Is cupping effective as a treatment for medical conditions?

Cupping Therapy as a Medical Treatment: Limited Evidence for Effectiveness

Cupping therapy has low to moderate evidence for treating musculoskeletal pain conditions but lacks sufficient evidence to recommend it for most medical conditions. 1

Evidence Assessment

Musculoskeletal Conditions

• The strongest evidence for cupping exists for musculoskeletal pain management:
  • Low to moderate evidence for decreasing low back pain and neck pain 1
  • Moderate evidence for increasing soft tissue flexibility 1
  • Some promising evidence for carpal tunnel syndrome and brachialgia 2
  • Very low to low evidence for other musculoskeletal conditions 1

Other Medical Conditions

• Limited evidence for:
  • Hypertension (one positive RCT) 2
  • Oxygen saturation in smokers with COPD (one positive RCT) 2
  • Oral and genital ulcers due to Behçet disease (one positive RCT) 2
• No significant benefit shown for:
  • Metabolic syndrome 2
  • Migraine headaches 2

Types of Cupping

1. Dry cupping: Most commonly studied form, involves creating suction on the skin without breaking it 1
2. Wet cupping: Involves small incisions made to the skin before applying suction 1

Methodological Issues in Research

• Most studies comparing cupping have significant limitations:
  • Variable risk of bias across all domains 2
  • Small sample sizes 2
  • Short treatment durations (ranging from 1 day to 12 weeks) 1
  • Inconsistent control interventions (non-intervention, standard medical care, heat, routine physiotherapy, etc.) 1
  • Lack of standardized protocols 2

Safety Considerations

• The incidence of adverse events is very low 1
• Most common adverse effects occur at the skin level 3
• Potential rare induction of rheumatic conditions has been partly attributed to immunomodulatory effects 4

Clinical Application

For patients with musculoskeletal pain who are interested in cupping:

1. Consider as an adjunct to conventional treatments, not a replacement
2. Inform patients about the limited evidence base
3. Monitor for skin reactions or other adverse effects
4. Evaluate response after a short trial period (2-4 weeks)
5. Discontinue if no improvement is observed

Conclusion

While cupping has historical roots in traditional Chinese and Persian medicine 3, modern evidence supporting its use remains limited. The strongest evidence exists for musculoskeletal pain conditions, but even this evidence is of low to moderate quality. Better-quality trials are needed before cupping can be firmly recommended as a standard treatment option for any medical condition 2.