cupping
I am sure that many of my readers have no idea what ‘Slinding Cupping Therapy’ is. It is a TCM therapy that, according to the authors of this paper, receives much appreciation for treating plaque psoriasis. This study was designed to test the hypothesis that sliding cupping therapy is non-inferior to narrowband ultraviolet B (NBUVB) therapy in improving disease severity in patients with plaque psoriasis.
This prospective trial recruited 60 patients with plaque psoriasis who were randomized to receive either sliding cupping intervention or NBUVB treatment. The cup was moved 30 times for each skin lesion until the target skin area turned purple. The initial dose (mJ/cm2) of ultraviolet radiation b (UVB) was determined based on sun-reactive skin types I through VI, which ranged from 300 mJ/cm2 to 800 mJ/cm2. Both treatments were performed 3 times per week for 8 weeks. The primary endpoint was the percentage reduction in Psoriasis Area and Severity Index (PASI) score at week 8, with secondary endpoints, including Physician’s Global Assessment (PGA), body surface area, visual analogue scale scores, and quality of life measures.
The total response rates were 69% (18/26) and 79% (19/24) for patients receiving sliding cupping intervention and those receiving NBUVB treatment, respectively, which showed no significant difference (P = .526). The PASI scores, body surface area, and PGA were reduced in patients with plaque psoriasis at W0, W4 and W8 after either sliding cupping intervention or NBUVB treatment (P <.001), and these reductions were not significantly different between the patients receiving sliding cupping intervention and those receiving NBUVB treatment at W0, W4, W8, and W12. At W8, the mean percentage reduction in PASI was 62.4% (95% CI, 54.9–69.8) in the sliding cupping group and 66.9% (95% CI, 59.6–74.2) in the NBUVB group, with no significant difference between groups. The total response rates were 69.23% (18/26) and 79.17% (19/24), respectively (P = .526). Patients receiving sliding cupping intervention and those receiving NBUVB treatment did not show statistically significant differences in these outcomes at W0, W4, W8, and W12 (P >.05).
The authors concluded that the overall results suggest that sliding cupping therapy exhibits statistically similar efficacy and safety profiles as NBUVB treatment, especially at 8 weeks after treatment.
Sliding cupping therapy is a form of cupping in which cups producing mild suction are placed on oiled skin and then moved along the body surface, generating a “reverse massage” that lifts rather than compresses the subcutaneous tissues. The negative pressure is thought to increase local blood flow and lymphatic drainage, reduce perceived muscle tension, and temporarily improve range of motion, though high‑quality clinical evidence for most claimed benefits remains limited.
The treatment is used mainly by massage therapists, physiotherapists, and TCM practitioners in musculoskeletal and sports‑rehab settings, as well as in wellness and spa‑oriented clinics; it is commonly applied to the back, shoulders, neck, limbs, and along fascial lines or acupuncture meridians, often for pain, stiffness, “trigger‑point”‑type tension, and post‑exercise recovery. The popularity of this therapy is best characterised as a niche within broader cupping and fascial‑release practice rather than a mainstream standard treatment.
The new study is a text-book example of how to mislead people with seemingly reliable research. The fact that it was grossly under-powered – and not the effectiveness of the sliding cupping therapy – is obviously the cause of the lack of a difference between the effective therapy (NBUVB) and the sliding quackery.
Let me give you an example: say, we compare antibiotics (A) to homeopathy (H) as treatments for bacterial pneumonia. We treat 10 patientsin each group, and 8 of them recover in group A within a week, while in the H-group the amount is 6 (many patients recover even without an effective treatment). We run statistical tests which tell us that the difference is not significant. Thus we falsely conclude that homeopathy is as effective as antibiotics in the treatment of pneumonia. The 2 treatments were, in fact, not equal but the lack of power of the small study failed to detect the existing difference.
It seems rather obvious to me that a similar thing has happened with the above study. Its authors are to be congratulated for cheating so slyly that neither the editors nor the reviewers of the journal ‘Medicine’ managed to see through their simple litte trick.
