Is cupping therapy (a form of alternative medicine) effective for treating medical conditions?

Is Cupping Therapy Effective?

Cupping therapy has limited evidence supporting its use, with the strongest data showing it may reduce pain in musculoskeletal conditions, though even this evidence remains weak and insufficient to make a strong recommendation for routine clinical use.

Evidence Quality and Guideline Recommendations

What Major Guidelines Say

The most relevant guideline evidence comes from multiple high-quality sources that address complementary and alternative medicine (CAM) therapies:

• The British Society of Gastroenterology (2019) states that while 30-50% of IBD patients use CAMs, there is no evidence to recommend routine use of most CAM therapies, and larger studies are needed before recommendations can be made 1

• The American College of Chest Physicians (2013) clearly distinguishes between evidence-based complementary therapies (like acupuncture for specific indications) and unproven "alternative medicine" that lacks data to support purported benefits and safety 1

• The American College of Physicians (2017) guideline on low back pain does not include cupping therapy among recommended treatments, despite reviewing numerous non-invasive therapies including massage, spinal manipulation, and superficial heat 1

• The Expert Panel on Asthma Management (2007) explicitly states that evidence is insufficient to recommend most complementary and alternative treatments, noting that clinical trials on safety and efficacy are limited and their scientific basis has not been established 1

What the Research Shows

For Pain Conditions:

• A 2011 systematic review of systematic reviews found that relatively clear evidence emerged only for pain reduction, but even for this indication, doubts remain 2
• A 2023 evidence-based review concluded that cupping has low to moderate evidence for decreasing low back pain or cervical pain, with very low to low evidence for other musculoskeletal conditions 3

Mechanism of Action:

• A 2019 study using embedded optical sensors demonstrated that cupping increases blood volume and tissue oxygenation at the treatment site while slightly decreasing these parameters in surrounding tissue 4
• A 2025 review suggested potential hemodynamic benefits and possible effects on blood pressure and cardiac rhythm, though contradictory evidence exists 5

Clinical Practice Reality:

• A 2024 cross-sectional study of 646 Brazilian physical therapists revealed they use cupping based primarily on patient demand and personal experience rather than scientific evidence, identifying lack of high-quality evidence as a major barrier 6

Clinical Decision Algorithm

When Cupping Should NOT Be Recommended:

1. As a primary treatment for any serious medical condition - Guidelines consistently emphasize that CAM therapies should never replace evidence-based conventional treatments 1

2. For conditions with established effective treatments - Use proven therapies first (exercise, NSAIDs, physical therapy, etc.) 1

3. In patients with bleeding disorders or on anticoagulation - Wet cupping involves breaking the skin 3

When Cupping Might Be Considered (With Caveats):

1. Chronic musculoskeletal pain refractory to conventional treatment - Only after optimizing evidence-based therapies like exercise, manual therapy, and appropriate medications 1, 3

2. Patient strongly desires complementary therapy - If conventional treatments have been tried and patient understands the limited evidence 1

3. As an adjunct, never as monotherapy - Should always be combined with proven treatments 3

Critical Pitfalls to Avoid

The "Alternative Medicine" Trap:

• The American College of Chest Physicians warns that "alternative medicine" often promotes unproven methods instead of mainstream care, which can be especially harmful when patients postpone needed treatment and diminish possibility of remission and cure 1

Patient Communication:

• The British Society of Gastroenterology recommends good practice includes inquiring about CAM use, as patients are often reluctant to mention it 1
• Discuss that cupping has very low incidence of adverse events but also lacks robust evidence for efficacy 3

Evidence Misinterpretation:

• The 2024 study revealed practitioners are implementing cupping without utilizing the best available evidence pillar of evidence-based practice 6
• Hemodynamic changes observed in research studies do not automatically translate to clinically meaningful outcomes 4

What TO Recommend Instead

For the conditions where cupping is most commonly sought:

For chronic pain:

• Exercise therapy (moderate evidence for small improvements) 1
• Superficial heat (moderate evidence for pain relief) 1
• Massage (moderate evidence when combined with exercise) 1
• Spinal manipulation (low-quality evidence for small functional improvements) 1

For musculoskeletal conditions:

• Progressive exercise programs with gradual advancement 7
• Manual therapy techniques with established evidence 1
• Appropriate use of NSAIDs or acetaminophen 7

Bottom Line for Clinical Practice

Given the absence of cupping therapy from major clinical practice guidelines despite extensive review of complementary therapies, combined with only low-to-moderate quality evidence for pain reduction, cupping cannot be recommended as a standard treatment approach 1, 2, 3. If patients insist on trying it after conventional therapies have been optimized, ensure they understand the limited evidence, continue proven treatments, and monitor for any adverse effects 1, 3.