Cupping therapy on low back pain. A systematic review
Rulewska et al. · Quality in Sport · 2025
Evidence Level
MODERATEOBJECTIVE
To evaluate the efficacy of cupping therapy in the treatment of low back pain
WHO
Patients with acute, subacute, and chronic low back pain
DURATION
Analysis of studies with follow-up from 4 weeks to 6 months
POINTS
Lumbar region and specific acupuncture points
🔬 Study Design
Dry cupping
n=0
Cups applied directly to the skin with negative pressure
Wet cupping
n=0
Small incisions before applying the cups
Control/placebo
n=0
Usual care or sham cupping
📊 Results in numbers
Pain reduction at end of treatment
Efficacy superior to usual care
Reduction in acetaminophen use
Improvement in quality of life
📊 Outcome Comparison
Efficacy in pain relief
This study shows that cupping therapy may be a promising option for people who suffer from back pain. The technique proved effective in reducing pain, especially in the long term, and may decrease the need for medication.
Article summary
Plain-language narrative summary
This systematic review investigated the efficacy of cupping therapy in the treatment of low back pain, a condition that affects millions of people worldwide and represents a significant challenge for healthcare systems. Low back pain is classified temporally as acute (less than 6 weeks), subacute (6-12 weeks), and chronic (more than 12 weeks), with approximately 90% of cases having no identifiable anatomic cause. The authors performed a comprehensive analysis of the literature available in PubMed and Google Scholar, focusing on studies that evaluated both dry and wet cupping. Dry cupping involves applying cups directly to the skin using negative pressure, whereas wet cupping includes small skin incisions before cup application.
According to traditional Chinese medicine, the technique improves blood and lymphatic circulation, reduces inflammation, and facilitates toxin removal. The review found that cupping therapy was effective in reducing pain at the end of interventions, although it did not demonstrate significant immediate benefits. A study by Zhang et al. revealed that efficacy varied by type of low back pain and application site.
Research by Kim et al. showed that patients undergoing wet cupping experienced reductions in pain scores and decreased need for acetaminophen after four weeks. Mardini-Kivi et al. found that cupping was as effective as standard care after one month, but superior to conventional treatments at three to six months of follow-up.
However, a study by Silva et al. found no significant differences between real and sham cupping in patients with chronic nonspecific low back pain. The clinical implications suggest that cupping may be a promising alternative to conventional treatments, which often include nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and, in extreme cases, surgery. These traditional treatments may cause adverse effects such as hepatic injury and hemorrhagic gastritis.
Cupping offers a non-pharmacologic option that may reduce dependence on medications and their associated risks. Identified limitations include the need for additional randomized controlled trials with rigorous methodology and adequate follow-up to determine the duration of beneficial effects. In addition, the heterogeneity of the analyzed studies and differences in application techniques hinder definitive conclusions about optimal treatment protocols.
Strengths
- 1Comprehensive analysis of available literature
- 2Evaluation of different types of cupping
- 3Consideration of multiple clinical outcomes
- 4Identification of long-term benefits
Limitations
- 1Heterogeneity of included studies
- 2Lack of standardization in application techniques
- 3Need for additional randomized controlled trials
- 4Limited follow-up in some studies
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Chronic nonspecific low back pain remains one of the most prevalent diagnoses in any physiatry service, and cupping therapy emerges here as a non-pharmacologic adjunct with a clinically relevant efficacy window. The data from Mardini-Kivi et al., showing superiority over conventional care at three to six months of follow-up, falls precisely within the interval in which our patients tend to plateau on analgesics and we need alternatives that sustain functional gains. For populations with contraindications or intolerance to NSAIDs — older adults with kidney disease, patients with liver disease, and those on anticoagulation — a technique that reduces the need for acetaminophen at four weeks, as demonstrated by Kim et al., adds direct value to clinical management. The technique integrates well into the multimodal rehabilitation arsenal, especially in the subacute phase, when the goal is to break the pain-spasm-pain cycle before progression to chronicity.
▸ Notable Findings
Two findings deserve special attention. First, the absence of significant immediate benefit contrasts with sustained efficacy at one to six months of follow-up — a pattern that suggests a slower mechanism of action than over-the-counter analgesics, possibly via autonomic modulation and reorganization of the local inflammatory environment, rather than simple mechanical effect or attention bias. Second, the variation in efficacy by type of low back pain and application site described by Zhang et al. indicates that we are dealing with a technique with a specific indication window, not a panacea. The Silva et al. study, which found no difference between real and sham cupping in chronic nonspecific low back pain, reinforces that not every low back pain phenotype responds the same way — which, far from weakening the technique, guides more careful candidate selection.
▸ From My Experience
In my practice at the musculoskeletal pain clinic, I usually reserve cupping therapy for patients with an evident myofascial component on palpation — those with active paravertebral trigger points at L3-L5 and tense thoracolumbar fascia, generally after an acute episode that did not fully resolve. I have observed that the subjective response of reduced morning stiffness usually appears between the second and third sessions, but sustained functional gain — which is what matters to me for rehabilitation discharge — rarely consolidates before six to eight sessions. I routinely combine cupping therapy with floor-based lumbar stabilization work, and when there is marked central sensitization, I combine it with systemic acupuncture for descending modulation. The patient profile that responds best in my experience is the middle-aged adult with subacute to chronic low back pain of low intensity, without overt radicular irradiation and with a predominantly mechanical-myofascial component. I avoid indicating it in patients with coagulopathy or active skin lesions in the lumbar region.
Full original article
Read the full scientific study
Quality in Sport · 2025
DOI: 10.12775/QS.2025.41.59807
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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