What are the potential effects of cupping therapy (cupping) applied to the lower back and subsequently self-administered to the upper back 3 days prior at an acupuncture appointment?

From the Guidelines

The patient should monitor the cupping sites for any signs of infection and seek medical attention if severe symptoms occur, as cupping therapy is generally considered safe but can have adverse effects in rare cases. Cupping therapy is a traditional practice where suction is created on the skin using cups, typically to improve blood flow and relieve muscle tension. It's normal for cupping to leave circular bruise-like marks that can last for several days to a week. These marks are not typically a cause for concern and will fade naturally. According to a systematic review on nonpharmacologic therapies for low back pain, including cupping therapy, acupuncture, and massage, these therapies can have small to moderate effects on pain relief 1.

Key Considerations

• The patient should apply a cool compress to help with any discomfort and engage in gentle stretching to aid in relieving muscle soreness.
• For future sessions, it's advisable to discuss treatment areas with the acupuncturist beforehand rather than modifying the treatment independently, as practitioners plan treatments based on specific therapeutic goals.
• The evidence from studies on nonpharmacologic therapies for low back pain, such as the systematic review by the American College of Physicians, suggests that these therapies can be effective for pain relief, but the magnitude of benefits is generally small to moderate and short-term 1.
• The patient should be aware of the potential risks and benefits of cupping therapy and other nonpharmacologic therapies, and discuss any concerns with their healthcare provider.

Recommendations

• Monitor the cupping sites for signs of infection, such as increasing redness, warmth, swelling, or discharge.
• Seek medical attention if severe symptoms occur, such as severe pain, spreading redness, fever, or other concerning symptoms.
• Discuss treatment areas with the acupuncturist beforehand to ensure safe and effective therapy.
• Consider combining cupping therapy with other nonpharmacologic therapies, such as acupuncture or massage, for optimal pain relief, as suggested by the systematic review 1.

From the Research

Cupping Therapy and Arnica

• Cupping therapy is a traditional practice that involves creating suction on the skin to promote healing and relaxation.
• The patient had cupping done to the lower back and rolled it up to the upper back at her acupuncture appointment 3 days ago.
• There is no direct evidence in the provided studies to support the use of cupping therapy for pain management or its potential interactions with arnica.

Arnica for Pain Management

• Arnica has been traditionally used to treat various medical conditions, including inflammation and pain 2.
• Studies have shown that arnica extract or gel/cream containing arnica extract has promising effects for pain relief, particularly for post-operative, arthritis, low back pain, and other types of musculoskeletal pain 2, 3.
• Topical 20% arnica ointment may be effective in reducing bruising and promoting wound healing 4.

Potential Benefits and Limitations

• Arnica may be a valid alternative to non-steroidal anti-inflammatory drugs for treating specific conditions, such as post-traumatic and postoperative pain, edema, and ecchymosis 3.
• However, the dosages and preparations of arnica used can produce substantial differences in clinical outcomes 3.
• Some reported benefits of arnica may be due to other factors, including placebo response and natural course of disease 5.