Efficacy of cupping therapy on pain outcomes: an evidence-mapping study

Liaoyao Wang, Ziling Cai, Xuanlin Li, Aisong Zhu, Liaoyao Wang, Ziling Cai, Xuanlin Li, Aisong Zhu

Abstract

Objective: Cupping therapy is an ancient technique of healing used to treat a variety of ailments. An evidence-mapping study was conducted to summarize the existing evidence of cupping therapy for pain-related outcomes and indicate the effect and the quality of evidence to provide a comprehensive view of what is known.

Methods: PubMed, Cochrane Library, Embase, and Web of Science were searched to collect the meta-analyses investigating the association between cupping therapy and pain-related outcomes. The methodological quality was assessed by using the AMSTAR 2 tool. Significant outcomes (p < 0.05) were assessed using the GRADE system. The summary of evidence is presented by bubble plots and human evidence mapping.

Results: Fourteen meta-analyses covering five distinct pain-related conditions were identified and assessed for methodological quality using the AMSTAR 2, which categorized the quality as critically low (36%), low (50.0%), moderate (7%), and high (7%). In accordance with the GRADE system, no high-quality evidence was found that demonstrates the efficacy of cupping therapy for pain-related outcomes. Specifically, for neck pain, there were two moderate-quality, four low-quality, and two very low-quality evidence, while only one very low-quality evidence supports its efficacy in treating herpes zoster and one low-quality evidence for chronic back pain. Additionally, for low back pain, there were two moderate-quality, one low-quality, and four very low-quality evidence, and for knee osteoarthritis, three moderate-quality evidence suggest that cupping therapy may alleviate pain score.

Conclusion: The available evidence of very low-to-moderate quality suggests that cupping therapy is effective in managing chronic pain, knee osteoarthritis, low back pain, neck pain, chronic back pain, and herpes zoster. Moreover, it represents a promising, safe, and effective non-pharmacological therapy that warrants wider application and promotion.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255879, identifier: CRD42021255879.

Keywords: cupping therapy; evidence mapping; meta-analysis; pain-related conditions; systematic review.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2023 Wang, Cai, Li and Zhu.

Figures

Figure 1
Figure 1
Flow chart of the literature search and screening process.
Figure 2
Figure 2
AMSTAR 2 quality assessment.
Figure 3
Figure 3
Evidence mapping of cupping therapy. KOA, knee osteoarthritis; NP, neck pain; LBP, low back pain; VAS, visual analog scale. The size of the bubbles corresponds to the total population’s sample size for the effects of cupping, with bigger bubbles representing a larger sample size. The colors symbolize the different interventions of cupping and non-cupping groups.
Figure 4
Figure 4
Grade distribution of evidence of cupping therapy for pain-related conditions.

