Effects of cupping therapy on chronic musculoskeletal pain and collateral problems: a systematic review and meta-analysis
Jia et al. · BMJ Open · 2025
Evidence Level
MODERATEOBJECTIVE
Evaluate the efficacy of cupping therapy on chronic musculoskeletal pain, functionality, and mental health
WHO
656 adults with chronic musculoskeletal pain (>3 months)
DURATION
Immediate post-treatment effects
TYPES
Dry, wet, pulsatile, and massage cupping
🔬 Study Design
Cupping Therapy
n=328
Various types of cupping therapy
Control
n=328
Placebo, waitlist, or rest
📊 Results in numbers
Reduction in pain intensity
Improvement in functional disability
Improvement in mental health
p-value for pain
📊 Outcome Comparison
Pain intensity (significant effect)
Functional disability (no effect)
This research shows that cupping therapy may help reduce pain in people with chronic muscle and joint pain shortly after treatment. However, it did not significantly improve the ability to carry out daily activities nor the emotional well-being of patients.
Article summary
Plain-language narrative summary
This systematic review and meta-analysis investigated the efficacy of cupping therapy in the treatment of chronic musculoskeletal pain (CMP), a condition that globally affects more than 1.5 billion people and represents a significant burden on healthcare systems. The researchers analyzed data from 10 randomized controlled trials involving 656 adult participants with CMP lasting more than 3 months, examining three main outcomes: pain intensity, functional disability, and mental health. The methodology was rigorous, following PRISMA guidelines and including searches in five databases through December 2024. The studies analyzed included different cupping modalities: dry cupping (most common), wet cupping, pulsatile therapy, and cupping massage.
Control groups received placebo treatment, remained on a waitlist, or rested. The conditions studied included primarily chronic low back pain (50% of studies) and chronic neck pain (40%), with mean symptom duration ranging from 20 to 190 months. Results showed that cupping therapy was effective in immediately reducing pain intensity (standardized mean difference = -1.17; 95% CI: -1.93 to -0.42; p=0.002), with moderate-quality evidence. Both dry and wet cupping demonstrated similar benefits.
Subgroup analysis revealed that a single treatment was more effective than multiple sessions, and the therapy proved particularly beneficial for neck/shoulder pain compared with low back pain. However, no significant benefits were observed in improvement of functional disability (SMD = -0.24; 95% CI: -0.93 to 0.46; p=0.51) or mental health (SMD = 0.08; 95% CI: -0.12 to 0.27; p=0.46). The authors explain that the neurobiological mechanisms of cupping therapy may involve blocking pain conduction through activation of mechanosensitive Aβ fibers, which transmit signals more rapidly than the nociceptive Aδ and C fibers, in line with the gate control theory of pain. In addition, increased blood flow induced by negative pressure may accelerate clearance of inflammatory cytokines such as IL-1 and IL-6, contributing to pain relief.
The lack of functional improvement may be related to the fact that assessments were performed at rest, whereas functional limitations generally occur during movement and activity. For mental health, the questionnaires used (mainly SF-36) assessed states over the previous 4 weeks, making them inadequate for capturing immediate post-treatment effects. Clinical implications suggest that cupping therapy may be a safe and effective complementary option for immediate relief of chronic pain, especially in neck/shoulder conditions, but should not be considered a complete solution for the functional and psychological aspects of CMP. The study presents high between-study heterogeneity (I²=94%), requiring caution in interpreting the results.
Strengths
- 1First comprehensive meta-analysis integrating pain, function, and mental health for cupping therapy
- 2Rigorous methodology following PRISMA guidelines and PROSPERO registration
- 3Detailed subgroup analysis by cupping type, pain location, and frequency
- 4Quality assessment using established Cochrane tools
Limitations
- 1Only immediate effects analyzed, without long-term follow-up
- 2High heterogeneity across studies (I²=94%) due to methodological differences
- 3Limited number of included studies (n=10)
- 4Mental health instruments inadequate to capture immediate effects
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Chronic musculoskeletal pain represents one of the most frequent complaints in physiatry and rehabilitation services, and the search for adjunctive interventions with a good risk-benefit profile is constant. This meta-analysis provides substrate to position cupping therapy as an option for immediate analgesic relief within a multimodal therapeutic plan, especially in neck and shoulder pain. The effect on pain intensity — with a standardized mean difference of -1.17 and p=0.002 — has practical relevance in the context of patients who present with acute exacerbation over a chronic condition and need a window of comfort to adhere to an exercise and physical therapy program. The absence of significant impact on functional disability and mental health, on the other hand, reinforces that the technique does not replace functional rehabilitation approaches and biopsychosocial management, and should be understood as an analgesic tool within a broader therapeutic set.
▸ Notable Findings
The most robust finding of this analysis is the immediate analgesic effect with moderate-quality evidence, supported by both dry and wet cupping — which broadens clinical applicability regardless of the modality available in the service. The subgroup analysis deserves special attention: a single session demonstrated superiority over multiple sessions for immediate pain relief, and the cervical and shoulder region showed a more favorable response compared with the lumbar region. From a neurophysiological standpoint, the authors articulate the mechanism of action through activation of mechanosensitive Aβ fibers — which conduct more rapidly than nociceptive Aδ and C fibers — modulating pain transmission through the gate control theory. Added to this is the possible role of negative pressure in clearing pro-inflammatory cytokines such as IL-1 and IL-6. These mechanisms align cupping therapy with the same rationale we use for other forms of peripheral sensory stimulation, such as dry needling and transcutaneous electrical stimulation.
▸ From My Experience
In my practice at a musculoskeletal pain service, cupping therapy occupies a fairly specific niche: I use it as a tool to open an analgesic window before therapeutic mobilization, particularly in cervicobrachialgia and rotator cuff syndromes with a significant myofascial component. I have observed an analgesic response as early as the first session in patients with predominantly mechanical neck pain, which is consistent with the finding of single-session superiority in this meta-analysis. When I combine cupping with systemic acupuncture and trigger point work, the functional outcome is usually more consistent than with any technique in isolation. I do not indicate the technique as monotherapy for complex chronic low back pain — in these cases, the central and functional component requires much more than immediate peripheral relief. The profile that responds best, in my experience, is the patient with regional musculoskeletal pain, low central sensitization, and a good functional reserve to engage in the subsequent rehabilitation program.
Full original article
Read the full scientific study
BMJ Open · 2025
DOI: 10.1136/bmjopen-2024-087340
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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