This study aimed to evaluate the comparative effectiveness of “fire cupping therapy” (FC) versus electroacupuncture for reducing pain and improving cervical spine range of motion in patients with neck pain due to cervical spondylosis. FC is essentially nothing else than the TCM version of cupping.
Eighty-two participants with neck pain caused by cervical spondylosis were randomly allocated in 1:1 ratio to either the fire cupping (FC) or the electroacupuncture (EA) group. Both groups received treatment at the EX-B2, A-shi, and GB21 acupuncture points. The two-week study assessed pain levels using the Visual Analog Scale (VAS) at 2 points in time post-intervention and evaluated adverse effects weekly.
After 2 weeks of intervention, VAS scores significantly decreased in both the FC group (from 6 (6–7) to 3 (2–3)) and the EA group (from 6 (6–7) to 2 (1–3)) (p<0.001). However, inter-group pain relief was not statistically significant (p = 0.5794, Cohen’s d = 21 0.12; 95% CI [-0.31–0.6]). Both groups showed statistically significant ROM improvement (p<0.001), though the EA group demonstrated better improvement in flexion, extension, and left/right lateral flexion (p<0.05). No adverse effects of FC were reported.
The authors concluded that FC appears to be an effective and safe therapy for neck pain due to cervical spondylosis, showing similar pain relief efficacy with no statistically significant difference compared to electroacupuncture despite a lower treatment dosage. However, due to methodological limitations, these findings should be interpreted with caution and warrant further validation in rigorously designed studies.
I do agree with the authors’ call for caution – but with little else of what they state. Here are some of my concerns:
- A trial comparing two supposedly active treatments is an ‘equivalence study’; and such investigations require much larger sample sizes that 80.
- Equivalence studies only make sense, if one of the two treatments has been shown beyond doubt to be effective; this is not the case for electroacupuncture nor for FC.
- As it stands, the study does not control for placebo effects; thus the findings are in accordance with both treatments being pure placebos.
- A study with 80 patients tells us as good as nothing about the safety of the iterventions; to draw conclusions about safety is thus unwarranted
My conclusion (yet again) is this:
If you design a nonsense study, you are asking for a nonsense result.
Fatigue is one of the most common symptoms in patients with Multiple Sclerosis (MS). It can cause severe psychological problems and reduce their Quality of Life (QOL). Cupping therapy is known as a method of alternative medicine that can be used to treat or reduce patient symptoms. Thus, this randomized clinical trial was conducted to determine the effect of dry cupping therapy on the fatigue and QOL of women with MS.
It 60 patients (30 patients in each group) with MS referred to the Medical Center of Special Diseases in southeast Iran. Patients in the intervention group received eight sessions of dry cupping therapy (plus standard care) twice a week over 4 weeks, while the control group received just standard care. Data were collected before and after the intervention by using the demographic information questionnaire, the Fatigue Severity Scale, and the Multiple Sclerosis Quality of Life questionnaire. Data were analyzed using SPSS 18. The significance level was 0.05.
Thirty patients entered the study; none of them were excluded from the study, and 30 patients were finally analyzed. Before the intervention, there was no statistically significant difference between the two groups in terms of fatigue (intervention group: 47.67) 7.83); control group: 47.63) 8.76)) and QOL (intervention group: 48.85) 9.55); control group: 49.64) 9.90) (t = 0.018, p = 0.98 and t = 0.31, p = 0.75, respectively)). After performing cupping therapy in the intervention group, a significant decrease and increase were observed in the mean (SD) score of fatigue (intervention group: 34.48) 6.16); control group: 46.85 (8.95)) and QOL (intervention group: 60.14) 7.46); control group: 51.96) 9.45)), respectively (p < 0.001).
The authors concluded that cupping therapy significantly reduced the patients’ fatigue and increased their QOL. This method is recommended for reducing fatigue and improving QOL in patients with MS.
Oh dear, where to begin?
One is spoilt for choice when criticising this study, e.g.:
- A controlled trial is meant to compare the outcomes BETWEEN groups and not to calculated within-groups changes.
- The results of a single study should never be the basis for far-reaching recommendations.