References

    1. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. . The revised international association for the study of pain definition of pain: concepts, challenges, and compromises. Pain. (2020) 161:1976–82. doi: 10.1097/j.pain.0000000000001939, PMID:
    1. St Sauver JL, Warner DO, Yawn BP, Jacobson DJ, McGree ME, Pankratz JJ, et al. . Why patients visit their doctors: assessing the most prevalent conditions in a defined american population. Mayo Clin Proc. (2013) 88:56–67. doi: 10.1016/j.mayocp.2012.08.020, PMID:
    1. Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. Lancet. (2021) 397:2082–97. doi: 10.1016/S0140-6736(21)00393-7, PMID:
    1. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators . Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the global burden of disease study 2016. Lancet. (2017) 390:1211–59. doi: 10.1016/S0140-6736(17)32154-2, PMID:
    1. Fan BF. Blue book of pain prevention and health promotion strategy in China: Report on the development of pain medicine in China (2020). Beijing: Tsinghua University Press; (2020).
    1. Dale R, Stacey B. Multimodal treatment of chronic pain. Med Clin N Am. (2016) 100:55–64. doi: 10.1016/j.mcna.2015.08.012
    1. Chen L, Michalsen A. Management of chronic pain using complementary and integrative medicine. BMJ. (2017) 357:j1284. doi: 10.1136/bmj.j1284
    1. Wang SZ, Lu YH, Wu M, Chen KJ, Liu Y, Liu LT. Cupping therapy for diseases: an overview of scientific evidence from 2009 to 2019. Chin J Integr Med. (2021) 27:394–400. doi: 10.1007/s11655-020-3060-y, PMID:
    1. Chen B, Guo Y, Chen ZL, Shang XK. Cupping: the common wealth of world traditional medicine. World J Acupunct Moxibust. (2016) 26:1–13. doi: 10.1016/S1003-5257(17)30055-7
    1. Mehta P, Dhapte V. Cupping therapy: a prudent remedy for a plethora of medical ailments. J Tradit Complement Med. (2015) 5:127–34. doi: 10.1016/j.jtcme.2014.11.036
    1. Aboushanab TS, Alsanad S. Cupping therapy: an overview from a modern medicine perspective. J Acupunct Meridian Stud. (2018) 11:83–7. doi: 10.1016/j.jams.2018.02.001, PMID:
    1. Hasbani GE, Jawad A, Uthman I. Cupping (hijama) in rheumatic diseases: the evidence. Mediterr J Rheumatol. (2021) 32:316–23. doi: 10.31138/mjr.32.4.316, PMID:
    1. Chiu YC, Manousakas I, Kuo SM, Shiao JW, Chen CL. Influence of quantified dry cupping on soft tissue compliance in athletes with myofascial pain syndrome. PLoS One. (2020) 15:e0242371. doi: 10.1371/journal.pone.0242371, PMID:
    1. Choi TY, Ang L, Ku B, Jun JH, Lee MS. Evidence map of cupping therapy. J Clin Med. (2021) 10:1750. doi: 10.3390/jcm10081750, PMID:
    1. Mohamed AA, Zhang X, Jan YK. Evidence-based and adverse-effects analyses of cupping therapy in musculoskeletal and sports rehabilitation: a systematic and evidence-based review. J Back Musculoskelet Rehabil. (2023) 36:3–19. doi: 10.3233/BMR-210242, PMID:
    1. Salemi MM, Gomes VMDSA, Bezerra LMR, Melo TMS, Alencar GG, Montenegro IHPM, et al. . Effect of dry cupping therapy on pain and functional disability in persistent non-specific low Back pain: a randomized controlled clinical trial. J Acupunct Meridian Stud. (2021) 14:219–30. doi: 10.51507/j.jams.2021.14.6.219, PMID:
    1. Stephens SL, Selkow NM, Hoffman NL. Dry cupping therapy for improving nonspecific neck pain and subcutaneous hemodynamics. J Athl Train. (2020) 55:682–90. doi: 10.4085/1062-6050-236-19, PMID:
    1. Almeida Silva HJ, Barbosa GM, Scattone Silva R, Saragiotto BT, Oliveira JMP, Pinheiro YT, et al. . Dry cupping therapy is not superior to sham cupping to improve clinical outcomes in people with non-specific chronic low back pain: a randomised trial. J Physiother. (2021) 67:132–9. doi: 10.1016/j.jphys.2021.02.013
    1. National Center for Complementary and Integrative Health . (2018). Cupping [EB/OL]. Available at: (Accessed June 19, 2021)
    1. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. . Amstar 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. (2017) 358:j4008. doi: 10.1136/bmj.j4008, PMID:
    1. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. . Grade: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. (2008) 336:924–6. doi: 10.1136/, PMID:
    1. Azizkhani M, Ghorat F, Soroushzadeh S, Karimi M, Yekaninejad S. The effect of cupping therapy on non-specific neck pain: a systematic review and meta-analysis. Iran Red Crescent Med J. (2018) 20:e55039. doi: 10.5812/ircmj.55039
    1. Cao H, Zhu C, Liu J. Wet cupping therapy for treatment of herpes zoster: a systematic review of randomized controlled trials. Altern Ther Health Med. (2010) 6:364–70. doi: 10.1016/j.explore.2010.08.001, PMID:
