Letter
when the skin is sucked in); and
balance-cupping (composite manipulation, each dose including cupping
with retention 6–8 min, movingcupping four times, shaking-cupping
Cupping therapy has been used for three times and quick-cupping three
thousands of years in traditional times).
Chinese medicine for the treatment
Nowadays, an increasing number
of several chronic
conditions, of patients have shown an interest in
such as low back pain, chronic arth- using cupping therapy for the treatralgia, radiculopathy and respiratory ment of low back pain owing to
disease.1 Dry and wet cupping (with their belief that it is more effective
controlled bleeding) are the two than Western therapeutics. Although
main types of cupping therapy. cupping therapy is considered a safe,
Other subtypes of the treatment are non-invasive procedure, the outcome
cupping with retention (keeping does not always fulfil the expectation
cups on the skin or acupuncture of therapists and patients. Moreover,
points for 10–15 min); moving- complications of cupping therapy,
cupping (sliding cups over the skin such as anaemia and skin pigmentaor acupuncture points with lubri- tion, have also been reported.2
cants); shaking-cupping
(moving
Since there is no consensus on
cups up and down repeatedly on the role of cupping therapy in the
skin or acupuncture points); quick- treatment of low back pain, we
cupping (removing cups immediately reviewed the medical literature in
Effectiveness of cupping
therapy for low back pain:
a systematic review
Table 1
The studies with levels I and II evidence
Studies (level of
evidence)
Kim et al
(level I)
4
Liu et al5
(level II)
Xuan6
(level II)
Hong et al
(level II)
an attempt to test its effectiveness
in low back pain and to further
examine this method.
The systematic research started
with a thorough English and Chinese
language literature search of PubMed
from 1980 through 2013. The
keyword search terms in combination were ‘cupping therapy’, ‘low
back pain’, ‘lumbar sprain’, ‘lumbar
myofascitis’ and ‘lumbosacral pain’.
Articles with laboratory studies were
excluded.
Three reviewers took part in the
study. One reviewer selected the
titles and abstracts for inclusion,
one extracted data from the full-text
articles and the third reviewer confirmed the reference lists of potentially eligible studies. Identified
studies were assigned a level of evidence according to the Oxford
Centre for Evidence-Based Medicine
2011 levels of evidence.3
7
Lo and Ma8
(level II)
Ma and Lo9
(level II)
Chen and Pan10
(level II)
Treatment (N)
Dose and regimen
Intervention group Wet cupping
(21)
Control group (11) Waiting-list
1. Brochures for
exercise
2. General advice
3. Acetaminophen
500 mg
Intervention group Cupping with retention
(25/25)
Balance-cupping*
Bilateral at BL, 15 min daily
Bilateral low back area, along BL and GV,
every 2 days
50 mg, daily
Bilateral at BL, 5–10 times (about 5 min),
alternate days for 11 days
0.15 g, T.I.D. for 12 days
Bilateral at BL, 5–10 times (about 5 min),
alternate days for 11 days
0.15 g, T.I.D. for 12 days
Bilateral low back area, along BL, GV and local tender
points, every 2 days for 2 weeks
1 tablet of composite chlorzoxazone (chlorzoxazone
0.25 g+ acetaminophen 0.3 g),
B.I.D. for 2 weeks
Bilateral low back area, along BL and GV, every 2 days
Control group
Intervention
group (40)
Control group
Intervention
group (37)
Control group
Intervention
group (33)
Control group
(25) Diclofenac
Moving-cupping
(40) Dexibuprofen
Moving-cupping
(33) Dexibuprofen
Balance-cupping
(31) Western medication
Balance-cupping
Intervention
group (33)
Control group (31) Western medication
Results ( p value)
Bilateral BL23, BL24 and BL25,
3 times weekly for 2 weeks
1. NRS scores >0.05
2. PPI scores <0.05
3. ODQ scores >0.05
1. VAS <0.05
2. ODQ scores < 0.05
1. VAS <0.01
2. SF-36 <0.01
1. VAS<0.012.
2. SF-36 <0.01
VAS <0.05
VAS <0.05
1 tablet of composite chlorzoxazone (chlorzoxazone
0.25 g+ acetaminophen 0.3 g), B.I.D.