- The study followed the infamous ‘A + B versus B’ design. This does not control for placebo effects and thus does not permit conclusions about a therapy per se. (For those new to the subject, I have previously dealt with this study design as nauseam. Please do a simple search of previous explanations)
In view of this, I think I ought to re-phrase the conclusions as follows:
Like most treatments, cupping therapy is associated with significant placebo effects which can significantly reduce the patients’ fatigue and increased their QOL. Studies that fail to control for placebo effects cannot tell us about the sepcific effects of medical interventions and therefore are prone to mislead the public.
Wet cupping therapy (hijama), a traditional medicine practice, holds religious and cultural significance, particularly in Middle Eastern and Islamic societies. However, this practice can lead to serious complications, particularly when performed under inappropriate conditions or by unqualified individuals. This paper presents a case in which sudden cardiac death occurred following a hijama performed by an unlicensed practitioner on a patient diagnosed with ischemic stroke and a bladder tumor.
A 40-year-old male patient had hijama applied to different parts of his body on consecutive days. In the case review, it was determined that this may have contributed to hemodynamic instability and potentially precipitated sudden cardiac arrest due to cumulative blood loss and stress. Autopsy findings revealed myocardial fibrosis associated with previous myocardial infarction, and no other acute toxicological or pathological findings were present. While a direct causal link cannot be definitively proven, the close temporal association, forensic assessment, and lack of alternative causes suggest a plausible connection between the hijama procedure and the fatal outcome.
The authors concluded that this case underscores the importance of performing invasive traditional medicine practices under appropriate conditions and by authorized healthcare professionals. Raising awareness among the public and healthcare workers about such practices and ensuring the effective enforcement of legal regulations is critical to preventing potential complications.
Wet cupping involves scarring the skin at multiple sites and subsequently placing a vacuum cups on the areas. This would suck blood from the microcirculation of the skin into the cups. The total volume of blood is usually small relative to the ~5L a human body contains. It seems thus unlikely that it can contribute to hemodynamic instability in healthy individuals. However, the above patient was far from healthy. Thus, the procedure might indeed have contributed to his death.
This effect is likely to be an extremely rare event. Yet, it is worth remembering that wet cupping has other adverse effects that are much more frequent:
- It is painful.
- It can lead to nasty infections.
- It can leave unsightly scars.
Even more important is, I think, the fact that wet cupping has no or very few benefits. This means its risk/benefit balance fails to be positive. And, in turn, this means, that we should discourage people from using it.
Cupping is one of those types of so-called alternative medicine (SCAM) that have been used for centuries, in many cultures and for most conditions. So, why not also for incontinence?
Urinary incontinence (UI) is a common condition that affects people of all ages worldwide and can lead to social isolation, low self-esteem, and depression if not treated successfully. The present randomized clinical clinical trial aimed to compare the efficacy of dry cupping and tolterodine in controlling UI in women.
The study included a total of 73 women, 36 in the dry cupping group and 37 in the tolterodine group. During the six weeks intervention, the tolterodine group received 2mg of tolterodine twice daily, while the dry cupping group underwent two sessions of dry cupping in the right and left lower quadrant area every week. The severity of UI and the quality of life of patients were evaluated using the International Consultation on Incontinence Questionnaire—Urinary Incontinence Short Form (ICIQ-SF) and the Incontinence Quality of Life (IQOL) questionnaire at the beginning of the study, at weeks 3, 6, and 4 weeks after the end of the intervention (week 10).
The results showed that UI symptoms improved significantly in the dry cupping group compared to the tolterodine group. According to ICIQ-SF, The effect of dry cupping on the total score (mean difference: -6.72, 95 % CI: -9.26 to -4.17), the frequency of urine leakage (mean difference: -1.52, 95 % CI: -2.18 to -0.85), and the quality of life (mean difference: -3.68, 95 % CI: -4.96 to -2.40) were significant throughout the study and the follow-up period, at week 10. No adverse events were reported.
The authors concluded that, based on the results of the present study and considering the adverse events of the tolterodine use, dry cupping can be suggested as a therapeutic modality for women suffering from UI.
