The aim of this systematic review and meta-analysis was to investigate the efficacy of dry cupping compared to placebo cupping in community-dwelling adults with musculoskeletal pain in the short-term (up to 1-week post-intervention), medium-term (up to 4 weeks post-intervention) and long-term (up to 6 months post-intervention).
This systematic review was pre-registered in Open Science Framework on December 6, 2023 (https://osf.io/3fa9m/). Placebo-controlled randomized trials investigating people with musculoskeletal pain of any duration were eligible. The intervention was dry cupping, where a cup was placed on the skin and suction was created between the cup and the skin and a control (placebo) intervention that intended to mimic the cupping intervention. Trials needed to report on pain or function. Medline (Ovid), EMBASE (Ovid), CENTRAL (Wiley), AMED (Ovid), CINAHL (EBSCO), Physiotherapy Evidence Database (PEDro) and Web of Science Core Collection were searched from inception to May 31, 2024. Trials were independently selected by two reviewers conducting title and abstract, and full-text screening. Data extraction was performed by two independent reviewers using Microsoft Excel. Risk of Bias was assessed using the Cochrane Risk of Bias 2.0 tool. Pain scales were converted to a 0 to 100 scale, with a minimally important difference of 20 points. Random effects meta-analyses were conducted. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was performed.
We located 3330 records, and after screening, finally included 5 studies. Three studies investigated low back pain, 1 study investigated neck pain and 1 study investigated fibromyalgia. There was no difference between cupping and placebo cupping for pain in the short term (mean difference: -9.9, 95%CI: -22.0 to 2.1, I2: 84%, 4 studies, very low certainty evidence) and long-term (mean difference: -2.2, 95%CI: -11.8 to 7.4, 1 study, low certainty evidence). There was a significant difference that may or may not be clinically worthwhile for pain in the medium term (mean difference: -17.2, 95%CI: -33.0 to -1.4, 1 study, low certainty evidence).
The certainty of evidence for the effectiveness of cupping is low or very low. Therefore, true estimates could vary substantially from the estimates presented here.
It is too early to recommend dry cupping in the short-, medium- or long-term for the treatment of musculoskeletal pain and alternative evidence-informed interventions should be prioritised in clinical practice. Larger and higher quality studies are required with multiple follow-up timepoints to determine the efficacy of dry cupping.
musculoskeletal
pain
