An overview of systematic reviews of clinical evidence for cupping therapy

This comprehensive review of systematic reviews investigated the efficacy and safety of cupping therapy, a traditional Chinese technique widely used in Asian countries. The researchers analyzed eight systematic reviews that evaluated cupping therapy for 18 different medical conditions, with a primary focus on pain-related conditions. Cupping therapy involves the application of cups to the skin to create suction, and can be dry (suction only) or wet (with small incisions for bloodletting). The study used rigorous methodological quality criteria (AMSTAR) to evaluate the included reviews.

Of the eight reviews analyzed, all were considered to be of good methodological quality, although only one provided registration and protocol information. Four reviews conducted meta-analyses, demonstrating that cupping therapy was more effective than medications or other isolated treatments. The most promising results were observed for herpes zoster, where wet cupping showed a cure rate 2.49 times higher than conventional medications. For low back pain, the therapy demonstrated significant reduction in pain intensity when compared with wait list or heat therapy.

In acne, wet cupping was 2.14 times more effective than traditional medications. Facial palsy also responded positively, especially when cupping was combined with other interventions. Thirteen of the 18 evaluated conditions were pain-related, including low back pain, neck pain, headache, osteoarthritis, and postoperative pain. Traditional Chinese medicine theory explains that cupping regulates the flow of qi and blood in the meridians, removing stagnations that cause pain.

Scientifically, it is believed that the negative pressure created by cupping induces local hyperemia and stimulates the central nervous system to release neurotransmitters that mediate pain. In terms of safety, only one review reported adverse events in detail, including hematomas, increased local pain, and tingling at the treatment site. These effects are generally considered normal manifestations of treatment in traditional Chinese medicine. Limitations include the poor methodological quality of the original studies included in the reviews, insufficient number of high-quality randomized clinical trials, and potential publication bias, since five of the eight reviews were conducted in Asian countries.

The ideal treatment duration and frequency of sessions still need to be established through more rigorous studies. The authors concluded that, although cupping therapy shows potential benefit for pain-related conditions, acne, and facial palsy, a definitive conclusion cannot be established due to the limited quality of the original studies.