Really?
Who would make such a far-reaching recommendation on the back of such a flimsy trial?
- The study was tiny.
- There was no control or a placebo effect which can be expected to be substantial for dry cupping.
- Tolterodine is not hugely effective either.
- The treatment period was short and long-term results are unknown.
So, who would make such a far-reaching recommendation on the back of such a flimsy study? The researchers have the following affiliations:
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Persian Medicine Network (PMN), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
I cannot say that these affiliations boost my trust in dry cupping as a therapeutic modality for women suffering from UI!
This “randomized controlled clinical trial” (has anyone ever seen a randomized trial without a control group? – No, therefore, the correct term is “ramdomized clinical trial (RCT)”) aimed to compare the effectiveness of wet cupping therapy (WCT) and Acupuncture in treating migraine patients. It was conducted between 01.03.2022 and 01.10.2023 in a Traditional and Complementary Medicine Center of a tertiary hospital. Patients diagnosed with migraine were included in the study and randomized into three groups.
- The WCT group received wet cupping 3 times, once a month.
- The acupuncture group received 10 sessions of acupuncture once a week.
- The waiting list group served as the control group.
VAS and MIDAS scales were used for all groups at the beginning and the end of the treatment, and the results were compared.
Initially, 168 patients were enrolled. However, there were some dropouts throughout the study period. In the acupuncture group, 11 patients did not attend subsequent sessions, with one dropout occurring due to adverse effects. In the wet cupping (WCT) group, three patients discontinued their participation following the initial treatment. Ultimately, a total of 153 patients were included.
The findings show that all three groups were similar regarding age and sex. Migraine Disability Assessment Scale (MIDAS) and Visual Analogue Scale (VAS) pain scores decreased significantly in both treatment groups after the applications, while they remained similar for the same period in the control group. Additionally, the post-treatment values of MIDAS and VAS in both the WCT and acupuncture groups were significantly lower compared to controls, while they were similar when compared in between.
The authors concluded that both of these applications were found to be similarly effective in improving disability status and pain intensity in patients with migraine.
I beg to differ!
Apart from all other flaws of this trial, it did not control for placebo effects. Both WCT and acupuncture are invasive treatments that are bound to cause sizeable placebo responses. The waiting list control might account for the natural history of the disease and for regression towards the mean, but it is not a method for allowing for placebo effects. In view of this fundamental limitation of the study, its conclusions should be re-written as follows:
Both of these applications were similarly effective in producing sizeable placebo effects which in turn improved disability status and pain intensity in patients with migraine.
For migraine patients, this means that neither of these therapies are likely to be the best available option.
The aim of this recent review was to investigate the efficacy of non-surgical and non-interventional treatments for adults with low back pain compared with placebo. It included all randomised controlled trials evaluating non-surgical and non-interventional treatments compared with placebo or sham in adults (≥18 years) suffering from non-specific low back pain.
Random effects meta-analysis was used to estimate pooled effects and corresponding 95% confidence intervals on outcome pain intensity (0 to 100 scale) at first assessment post-treatment for each treatment type and by duration of low back pain—(sub)acute (<12 weeks) and chronic (≥12 weeks). Certainty of the evidence was assessed using the Grading of Recommendations Assessment (GRADE) approach.
A total of 301 trials (377 comparisons) provided data on 56 different treatments or treatment combinations. One treatment for acute low back pain: (non-steroidal anti-inflammatory drugs (NSAIDs)), and five treatments for chronic low back pain:
- exercise,
- spinal manipulative therapy,
- taping,
- antidepressants,
- transient receptor potential vanilloid 1 (TRPV1) agonists)
were found to be efficacious. However, effect sizes were small and of moderate certainty. Three treatments for acute low back pain (exercise, glucocorticoid injections, paracetamol), and two treatments for chronic low back pain (antibiotics, anaesthetics) were not efficacious and are unlikely to be suitable treatment options; moderate certainty evidence. Evidence is inconclusive for remaining treatments due to small samples, imprecision, or low and very low certainty evidence.
