The Effect of Cupping Therapy on Non-specific Neck Pain: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis examined the efficacy of cupping therapy in the treatment of non-specific cervical pain, an extremely common condition affecting up to 50% of the general population. Neck pain represents an important public health problem, associated with significant disability in daily activities and work absenteeism. Although conventional therapeutic options include physical therapy, activity modification, and anti-inflammatory medications, these treatments have variable efficacies and, in some cases, prove ineffective. Cupping therapy, an ancient therapeutic modality documented across various cultures including traditional Iranian medicine, has gained growing interest as a complementary treatment for painful conditions.

The proposed mechanism of action involves the creation of negative pressure that draws blood to the painful area, removing blood stasis and increasing local circulation to relieve muscular tension and pain. Researchers conducted systematic searches in eight medical databases through March 2017, including PubMed, EMBASE, Cochrane Library, and Iranian databases, without temporal restrictions. Randomized clinical trials comparing cupping therapy (dry or wet) with other treatments or no treatment in adults with non-specific cervical pain were included. Primary outcomes included pain intensity measured by the Visual Analog Scale (VAS), while secondary outcomes assessed disability through the Neck Disability Index (NDI) and quality of life through the SF-36 questionnaire.

Ten randomized clinical trials involving 441 participants were included in the analysis. Most patients were women with chronic non-specific cervical pain, aged 20-57 years. Interventions included dry cupping, traditional cupping, cupping massage, and pulsatile cupping. Treatment duration ranged from 2-13 weeks in most studies, with one 2-year follow-up.

Meta-analysis of five studies with 272 participants revealed significant differences in pain relief favoring cupping therapy compared to the control group (VAS 100mm: mean difference -0.84, 95% CI -1.22 to -0.46). Heterogeneity between studies was moderate (I²=54.7%). For functional disability, six studies with 301 participants showed clinical superiority of cupping therapy (SMD=-0.60, 95% CI -0.86 to -0.35, I²=16.4%). Quality of life assessment using the SF-36 in five studies with 261 participants showed that cupping therapy increased quality of life compared to control (SMD=-0.56, 95% CI -0.20 to -0.92, I²=51.4%).

Two studies assessed pain via the Numeric Rating Scale, both showing superiority of cupping therapy. None of the clinical trials reported serious adverse effects. Proposed mechanisms for the efficacy of cupping therapy include increased blood flow to skin and muscles, stimulation of the peripheral nervous system, modulation of neurohormonal systems, and improvement of subcutaneous circulation. Study limitations include the relatively small number of trials included, focus only on publications in English and Persian, predominantly moderate-to-low methodological quality of the studies, and inability to assess publication bias due to the limited number of studies.

The observed heterogeneity may reflect differences in cupping techniques, populations studied, and treatment protocols. This review provides evidence that cupping therapy may offer partial pain relief for patients with non-specific cervical pain, with benefits observed in pain intensity reduction, functional disability improvement, and quality of life enhancement. However, results should be interpreted with caution due to evidence heterogeneity. Future studies with larger samples and the development of placebo controls for cupping therapy are needed to confirm the therapeutic value of this modality in the treatment of cervical pain.