 2009;10(6):601–608.
    1. Cao H, Zhu C, Liu J. Wet cupping therapy for treatment of herpes zoster: a systematic review of randomized controlled trials. Alternative therapies in health and medicine. 2010;16(6):48–54.
    1. Abele J. Das Schröpfen: Eine Bewährte Alternative Heilmethode. 5th edition. München, Germany: Urban & Fischer; 2003.
    1. Bachmann G, Pecker F. Die Schröpfkopfbehandlung. 3rd edition. Heidelberg, Germany: Haug; 1978.
    1. Irnich D, Behrens N, Molzen H, et al. Randomised trial of acupuncture compared with conventional massage and “sham” laser acupuncture for treatment of chronic neck pain. British Medical Journal. 2001;322(7302):1574–1577.
    1. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Academic Emergency Medicine. 2001;8(12):1153–1157.
    1. Dworkin RH, Turk DC, Wyrwich KW, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. Journal of Pain. 2008;9(2):105–121.
    1. Vernon H, Mior S. The neck disability index: a study of reliability and validity. Journal of Manipulative and Physiological Therapeutics. 1991;14:409–415.
    1. MacDermid JC, Walton DM, Avery S, et al. Measurement properties of the neck disability index: a systematic review. Journal of Orthopaedic and Sports Physical Therapy. 2009;39(5):400–416.
    1. Bullinger M, Kirchberger I, Ware J. The German SF-36 health survey translation and psychometric testing of a generic instrument for the assessment of health-related quality of life. Journal of Public Health. 1995;3(1):21–36.
    1. Bullinger M, Kirchberger I. SF-36. Fragebogen zum Gesundheitszustand. Handanweisung. Göttingen, Germany: Hogrefe; 1998.
    1. Keller SD, Bayliss MS, Ware JE, Jr., Hsu MA, Damiano AM, Goss TF. Comparison of responses to SF-36 health survey questions with one-week and four-week recall periods. Health Services Research. 1997;32(3):367–384.
    1. Rolke R, Magerl W, Campbell KA, et al. Quantitative sensory testing: a comprehensive protocol for clinical trials. European Journal of Pain. 2006;10(1):77–88.
    1. Rolke R, Baron R, Maier C, et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain. 2006;123(3):231–243.
    1. Vickers AJ, Altman DG. Analysing controlled trials with baseline and follow up measurements. British Medical Journal. 2001;323(7321):1123–1124.
    1. Lund I, Lundeberg T. Are minimal, superficial or sham acupuncture procedures acceptable as inert placebo controls? Acupuncture in Medicine. 2006;24(1):13–15.
    1. Sato A. Neural mechanisms of autonomic responses elicited by somatic sensory stimulation. Neuroscience and Behavioral Physiology. 1997;27(5):610–621.
    1. Ernst M, Lee MHM. Sympathetic effects of manual and electrical acupuncture of the Tsusanli knee point: comparison with the Hoku hand point sympathetic effects. Experimental Neurology. 1986;94(1):1–10.
    1. Weerapong P, Hume PA, Kolt GS. The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Medicine. 2005;35(3):235–256.
    1. Johnston V, Jimmieson NL, Jull G, Souvlis T. Quantitative sensory measures distinguish office workers with varying levels of neck pain and disability. Pain. 2008;137(2):257–265.
    1. Treede RD, Rolke R, Andrews K, Magerl W. Pain elicited by blunt pressure: neurobiological basis and clinical relevance. Pain. 2002;98(3):235–240.
    1. Ernst E. Testing traditional cupping therapy. Journal of Pain. 2009;10(6):p. 555.
    1. Lauche R, Cramer H, Choi K-E, et al. The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain—a randomised controlled pilot study. BMC Complementary and Alternative Medicine. 2011;11, article 63
    1. Sherman KJ, Cherkin DC, Hawkes RJ, Miglioretti DL, Deyo RA. Randomized trial of therapeutic massage for chronic neck pain. Clinical Journal of Pain. 2009;25(3):233–238.

Source: PubMed

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