The authors concluded that the current evidence shows that one in 10 non-surgical and non-interventional treatments for low back pain are efficacious, providing only small analgesic effects beyond placebo. The efficacy for the majority of treatments is uncertain due to the limited number of randomised participants and poor study quality. Further high-quality, placebo-controlled trials are warranted to address the remaining uncertainty in treatment efficacy along with greater consideration for placebo-control design of non-surgical and non-interventional treatments.
This is an important analysis, not least because of the fact that the research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The methodology is sound and the results thus seem reliable.
The findings are in keeping with what we have been discussing at nauseam here: no treatment works really well for back pain. For acute symptoms no so-called alternative medicine (SCAM) at all is efficacious. For chronic pain, spinal manipulation therapy (SMT) have small effects. As SMT is neither cheap nor free of risks, excercise is much preferable.
Considering that most SCAMs are heavily promoted for low back pain (e.g. acupuncture, Alexander technique, cupping, Gua Sha, herbal medicine, homeopathy, massage, mind-body therapies, reflexology, Reiki, yoga), this verdict is sobering indeed!
There are many interesting and complex interrelationships between religion ond so-called alternative medicine (SCAM). Some of them were discussed here:
- ‘The power of all religions’ is being tested in a study with severely ill corona-virus patients
- Alternative medicine = ‘Ersatz’ religion?
- The ‘Healing Power of God’: a religious group was found guilty of manslaughter of a diabetic girl
- UK politician dabbles in faith healing
- The spiritual healers who sexually harass, molest, and rape female patients
- A ‘Christian Checklist’ for so-called alternative medicine
- Biblical Naturopathy, another SCAM that is new to me
- The ‘WORST PAPER OF 2022’ COMPETITION. Entry No 3: Effects of an Islamic-Based Intervention on Depression and Anxiety
- Daily prayer against severe COVID – an update of a study started two years ago
- Reincarnation therapy “can change your life”
- Does religiosity influence post-operative survival?
- Scientology and chiropractic: is there a link?
- he real danger of yoga!
The list might need to be up-dated with ‘Prophetic Medicine’. This term, I must admit, was new to me. So, I studied the paper and was enlightened. Here is its abstract:
Integrative medicine (IM) aims to create a comprehensive healthcare system by combining conventional medicine with complementary and alternative approaches. This model prioritizes patients, emphasizing the importance of the doctor–patient relationship. By integrating the most beneficial elements of both conventional and complementary medicine, patients can benefit from enhanced therapeutic outcomes while minimizing risks associated with their combination. Given this complexity, patients need access to qualified IM practitioners who can provide guidance on the potential benefits and drawbacks of these combined approaches. One notable complementary approach is prophetic medicine (PM), particularly prevalent in Muslim communities. This practice offers preventive and curative treatments based on the teachings and practices of Prophet Muhammad. Its global recognition is on the rise, attracting increasing interest from scientists regarding its potential benefits. For instance, cupping therapy, a technique employed in PM, has been shown to offer advantages over conventional medications for various ailments, including pain management and blood conditions, such as thalassemia, offering potentially superior outcomes. A precise delineation of the scope of PM practices is crucial for a comprehensive understanding of the methodologies employed, their potential integration into contemporary healthcare systems, and the multifaceted factors influencing patient outcomes. By combining conventional medical practices with the principles of PM, IM can provide a more holistic approach to patient care. Hence, this paper explores this new model, its diverse applications, and its potential impact on IM.
The author’s lengthy conclusion in the article itself is as follows:
IM is gaining traction as it aims to improve patient care and alleviate suffering. Unlike merely combining CAM, IM emphasizes the holistic healing of the mind, body, and spirit. IM can be offered through consultations, standalone clinics, or even as a primary service. Many therapies rooted in PM can be particularly beneficial for patients facing challenging illnesses. However, the successful implementation of PM within an IM framework may be constrained by certain limitations. The most significant challenge is adapting cultural and religious beliefs to modern healthcare practices. To overcome these challenges, it is essential to establish clear, comprehensive, and universally applicable definitions and frameworks for IM. These frameworks should be comprehensive, well-developed, and consider historical roots, religious influences, and modern applications. Moreover, studies indicate that PM therapies are widely used around the world, yet there is a pressing need for a clear definition that encompasses these factors. Defining the scope of PM practices will facilitate a better understanding of the common methods, how they can be integrated into healthcare systems, and the various factors that influence patient care. Furthermore, PM practitioners require enhanced education and training to improve their understanding of traditional remedies and their effective application. Ultimately, addressing these challenges will likely lead to an improved IM model.
