MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Cupping is a so-called alternative medicine (SCAM) that has existed in several ancient cultures. It recently became popular when US Olympic athletes displayed cupping marks on their bodies, and it was claimed that cupping is used for enhancing their physical performance. There are two distinct forms: dry and wet cupping.

Wet cupping involves scarring the skin with a sharp instrument and then applying a cup with a vacuum to suck blood from the wound. It can thus be seen (and was traditionally used) as a form of blood-letting. Wet cupping is being recommended by enthusiasts for a wide range of conditions. But does it work?

This study compared the effects of wet-cupping therapy with conventional therapy on persistent nonspecific low back pain (PNSLBP). In this randomized clinical trial, 180 participants with the mean age of 45±10 years old, who had been suffering from PNSLBP were randomly assigned to wet-cupping or conventional treatment. The wet-cupping group was treated with two separate sessions (4 weeks in total) on the inter-scapular and sacrum area. In the conventional treatment group, patients were conservatively treated using rest (6 weeks) and oral medications (3 weeks). The primary and the secondary outcome were the quantity of disability using Oswestry Disability Index (ODI), and pain intensity using Visual Analogue Scale (VAS), respectively.
The results show that there was no significant difference in demographic characteristics (age, gender, and body mass index) between the two groups. Therapeutic effect of wet-cupping therapy was comparable to conventional treatment in the 1st month follow-up visits. The functional outcomes of wet-cupping at the 3rd and 6th month visits were significantly superior compared to the conventional treatment group. The final ODI scores in the wet-cupping and conventional groups were 16.7 ± 5.7 and 22.3 ± 4.5, respectively (P<0.01).

The authors concluded that wet-cupping may be a proper method to decrease PNSLBP without any conventional treatment. The therapeutic effects of wet-cupping can be longer lasting than conventional therapy.

Perhaps the authors were joking? In any case, their conclusions cannot be taken seriously. Why? There are several reasons, but the most obvious ones are:

  1. There was no adequate control of the presumably substantial placebo effects of wet cupping.
  2. The control group received a treatment that is known to be ineffective or even detrimental.

For people with acute low back pain, advice to rest in bed is less effective than advice to stay active. Thus comparing wet cupping to a control group treated with bed rest is bound to generate a false-positive outcome for wet cupping.

My final point is perhaps the most important: wet cupping can lead to serious complication, and I therefore do not recommend it to anyone – other than masochists, perhaps.

11 Responses to Wet cupping and dry humour

  • Wow, and our gold medalist swimmer has endorsed this crazy in US. Athletes are looked up to but their beliefs are surreal and very alarming. Wondering if they really believe it or were paid well to endorse. I have a co-worker who wears a titanium encrusted necklace because he is so much better at softball wearing it, in his mind of course. I have posted before but no sign-in procedure. Hopeful same username.

  • Dear Edzard,
    I don’t get your point 1. about controlling the placebo effect. Let us assume that the control group had received an effective treatment. If wet cupping was found to be more effective, then shouldn’t we simply conclude that wet cupping is a better treatment than the control treatment ? Are you saying that it could be thanks to a stronger placebo effect of wet cupping compared to the control treatment ? I can see why it could be considered problematic, but at the same time I am thinking, “well, wet cupping would still be more effective”. Sorry for this probably silly question. I am no expert, but I find these stuffs interesting 🙂

    • I am trying to say that the positive outcome could easily be caused by the non-specific effects of the ritual rather than by a specific effect of cupping.

      • Ok. My question then is: if point 2 did not hold, would point 1 still be relevant ? I mean, if the ritual itself was more effective than the best known treatment, wouldn’t it justify the use of this ritual ?

  • Causing a burning sensation and forcing the tissues to have a higher local blood circulation is done traditionally by

    exercise
    gymnastics
    sports
    hot water
    hot wax
    Baunscheidtism
    Spanish Fly plaster
    Zhenjiu (“sting and heat up” which is falsy translated as “Acupuncture”)
    burning instruments made of iron or other metals are heated and applied to selected points of the skin.
    leech
    massage
    blood letting
    dry and wet cupping
    ultrasound
    radiation therapy
    surgery
    and other methods

    most of it is mixed up with speculative magic which expresses that most medical systems are reacting helplessly in sich cases

    But heating up the tissue or causing a higher local blood supply doesn’t mean that the local regional and global cause for a local painful tissue tension and painful pattern is understood or diagnosed.

    There are no ICD-10 categories for compensation patterns of diseases or for functional disorders caused by compensation patterns of the movement apparatus. So how can something be categorised as a medical problem in studies which is not considered to be a complex situation with mulilayered dynamic and intransparent interconnected problems at all, consisting as a mixture of diseases and of local regional and global patterns and protection reflexes?

  • .. and gua sha of course. (刮痧, “scratch fever”, scraping the skin)
    https://cmjournal.biomedcentral.com/articles/10.1186/1749-8546-5-5
    Usual story of insufficient evidence and poor designs.
    Not that one should argue from ignorance that it doesn’t work.

    • treatments that are not supported by good evidence are considered unproven and should not be used in routine healthcare.

  • Very popular (even mandated) in Islamic medicine.

    “In Islamic Medicine, Hijama (wet cupping) is used by the permission of Allah for the treatment of every type of physical and mential illness or disease and its excellence is recorded in many of the Sahih Hadith.”
    https://prophetic-medicine.blogspot.com/2009/06/cupping.html

    The TCM and AV views would be that it is not suitable for everyone, however, despite the encouragement of the Prophet (bless him).

    Homeopaths would be against it.

  • Ah! The good old days: https://en.wikipedia.org/wiki/Pin_firing Bring it all back, I say, cupping,firing and all.

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