    1. Cramer H, Klose P, Teut M, Rotter G, Ortiz M, Anheyer D, et al. . Cupping for patients with chronic pain: a systematic review and meta-analysis. J Pain. (2020) 21:943–56. doi: 10.1016/j.jpain.2020.01.002, PMID:
    1. Kim S, Lee SH, Kim MR, Kim EJ, Hwang DS, Lee J, et al. . Is cupping therapy effective in patients with neck pain? A systematic review and meta-analysis. BMJ Open. (2018) 8:e21070: e021070. doi: 10.1136/bmjopen-2017-021070, PMID:
    1. Li JQ, Guo W, Sun ZG, Huang QS, Lee EY, Wang Y, et al. . Cupping therapy for treating knee osteoarthritis: the evidence from systematic review and meta-analysis. Complement Ther Clin Pract. (2017) 28:152–60. doi: 10.1016/j.ctcp.2017.06.003, PMID:
    1. Moura CC, Chaves É, Cardoso A, Nogueira DA, Corrêa HP, Chianca T. Cupping therapy and chronic back pain: systematic review and meta-analysis. Rev Lat Am Enfermagem. (2018) 26:e3094. doi: 10.1590/1518-8345.2888.3094, PMID:
    1. Seo J, Chu H, Kim CH, Sung KK, Lee S. Cupping therapy for migraine: a prisma-compliant systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. (2021) 2021:7582581. doi: 10.1155/2021/7582581, PMID:
    1. Shen WC, Jan YK, Liau BY, Lin Q, Wang S, Tai CC, et al. . Effectiveness of self-management of dry and wet cupping therapy for low back pain: a systematic review and meta-analysis. Medicine. (2022) 101:e32325. doi: 10.1097/MD.0000000000032325, PMID:
    1. Wang YL, An CM, Song S, Lei FL, Wang Y. Cupping therapy for knee osteoarthritis: a synthesis of evidence. Complement Med Res. (2018) 25:249–55. doi: 10.1159/000488707, PMID:
    1. Wang YT, Qi Y, Tang FY, Li FM, Li QH, Xu CP, et al. . The effect of cupping therapy for low back pain: a meta-analysis based on existing randomized controlled trials. J Back Musculoskelet Rehabil. (2017) 30:1187–95. doi: 10.3233/BMR-169736, PMID:
    1. Wood S, Fryer G, Tan L, Cleary C. Dry cupping for musculoskeletal pain and range of motion: a systematic review and meta-analysis. J Bodyw Mov Ther. (2020) 24:503–18. doi: 10.1016/j.jbmt.2020.06.024, PMID:
    1. Xie CJ, Sun ZY, Ji CC, Jinsheng Y. Efficacy and safety of blood pricking and cupping for treating nonspecific low back pain: a systematic review and meta-analysis. J Tradit Chin Med. (2022) 42:869–76. doi: 10.19852/j.cnki.jtcm.20220922.003, PMID:
    1. Yuan QL, Guo TM, Liu L, Sun F, Zhang YG. Traditional Chinese medicine for neck pain and low back pain: a systematic review and meta-analysis. PLoS One. (2015) 10:e117146. doi: 10.1371/journal.pone.0117146, PMID:
    1. Zhang YJ, Cao HJ, Li XL, Yang XY, Lai BY, Yang GY, et al. . Cupping therapy versus acupuncture for pain-related conditions: a systematic review of randomized controlled trials and trial sequential analysis. Chin Med. (2017) 12:21. doi: 10.1186/s13020-017-0142-0, PMID:
    1. Hou X, Bai ZM, Liu JM. Physiological mechanisms and clinical research progress of cupping therapy. Acupunct Res. (2021) 46:254–8. doi: 10.13702/j.1000-0607.200334, PMID:
    1. Rozenfeld E, Kalichman L. New is the well-forgotten old: the use of dry cupping in musculoskeletal medicine. J Bodyw Mov Ther. (2016) 20:173–8. doi: 10.1016/j.jbmt.2015.11.009, PMID:
    1. Emerich M, Braeunig M, Clement HW, Lüdtke R, Huber R. Mode of action of cupping--local metabolism and pain thresholds in neck pain patients and healthy subjects. Complement Ther Med. (2014) 22:148–58. doi: 10.1016/j.ctim.2013.12.013
    1. Subadi I, Nugraha B, Laswati H, Josomuljono H. Pain relief with wet cupping therapy in rats is mediated by heat shock protein 70 and ß-endorphin. Iranian J Med Sci. (2017) 42:384–91. PMID:
    1. Kim S, Kim E, Jung G, Lee S, Kim JG. The hemodynamic changes during cupping therapy monitored by using an optical sensor embedded cup. J Biophotonics. (2019) 12:e201800286. doi: 10.1002/jbio.201800286, PMID:
    1. Song C, Wang Q, Song N. Hemorphin-based analgesia: a mechanism of cupping technique? J Pain Res. (2023) 16:1751–4. doi: 10.2147/JPR.S413021, PMID:
    1. Guo Y, Chen B, Wang DQ, Li MY, Lim CH, Guo Y, et al. . Cupping regulates local immunomodulation to activate neural-endocrine-immune worknet. Complement Ther Clin Pract. (2017) 28:1–3. doi: 10.1016/j.ctcp.2017.04.005, PMID:
    1. Al-Bedah A, Elsubai IS, Qureshi NA, Aboushanab TS, Ali G, El-Olemy AT, et al. . The medical perspective of cupping therapy: effects and mechanisms of action. J Tradit Complement Med. (2018) 9:90–7. doi: 10.1016/j.jtcme.2018.03.003, PMID:

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