Who writes such remarkable nonsense?
The author of the paper is Saud Alsanad, an Associate Professor of Complementary and Alternative Medicine (CAM) in the College of Medicine at the University of Imam Mohammad Ibn Saud Islamic University (IMSIU), Kingdome of Saudi Arabia. He is a founding member and the former CEO of the Saudi National Centre for Complementary and Alternative Medicine, Riyadh, Kingdome of Saudi Arabia. Dr Alsanad is a registered pharmacist at the Saudi Commission for Health Specialists. He completed his PhD in Complementary and Alternative Medicine at the Reading School of Pharmacy, University of Reading, UK, under the supervision of Professor Elizabeth M Williamson.
Alsanad defines PM as medicine “based on the teachings and practices of Prophet Muhammad”. It includes a weird mix of modalities (for instance: spiritual and religious therapy as well as cupping). Would it not be reasonable to demand that each modality of whatever medicine must meet the accepted standards of effectiveness and safety that are applied in conventional medicine? If a therapy demonstrably generates more good than harm, we might consider it for integration into routine care. If not we shouldn’t even be called ‘medicine’!
Most of the treatments listed under the PM-umbrella fall into the second category. Therefore PM is arguably not medicine at all. Whether or not a therapy was mentioned by a this or that prophet is utterly immaterial and should really not matter in the age of evidence-based medicine.
Cupping is a from of so-called alternative medicine (SCAM) that has featured already many times on this blog, e.g.:
- Wet cupping in the management of cervical spondylosis? No!
- The effectiveness of cupping therapy for low back pain
- Cupping: “the propagation of ancient, scientifically unsound techniques that may cause more harm than benefit”
- Cupping therapy for non-specific chronic low back pain
- Cupping for Olympic swimmers. Or: why breaking your shoulder is not necessarily good for writing a successful book
- Wet cupping and dry humour
- Cupping for athletes: rubbish trials, rubbish review, rubbish journal
- The future of cupping: it’s bright, profitable and vacuous
Now a new and interesting paper has been published on the subject
This review aimed to investigate the effectiveness of cupping therapy on low back pain (LBP). Medline, Embase, Scopus and WANFANG databases were searched for relevant cupping RCTs on low back pain articles up to 2023. A complementary search was manually made on 27 September for update screening. Full-text English and Chinese articles on all ethnic adults with LBP of cupping management were included in this study. Studies looking at acute low back pain only were excluded. Two independent reviewers screened and extracted data, with any disagreement resolved through consensus by a third reviewer. The methodological quality of the included studies was evaluated independently by two reviewers using an adapted tool. Change-from-baseline outcomes were treated as continuous variables and calculated according to the Cochrane Handbook. Data were extracted and pooled into the meta-analysis by Review Manager software (version 5.4, Nordic Cochrane Centre).
