Efficacy of cupping therapy in patients with the fibromyalgia syndrome-a randomised placebo controlled trial

This randomized controlled trial investigated the efficacy of cupping therapy in the treatment of fibromyalgia syndrome, a condition characterized by chronic widespread pain accompanied by fatigue, sleep disturbances, and cognitive alterations. Fibromyalgia affects between 2.9% and 3.8% of the European population, predominantly in women. Cupping therapy is an ancient medical practice that applies suction to the skin through special cups, theoretically promoting increased microcirculation and relief of muscle tension. The study was conducted in Germany between October 2012 and February 2015, involving 141 participants diagnosed with fibromyalgia according to the 2010 American College of Rheumatology criteria.

Participants were predominantly women (139) with a mean age of 55.8 years, with pain for approximately 12 years on average. They were randomized into three groups: real cupping therapy (47 participants), sham cupping therapy with a placebo device (48 participants), and usual care (46 participants). The protocol consisted of five cupping therapy sessions applied twice a week over 18 days. The cups were placed on the upper and lower back regions, including the trapezius, levator scapulae, latissimus dorsi, and gluteus maximus muscles.

In the real cupping group, the negative pressure was maintained for 10-15 minutes, while in the placebo group, small holes in the cups released the pressure within seconds. The primary outcome was pain intensity measured by visual analog scale on day 18. Secondary outcomes included functionality, quality of life, fatigue, sleep quality, and pressure sensitivity. The results showed that cupping therapy was superior to usual care, with a significant reduction of 12.4 points in pain intensity (p < 0.001).

However, there was no statistically significant difference between real and sham cupping therapy (-3.0 points, p = 0.396). About 25.5% of patients in the real cupping group and 18.8% in the placebo group reported at least a 30% reduction in pain, compared to only 2.2% in the usual care group. Improvements in quality of life were observed in several domains of the SF-36 questionnaire, including bodily pain, vitality, social functioning, and mental health. The majority of patients (82.1% in the real group and 73.2% in the placebo group) were able to correctly identify which type of cupping they received, indicating failure of blinding.

Despite this, the placebo effect was preserved, possibly because participants did not know that one of the treatments was sham — they were informed only that two different techniques were being compared. Adverse events were minimal, mainly including temporary increased pain in two patients. No serious treatment-related adverse events were observed. Patient satisfaction was moderate in both cupping groups.

Study limitations include failure of patient blinding, the predominance of female participants (limiting generalization to men), and the fact that the effects were small and not superior to placebo. The authors conclude that, although cupping therapy was more effective than usual care in improving pain and quality of life, the effects were small and comparable to those of sham treatment. Therefore, there is currently insufficient evidence to recommend cupping in the treatment of fibromyalgia. The findings suggest that future studies should investigate different cupping techniques, treatment durations, and its application as part of multimodal approaches.