Cupping for Patients With Chronic Pain: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis represents the most comprehensive study on cupping therapy for chronic pain through 2020, analyzing 18 randomized clinical trials with 1,172 participants. Cupping therapy is a traditional technique that uses cups applied to the skin under negative pressure, creating suction that results in redness and warming of the treated area.

The researchers included studies of adults with chronic pain, including low back pain, neck pain, osteoarthritis, fibromyalgia, and other conditions. Different types of cupping therapy were analyzed: dry (without skin perforation), wet (with small perforations), massage cupping, and pulsatile pneumatic cupping. Most studies (10 of 18) were conducted in Germany, with others performed in Korea, China, India, Saudi Arabia, and Taiwan.

The results showed large and statistically significant effects of cupping therapy in reducing pain intensity when compared with no treatment (standardized mean difference = -1.03). For functional disability, effects were of medium magnitude (SMD = -0.66) compared with no treatment. These are considered clinically relevant effects.

However, when cupping therapy was compared with sham treatments, in which cups were applied without creating real negative pressure, the effects were not statistically significant for pain (SMD = -0.27) or disability (SMD = -0.26). This suggests that part of the observed benefits may be due to nonspecific factors such as attention, care, and expectation of improvement.

Analysis of different conditions showed that cupping therapy was superior to no treatment for low back pain, neck pain, and osteoarthritis. Among the types of cupping therapy, dry cupping, wet cupping, and pulsatile pneumatic cupping all showed benefits compared with no treatment.

Regarding safety, adverse events were more frequent in cupping groups compared with no treatment, but differences were not significant when compared with sham cupping or active treatments. Most adverse events were minor, typically consisting of temporary skin discoloration at cupping sites.

Main limitations include clinical heterogeneity of the studies (different conditions, types of cupping therapy, treatment durations), risk of methodological bias in most studies, inability to blind therapists and patients to treatment, and short-term follow-up in most studies (4 weeks or less). The overall quality of the evidence was considered limited because of these factors.

Clinical implications suggest that cupping therapy, especially dry cupping, may be considered as a nonpharmacologic treatment option for chronic pain, given its relatively favorable safety profile. It may be useful as part of a multimodal treatment strategy, potentially reducing the need for medications. However, more high-quality studies are needed, especially sham-controlled trials with long-term follow-up, to definitively establish its specific efficacy beyond placebo effects.