Eleven trials involving 921 participants were included (6 on dry and 5 on wet cupping). Five studies were assessed as being at low risk of bias, and six studies were of acceptable quality. High-quality evidence demonstrated cupping significantly improves pain at 2-8 weeks endpoint intervention (d=1.09, 95% CI: [0.35-1.83], p = 0.004). There was no continuous pain improvement observed at one month (d=0.11, 95% CI: [-1.02-1.23], p = 0.85) and 3-6 months (d=0.39, 95% CI: [-0.09-0.87], p = 0.11). Dry cupping did not improve pain (d=1.06, 95% CI: [-0.34, 2.45], p = 0.14) compared with wet cupping (d=1.5, 95% CI: [0.39-2.6], p = 0.008) at the endpoint intervention. There was no evidence indicating the association between pain reduction and different types of cupping (p = 0.2). Moderate- to low-quality evidence showed that cupping did not reduce chronic low back pain (d=0.74, 95% CI: [-0.67-2.15], p = 0.30) and non-specific chronic low back pain (d=0.27, 95% CI: [-1.69-2.24], p = 0.78) at the endpoint intervention. Cupping on acupoints showed a significant improvement in pain (d=1.29, 95% CI: [0.63-1.94], p < 0.01) compared with the lower back area (d=0.35, 95% CI: [-0.29-0.99], p = 0.29). A potential association between pain reduction and different cupping locations (p = 0.05) was found. Meta-analysis showed a significant effect on pain improvement compared to medication therapy (n = 8; d=1.8 [95% CI: 1.22 – 2.39], p < 0.001) and usual care (n = 5; d=1.07 [95% CI: 0.21- 1.93], p = 0.01). Two studies demonstrated that cupping significantly mediated sensory and emotional pain immediately, after 24 h, and 2 weeks post-intervention (d= 5.49, 95% CI [4.13-6.84], p < 0.001). Moderate evidence suggested that cupping improved disability at the 1-6 months follow-up (d=0.67, 95% CI: [0.06-1.28], p = 0.03). There was no immediate effect observed at the 2-8 weeks endpoint (d=0.40, 95% CI: [-0.51-1.30], p = 0.39). A high degree of heterogeneity was noted in the subgroup analysis (I2 >50%).
The authors concluded that high- to moderate-quality evidence indicates that cupping significantly improves pain and disability. The effectiveness of cupping for LBP varies based on treatment durations, cupping types, treatment locations, and LBP classifications. Cupping demonstrated a superior and sustained effect on pain reduction compared with medication and usual care. The notable heterogeneity among studies raises concerns about the certainty of these findings. Further research should be designed with a standardized cupping manipulation that specifies treatment sessions, frequency, cupping types, and treatment locations. The actual therapeutic effects of cupping could be confirmed by using objective pain assessments. Studies with at least six- to twelve-month follow-ups are needed to investigate the long-term efficacy of cupping in managing LBP.
A crucial point here is that only 3 of the included studies were ‘patient-blind’, i.e. tried to control for placebo effects by using a sham procedure:
- The first of these used leaking vaccum cups that failed to create sucction. This would therefore not have resulted in the typical circular hematoma. In other words, patients were easily de-blinded.
- The second trial compared two different wet cupping techniques which involved different procedures. This would have been easily identifiable by the patients. In other words, patients were easily de-blinded.
- The third (which showed no effectiveness of cupping) supposedly patient-blind study used a similar method as the first. In other words, patients were easily de-blinded.
In addition, we ought to remember that in no study was it possible to blind the therapists. Thus there is a danger of verbal or non-verbal communications impacting on the outcomes.
In my view, it follows that the effectiveness of cupping is far lass certain than the authors of this paper try to make us believe.
When I still worked as a clinician, I have looked after athletes long enough to know that they go for everything that promises to improve their performance. It is thus hardly surprising that Olympians would try all sorts of so-called alternative medicine (SCAM) regardless of whether the therapy is supported by evidence or not. Skeptics are tempted to dismiss all of SCAM for improving fitness. But is that fair? Is it true that no evidence evists for any of them?
The short answer to this question is NO.
Here I have looked at some of the possibilities and show you some of the Medline-listed papers that seem to support SCAM as a means of improving fitness:
Acupuncture
Ashwagandha
Balneology
Cupping
Ginkgo biloba
Ice
Kinesiology tape
Massage guns
Percussion massage
Sports massage
Tai massage
Vibrational massage
Yoga
Please do not mistake this for anything resembling a systematic review of the evidence; it is merely a list to give you a flavour of what is out there. And please don’t assume that the list is complete; I am sure that there is much more.
Looking at the articles that I found, one could get the impression that there is plenty of good evidence to support SCAM for improving fitness. This, however, would be wrong. The evidence for almost every of the above listed therapies is flimsy to say the least. But – as I stated already at the beginning – in my experience, this will not stop athletes to use them.
