Complementary Therapies in Medicine (2009) 17, 9—15

The effectiveness of wet-cupping for nonspecific low

back pain in Iran: A randomized controlled trial

Khosro Farhadia,David C.Schwebel, Morteza Saeb, Mansour Choubsaza, Reza Mohammadid, Ali Raza Ahmadi

a Department of Anesthesiology, Critical Care and Pain Management, Pain research centerKermanshah University of Medical Sciences, Iran

b University of Alabama at Birmingham, USA

c Department of Orthopedic Surgery, Kermanshah University of Medical Science, Irand Karolinska Institute, Stockholm, Sweden

Objectives: To determine the efficacy of wet-cupping for treating persistent nonspecific low back pain.

Background: Wet-cupping therapy is one of the oldest known medical techniques. It is still used in several contemporary societies. Very minimal empirical study has been conducted on itsefficacy.

Design: Randomized controlled trial with two parallel groups. Patients in the experimental group were offered the option of referral to the wet-cupping service; all accepted that option.

The control group received usual care.

Participants: 98 patients aged 17—68 years with nonspecific low back pain; 48 were randomly assigned to experimental group and 50 to the control group.

Intervention: Patients in the experimental group were prescribed a series of three staged wetcupping treatments, placed at 3 days intervals (i.e., 0, 3, and 6 days). Patients in the controlgroup received usual care from their general practitioner.

Main outcome measures: Three outcomes assessed at baseline and again 3 months following

intervention: the McGill Present Pain Index, Oswestry Pain Disability Index, and the Medication

Quantification Scale.

Results: Wet-cupping care was associated with clinically significant improvement at 3-month follow-up. The experimental group who received wet-cupping care had significantly lower levels

of pain intensity ([95% confidence interval (CI) 1.72—2.60] mean difference = 2.17, p < 0.01), pain-related disability (95% CI = 11.18—18.82, means difference = 14.99, p < 0.01), and medication use (95% CI = 3.60—9.50, mean difference = 6.55, p < 0.01) than the control group. The differences in all three measures were maintained after controlling for age, gender, and duration

of lower back pain in regression models (p < 0.01).

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Journal of Biomechanics

Cupping: From a biomechanical perspective

L.M. Thama, H.P. Lee, C. Lua

aInstitute of High Performance Computing, 1 Science Park Road, #01-01 The Capricorn, Singapore Science Park II, Singapore 117528, Singapore

bDepartment of Mechanical Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117576, Singapore

Accepted 29 June 2005

Abstract

The effectiveness of the cupping technique, a treatment modality in Traditional Chinese Medicine, in stimulating acupuncture points for pain relief was examined in this paper from a biomechanical perspective. Parametric studies including the effects of

vacuum pressure, loading rate, friction coefficient at the cup–skin interface, and size and shape of the cup were carried out using a model based on the finite-element method. The anatomical structures of skin, fat, and muscle were modelled. All the soft-tissue

layers were assumed to be nonlinearly elastic and viscoelastic. The rim of the cup was also modelled to study the interaction between cup and skin; the cup rim was assumed to be rigid. The simulation results showed that the stresses in the soft tissue were increased

for increasing applied vacuum pressures and that the effects of cupping were mostly limited to the region enclosed by the cup. The simulations also indicated that the magnitude of the applied vacuum may have had direct implications for the severity of bruising of

the skin following cupping treatment. Most significantly, the simulation results contradicted the established practice of cup size selection according to the depth of the disorder. Experimental verification of the proposed multi-layered finite-element model is

presented. The nature of the bruising inherent to the cupping treatment is also explained by the proposed model.

2005 Elsevier Ltd. All rights reserved.

For reprints and all correspondence: Myeong Soo Lee, PhD, Division

of Standard Research, Korea Institute of Oriental Medicine, Daejeon,

305-811, South Korea. Tel:þ82-42-868-9266; Fax:þ82-42-863-9464;

E-mail: drmslee@gmail.com; mslee@kiom.re.kr

________________________________________________________________________

eCAM Advance Access published May 7, 2009

The aim of this systematic review therefore, was to summarize

and critically evaluate the evidence for or against

the effectiveness of cupping as a singular treatment of pain.

Methods

Data Sources

The following databases were searched from inceptionthrough to January 2009: MEDLINE, AMED, EMBASE, CINAHL, five Korean Medical Databases

(Korean Studies Information, DBPIA, Korea Institute of Science and Technology Information, KoreaMed, and ResearchInformationCenter for Health Database),

four Chinese Medical Databases (China National Knowledge Infracture:China Academic Journal, Century JournalProject, China Doctor/Master Dissertation Full TextDB and China Proceedings Conference Full Text DB)and The Cochrane Library 2008, Issue 4. The search terms used were based on two concepts. First concept included terms for cupping and the other concept included terms for pain. The two concepts were combined using the Boolean operator AND. In the English databases it was unnecessary to use synonyms for cupping asthe only term used to describe this therapy is cupping.The term ‘cupping’ would also capture dry cupping, wetcupping, cupping therapy, etc. Korean and Chinese terms for cupping and pain were used in the Korean and Chinese databases. We also performed electronic searches of relevant journals [FACT (Focus on Alternative and

Complementary Therapies), and Research in Complementary Medicine (Forschende Komplementarmedizin) up to January 2009]. RCTs testing cupping with or without drawing blood as sole or adjunctive treatment, in patients of either sex or any age diagnosed as having any type of pain andassessing clinically relevant outcomes, were included.

Results

Study Description

The literature searches revealed 285 articles, of which 278 studies had to be excluded (Figure 1). One hundred and eighty five articles were excluded after retrieving full text and their reasons for exclusion are summarized in Supplement 1. Seven RCTs met our inclusion criteria and their key data are listed in Table 1 and 2 (7–13). One of the included RCTs originated from Iran (10), four RCTs from China (7–9,13) and two RCTs from Germany (11,12). All of the included trials adopted a

two-armed parallel group design. The treated conditions were low back pain (8,10) cancer pain (7), trigeminal neuralgia (9), Brachialgia paraesthetica nocturna (BPN)

(11,12) and herpes zoster (13). The subjective outcome measures were the McGill Pain Questionnaire (10), 100mm visual analogue scales (8,10,12), response rate

(7–9,13) and Likert scales (11). Five trials employed wet cupping (9–13) and two dry cupping (7,8). The number of treatment sessions ranged from 1 to

about 9, with a duration of 5–20 min per session.2 of 7 Cupping for treating pain:

An investigation into the effect of Cupping Therapy as a treatment for Anterior Knee Pain and its potential role in Health Promotion.

Kaleem Ullah, MScPhysiotherapy
University of East Anglia, Ahmed Younis Principal Lecturer
St Georges University of London , Mohamed Wali
St Georges University of London