Evidence Map of Cupping Therapy

Cupping therapy, also known simply as 'cupping,' is a millennia-old therapeutic practice that has gained growing interest in both Asian and Western countries. This technique involves the use of special cups made of glass, plastic, or bamboo that are applied to the skin to create suction, and it can be performed in a 'dry' (vacuum only) or 'wet' (with small cuts on the skin to draw blood) manner. Although widely used for various health conditions, especially pain-related problems, the quality and scope of scientific evidence on its efficacy remained fragmented and required a more comprehensive analysis.

This study aimed to create an 'evidence map' of cupping therapy, organizing and visualizing all the high-quality scientific research available on the topic. The researchers performed a systematic search in multiple scientific databases, including PubMed, EMBASE, and Chinese and Korean databases, covering studies published through March 2021. They specifically searched for systematic reviews — studies that analyze and compile results from several smaller studies on the same topic. To ensure quality, they used a tool called AMSTAR-2 to evaluate each included review.

The results were presented in a special 'bubble' graph in which each bubble represents a studied medical condition, with size indicating the number of participants, color showing confidence in the results, and position revealing efficacy and the amount of available studies.

Of the 107 publications initially identified, only 13 high-quality systematic reviews were included in the final map, generating 16 evidence 'bubbles.' The results showed that cupping therapy demonstrated potential benefits for various conditions. For low back pain, the evidence was considered 'effective,' representing the highest level of scientific confirmation found. For other conditions such as ankylosing spondylitis, knee osteoarthritis, neck pain, herpes zoster, migraine, plaque psoriasis, and chronic urticaria, results were classified as 'potentially effective,' indicating promising evidence that still needs more studies for definitive confirmation. On the other hand, for conditions such as hypertension, facial paralysis, acne, stroke rehabilitation, and obesity, the evidence remained 'inconclusive,' not allowing clear statements on the efficacy of the technique.

For patients who consider cupping therapy, these results offer valuable guidance on where the technique may be most beneficial. Low back pain appears as the application with the most solid evidence, while general musculoskeletal pain (neck, knees) and certain skin conditions show promising potential. For health care professionals, the study indicates areas where cupping therapy can be considered as a complementary therapeutic option, especially when integrated with conventional treatments. The map also highlights the need for more research in many areas, suggesting opportunities for more rigorous future clinical studies.

It is important to emphasize that, even in conditions with favorable evidence, cupping therapy should be performed by trained professionals and as part of a comprehensive therapeutic plan.

The study presents some important limitations that must be considered. Most of the analyzed reviews were classified as having 'moderate' to 'critically low' quality according to the most rigorous scientific criteria, which reduces overall confidence in the results. Many of the original studies included in the reviews had methodologic problems, such as lack of adequate control groups or small number of participants. In addition, the analyzed studies were performed mostly in Asia, which may limit the applicability of the results to other populations.

The wide variety of cupping techniques used in the different studies also makes it difficult to determine which specific approach is most effective. Despite these limitations, this evidence map represents an important advance in the organization of scientific knowledge on cupping therapy, offering a clear view of where promising evidence exists and where more research is needed, thus facilitating informed decisions for both patients and health policy makers.