The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain - a randomised controlled pilot study

This pilot study investigated the effects of dry cupping therapy in the treatment of patients with chronic non-specific neck pain, a condition that affects nearly half the population over the lifetime and becomes chronic in approximately 14% of cases. Cupping therapy is an ancient therapeutic technique used in European, Asian, and Middle Eastern cultures, employing glass cups to create suction over painful areas, with the goal of increasing local circulation and relieving muscle tension. The randomized controlled clinical trial included 50 patients with a mean age of 50.5 years who had neck pain at least 5 days per week for 3 consecutive months, with a minimum intensity of 40 mm on a 100 mm visual analog scale. Participants were randomized into two groups: treatment (n=25) and waiting list (n=25).

The treatment group received 5 sessions of dry cupping over 2 weeks, while the control group received no intervention during the study period. The cupping technique was performed using double-walled glass cups heated over an open flame to create a vacuum. The cups were applied over areas of muscle tension identified by physical examination, mainly on the trapezius muscle, remaining in place for 10-20 minutes until pinkish circular marks formed. Assessments included multiple pain measures: pain at rest and maximum movement-related pain on a visual analog scale, pain diaries on a numerical scale, the Neck Disability Index (NDI), and quality of life (SF-36).

In addition, quantitative sensory tests were performed to assess mechanical detection, vibration, and pressure pain thresholds in painful areas and control areas. The results demonstrated significant benefits of cupping therapy across multiple measures. Pain at rest decreased by 22.5 mm more in the treatment group than in the control group (p < 0.001), while pain on movement decreased by 17.8 mm (p = 0.01). Pain diaries revealed gradual improvement in the treatment group, with a significant difference after the fifth session.

The Neck Disability Index improved by 6.3% more in the treatment group (p = 0.002). In terms of quality of life, there were significant improvements in the bodily pain (13.8 points, p = 0.006) and vitality (10.2 points, p = 0.006) subscales. Interestingly, sensory tests showed that cupping therapy influenced functional pain processing, with significant increases in pressure pain thresholds in both painful and control areas, suggesting systemic effects beyond local ones. The effect size for pain at rest was d = 1.4, considered large.

The reduction of approximately 45% in pain intensity is within the range of clinical relevance. Patients reported high satisfaction with the treatment, rating the benefit at 60.4 mm on a 0-100 scale, and 95% would recommend the treatment to family members. Adverse effects were minimal and transient, including a tingling sensation, mild local pain, and fatigue, all resolving within 4 hours. Only one patient discontinued because of temporary worsening of symptoms.

Limitations include the small sample size, the inability to blind because of the visible cupping marks, and the absence of an adequate placebo group, since no reliable sham intervention exists for cupping therapy. Early randomization and the use of a waiting-list group may have influenced the results, although baseline values were comparable between groups. The proposed mechanism of action includes improvement in microcirculation, cellular metabolism, and tissue regeneration, as well as possible effects on autonomic nervous system regulation and immune response. The authors suggest that the effects are cumulative, justifying the multiple-session protocol consistent with traditional clinical practice.