Effects of ear acupuncture combined with cupping therapy on severity and threshold of chronic back pain and physical disability: A randomized clinical trial

This Brazilian study evaluated 182 people with chronic back pain, comparing the effects of auricular acupuncture alone versus combined with cupping therapy. Chronic back pain is a public health problem affecting millions of people, causing physical and emotional disability and impacting quality of life. The study was conducted as an open-label randomized controlled clinical trial, following CONSORT guidelines, in a Brazilian city between 2017 and 2018. Participants were 18 to 70 years old and had moderate to severe pain (greater than 4 on a 0-10 scale) for at least three months.

Patients with impaired cognitive conditions, continuous use of adjuvant medications, recent energy therapies, or conditions contraindicating the treatments were excluded. The auricular acupuncture protocol used semi-permanent needles at specific points of the ear, including Shenmen, Kidney, Sympathetic Nerve, Subcortex, Bladder, Liver, and vertebral points according to pain location. The needles remained in place for one week with microporous tape. Cupping therapy was applied bilaterally at specific points on the back for 10 minutes, including systemic points for all participants and regional points according to the location of cervical, thoracic, or lumbar pain.

Both groups received five weekly sessions over six weeks. Outcomes were measured using the Brief Pain Inventory for pain intensity, a digital algometer for pressure pain threshold, and the Roland-Morris Disability Questionnaire for physical limitations. Assessments occurred before treatment, after the last session, and seven days later. Results showed that both treatments were effective, but the combined therapy produced superior outcomes.

In the auricular-acupuncture-alone group, pain intensity decreased by 38% at the end of treatment and by 27% at follow-up, whereas the combined group showed reductions of 52% and 35%, respectively. Regarding physical disability, the auricular acupuncture group showed 45% improvement at the end of treatment and 32% at follow-up, compared with 60% and 54% in the combined group. By IMMPACT criteria, the auricular acupuncture group showed moderately important improvement, whereas the combined group reached substantially better improvement. Pressure pain threshold increased significantly in both groups, but with no statistical difference between them.

Pain relief was 6% greater in the combined group. Limitations include the use of standardized protocols, contrary to the principles of Traditional Chinese Medicine, which emphasize individualization, although standardization allows for reproducibility. Loss to follow-up was low (8.1%) and within expected ranges. This is the first study to specifically evaluate the combination of these therapies for chronic back pain.

The findings suggest that cupping therapy potentiates the effects of auricular acupuncture, offering a promising, low-cost, and low-risk therapeutic approach for the management of chronic back pain.