Pulsatile dry cupping in chronic low back pain - a randomized three-armed controlled clinical trial

M Teut, A Ullmann, M Ortiz, G Rotter, S Binting, M Cree, F Lotz, S Roll, B Brinkhaus, M Teut, A Ullmann, M Ortiz, G Rotter, S Binting, M Cree, F Lotz, S Roll, B Brinkhaus

Abstract

Background: We aimed to investigate the effectiveness of two different forms of dry pulsatile cupping in patients with chronic low back pain (cLBP) compared to medication on demand only in a three-armed randomized trial.

Methods: 110 cLBP patients were randomized to regular pulsatile cupping with 8 treatments plus paracetamol on demand (n = 37), minimal cupping with 8 treatments plus paracetamol on demand (n = 36) or the control group with paracetamol on demand only (n = 37). Primary outcome was the pain intensity on a visual analogue scale (VAS, 0-100 mm) after 4 weeks, secondary outcome parameter included VAS pain intensity after 12 weeks, back function as measured with the 'Funktionsfragebogen Hannover Rücken' (FFbH-R) and health related quality of life questionnaire Short form 36 (SF-36) after 4 and 12 weeks.

Results: The mean baseline-adjusted VAS after 4 weeks was 34.9 mm (95% CI: 28.7; 41.2) for pulsatile cupping, 40.4 (34.2; 46.7) for minimal cupping and 56.1 (49.8; 62.4) for control group, resulting in statistically significant differences between pulsatile cupping vs. control (21.2 (12.2; 30.1); p < 0.001) and minimal cupping vs. control (15.7 (6.9; 24.4); p = 0.001). After 12 weeks, mean adjusted VAS difference between pulsatile cupping vs. control was 15.1 ((3.1; 27.1); p = 0.014), and between minimal cupping vs. control 11.5 ((- 0.44; 23.4); p = 0.059). Differences of VAS between pulsatile cupping and minimal cupping showed no significant differences after 4 or 12 weeks. Pulsatile cupping was also better (- 5.8 (- 11.5;-0.1); p = 0.045) compared to control for back function after 4 weeks, but not after 12 weeks (- 5.4 (- 11.7;0.8); p = 0.088), pulsatile cupping also showed better improvements on SF-36 physical component scale compared to control at 4 and 12 weeks (- 5.6 (- 9.3;-2.0); p = 0.003; - 6.1 (- 9.9;-2.4); p = 0.002). For back function and quality of life minimal cupping group was not statistically different to control after 4 and 12 weeks. Paracetamol intake did not differ between the groups (cupping vs. control (7.3 (- 0.4;15.0); p = 0.063); minimal cupping vs. control (6.3 (- 2.0;14.5); p = 0.133).

Conclusions: Both forms of cupping were effective in cLBP without showing significant differences in direct comparison after four weeks, only pulsatile cupping showed effects compared to control after 12 weeks.

Trial registration: The study was registered at ClinicalTrials.gov (identifier: NCT02090686 ).

Keywords: Chronic low back pain; Cupping; Low back pain; Minimal cupping; Pulsatile cupping; RCT.

Conflict of interest statement

Ethics approval and consent to participate

The Ethics Committee of Charité Universitätsmedizin Berlin reviewed the study protocol and approved the study (EA1/031/14; 20.02.2014). All participants gave written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Application of the silicone cups at the low back area
Fig. 2
Fig. 2
Participant flow diagram
Fig. 3
Fig. 3
Pain intensity measured by Visual Analogue Scale at 4 and 12 weeks. Legend Fig. 3: VAS, 0–100 mm; 0 = no pain, 100 mm = maximum intensity †low vacuum vs high vacuum, ‡ control vs high vacuum, ‘control vs low vacuum

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Source: PubMed

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