Intervention
Moving-cupping and cupping Bilateral at BL, Huatuoliaji points and local tender points, Recurrence rate <0.05
group (60)
with retention
alternate days
Control group (40) Western medication
1. 2% Local anaesthetics (novocaine or lidocaine)
4–6 mL+ vitamin B12 500 mg + dexamethasone
5–10 mg for point injection, every 2 days
2. Indometacin 25 mg for oral administration, T.I.D.
*Refer to text.
B.I.D., twice a day; NRS, numerical rating scale; ODQ, Oswestry Disability Questionnaire; PPI, McGill Pain Questionnaire for pain intensity; SF-36, 36-item
Short Form; T.I.D., three times a day; VAS, visual analogue scale.
336
Acupunct Med 2013;31:336–337. doi:10.1136/acupmed-2013-010385
Letter
Through our electronic and reference search we identified 29 citations (table 1): one randomised
controlled trial (RCT, level I evidence),4 six non-RCTs (level II evidence),5–10 20 case reports (level
IV evidence) and two mechanismbased reasoning studies (level V
evidence).
In the RCT, the effective rate of
the wet-cupping group was similar to
that of the waiting-list group
( p>0.05). Interventions in both
groups decreased pain, disability and
acetaminophen dosage, but a significant decrease in pain intensity according to the McGill pain questionnaire
( p<0.01) and reduced consumption
of acetaminophen ( p=0.09) were
seen in the wet-cupping group.4
Of the six non-RCTs, one showed
that the visual analogue scale (VAS)
score and the Oswestry disability
index in the balance-cupping group
were significantly lower than in the
group with cupping with retention
and diclofenac ( p<0.05), but there
was no difference between the
cupping with retention group and
the
diclofenac-only
group
5
( p>0.05). The other studies individually showed that the effectiveness of cupping in decreasing
VAS,6–9 reducing recurrence rate10
and improving quality of life6 7 was
better than Western medication.
Although evidence level I and II
studies on the effectiveness of
cupping treatment in low back pain
have been reported, aspects such as
manipulations, sites and dosage of
cupping and Western medication in
the comparison group are not
uniform. Although RCTs provide a REFERENCES
higher quality of evidence, we 1 Cao H, Han M, Li X, et al. Clinical
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Anaemia and skin pigmentation after
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low back pain.
Chia-Yu Huang,1,2 Mun-Yau Choong,2,3
Tzong-Shiun Li2,3
1
Division of Plastic Surgery, Department of Plastic
Surgery, China Medical University Hospital,
Taichung, Taiwan, Republic of China
2
School of Medicine, China Medical University,
Taichung, Taiwan, Republic of China
3
Department of Plastic Surgery, Tainan Municipal
An-Nan Hospital, Tainan, Taiwan, Republic of China
Correspondence to Dr Tzong-Shiun Li,
Department of Plastic Surgery, Tainan Municipal
An-Nan Hospital, No. 66, Sec. 2 Chang-He Rd,
An-Nan District, Tainan City 70965, Taiwan,
Republic of China; li.tsa2@msa.hinet.net
Contributors C-YH: conducted the
experiment; wrote the article. M-YC:
analysed and interpreted the data;
provided materials. T-SL: designed the
experiment; proofed and revised the
article.
Competing interests None.
Provenance and peer review Not
commissioned; internally peer reviewed.
▸ Additional material is published online
only. To view please visit the journal
online (http://dx.doi.org/10.1136/
acupmed-2013-010385).
5
6
7
8
9
To cite Huang C-Y, Choong M-Y, Li T-S. Acupunct
Med 2013;31:336–337.
Received 25 April 2013
Accepted 8 July 2013
Published Online First 25 July 2013
Acupunct Med 2013;31:336–337. doi:10.1136/acupmed-2013-010385
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337
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