Effect of Dry Cupping Therapy on Pain and Functional Disability in Persistent Non-Specific Low Back Pain: A Randomized Controlled Clinical Trial
Salemi et al. · Journal of Acupuncture and Meridian Studies · 2021
Evidence Level
STRONGOBJECTIVE
Evaluate the effects of dry cupping therapy on pain and functional disability in people with persistent non-specific low back pain
WHO
Adults (18-59 years) with non-specific low back pain for more than 3 months
DURATION
5 sessions of 20 minutes, twice weekly, with 4-week follow-up
POINTS
GV-4, BL-23, BL-24, BL-25, BL-30, BL-40, BL-58, HT-3, and ST-36
🔬 Study Design
Cupping therapy
n=19
Cups with 300 millibar negative pressure at acupuncture points
Sham
n=18
Cups with a small hole preventing maintenance of suction
📊 Results in numbers
Post-treatment pain reduction
Pain reduction at follow-up
Post-treatment improvement in functionality
Pain statistical significance
📊 Outcome Comparison
Visual Analog Scale of Pain
Oswestry Disability Index
This study showed that dry cupping therapy is effective for reducing chronic low back pain and improving functional capacity. Treatment with cups applied at specific points was superior to simulated treatment, providing pain relief that lasted up to one month after the end of treatment.
Article summary
Plain-language narrative summary
This randomized clinical trial investigated the effects of dry cupping therapy in people with persistent non-specific low back pain, a condition that significantly affects quality of life and represents one of the leading causes of functional disability. The study was conducted in accordance with CONSORT standards and approved by the ethics committee, including 37 participants between 18 and 59 years old who had been experiencing low back pain for more than three months. The methodology involved randomizing participants into two groups: one group received true cupping therapy and the other received simulated (sham) treatment, ensuring blinding of participants, assessors, and statisticians. The treatment protocol consisted of five 20-minute sessions, performed twice weekly, using 17 reusable acrylic cups.
The distinguishing feature of this study was the comprehensive approach in selecting acupuncture points, including not only the classic points for low back pain (BL-23, BL-24, BL-25), but also points related to emotional aspects (HT-3, ST-36) and other points specific to strengthening the lumbar region (GV-4, BL-30, BL-40, BL-58). In the cupping group, moderate negative pressure of approximately 300 millibar was applied through a manual pump, while the sham group received cups with small holes that prevented maintenance of suction. The results demonstrated clear superiority of true cupping over the simulated treatment. In pain assessment using the Visual Analog Scale, the cupping group showed a mean reduction of 2.36 points post-treatment and 1.71 points at the four-week follow-up, with effect sizes considered large (-0.94 and -0.83, respectively).
For functional disability, measured by the Oswestry Disability Index, there was significant improvement of 4.68 points post-treatment, although this difference was not maintained at follow-up. The study also assessed the number of pain days per week, showing that the cupping group had earlier and sustained reduction compared with the control group. In addition, improvement was observed in psychosocial factors related to low back pain, assessed via the Start Back Screening Tool, both post-treatment and at follow-up. As for the analysis of the minimal clinically important difference, 68.42% of participants in the cupping group achieved clinically significant improvement in pain between post-treatment and baseline, compared with only 22% in the sham group.
For functional disability, 36.85% of the cupping group achieved clinically important improvement compared with 16.66% of the sham group. Adverse events were minimal, limited to mild changes in skin pigmentation that disappeared within four days, confirming the safety of the technique. The clinical implications of this study are significant, as it demonstrates that dry cupping therapy can be an effective and safe therapeutic option for chronic low back pain, especially when applied following a protocol that considers not only physical aspects but also emotional factors related to pain. The comprehensive approach used may explain the superior results compared with previous studies that used more limited protocols.
Strengths
- 1Well-executed randomized double-blind controlled design
- 2Comprehensive protocol including points for emotional aspects
- 3Use of an appropriate sham group to control for placebo effect
- 4Assessment of multiple outcomes including psychosocial aspects
- 54-week post-treatment follow-up
Limitations
- 1Small sample size limiting generalizability of results
- 2Predominantly young female population
- 3Absence of pain diary data at follow-up
- 4Need for studies with larger and more diverse samples
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
Persistent non-specific low back pain remains one of the most prevalent diagnoses in physiatry and pain clinics, and any tool that produces clinically relevant relief and is easy to perform deserves attention. In this trial, dry cupping therapy — applied in five 20-minute sessions over slightly more than two weeks — produced a 2.36-point reduction on the VAS and a 4.68-point improvement on the Oswestry Index post-treatment, with a large effect size. More than the absolute numbers, the finding that 68% of patients in the active group reached the minimal clinically important difference for pain, against 22% in the sham, translates into real bedside utility. For the physiatrist who treats patients with chronic low back pain refractory to conventional analgesics or who do not tolerate dry needling, cupping therapy constitutes an adjunct alternative with a favorable safety profile and a reproducible protocol.
▸ Notable Findings
The most noteworthy point is not simply analgesic efficacy, but the logic of the point protocol adopted. By incorporating HT-3 and ST-36 — points classically associated with autonomic-axis modulation and affective aspects of pain — into the conventional protocol of BL-23, BL-25, GV-4, and BL-40, the authors obtained measurable improvement in psychosocial factors on the Start Back Screening Tool both at end of treatment and during the four weeks of follow-up. This is relevant because non-specific chronic low back pain carries components of central sensitization and catastrophizing that purely biomechanical protocols often neglect. The effect on functionality, although robust post-treatment, was not maintained at the same magnitude at follow-up, which reinforces the need to integrate cupping therapy into medium-term strategies — exercise, pain education — and not to use it in isolation as a definitive solution.
▸ From My Experience
In my practice in the musculoskeletal pain clinic, I usually introduce dry cupping therapy as an adjuvant in patients with non-specific chronic low back pain who are already in a supervised exercise program but are progressing with an analgesic plateau. The initial response usually appears between the second and third session — a perception that aligns well with the design of this five-session protocol. For maintenance, we typically schedule biweekly to monthly returns after the intensive phase, especially in patients with an associated myofascial component, where we combine cupping with dry needling of lumbar trigger points at the same visit. The profile that responds best, in my observation over the years, is the patient with mechanical-postural pain, palpable paravertebral tension, and some degree of local hyperalgesia — exactly the profile recruited here. Patients with severe central amplification syndrome or diffuse fibromyalgia respond less predictably, and in those cases I prefer to prioritize neuromodulatory needling work before introducing cupping.
Full original article
Read the full scientific study
Journal of Acupuncture and Meridian Studies · 2021
DOI: 10.51507/j.jams.2021.14.6.219
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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