This 2024 systematic review and meta-analysis sheds some light on the effectiveness of cupping for low back pain.
A systematic review gathers and analyzes data from multiple well-designed studies, giving us a stronger overall picture than a single study could.
What the Researchers Did:
The goal of this review was to see how well cupping therapy helps with low back pain. The researchers looked through a wide range of studies, both English and Chinese, published up to late 2023. They specifically focused on studies where people with low back pain were randomly assigned to either receive cupping or another treatment (like medication or usual care). In total, they included 11 studies involving 921 participants with low back pain.
Key Findings – The Good News:
- Overall Pain & Disability Improvement: The good news is that cupping significantly helped reduce pain and improve daily function (disability) for people with low back pain. This effect was strongest in the short-term, typically within 2 to 8 weeks of starting treatment.
- Better than Medication and Usual Care: Cupping therapy actually showed a stronger and more lasting effect on pain reduction compared to standard medication and what's considered "usual care" (like rest or general physical activity).
- Acupoints vs. General Area: Where you place the cups matters! Cupping applied to specific "acupoints" (traditional acupuncture points) on the back was found to be much more effective at reducing pain than cupping applied to just a general area of the lower back. For example, specific points like BL23, BL24, and BL25 were often used. These points are shown below.
- Immediate Pain Relief: Cupping also showed an immediate positive effect on both the sensory (how much it hurts) and emotional (how pain affects mood) aspects of pain, lasting up to at least two weeks.
Things to Keep in Mind (The Nuances):
- Type of Cupping: While wet cupping (which involves small skin punctures before applying cups) showed a significant effect on pain, dry cupping (without punctures) did not show a clear statistical improvement in this review. However, the overall difference between dry and wet cupping wasn't considered statistically significant, meaning we can't definitively say one is much better than the other based solely on this review.
- Long-Term Effects: The pain relief from cupping seemed most pronounced in the short term (2-8 weeks). There wasn't strong evidence of continuous pain improvement at 1 month or 3-6 months follow-up. This suggests cupping might be most beneficial for acute or subacute pain relief rather than a long-term cure on its own.
- Chronic vs. Non-Specific Low Back Pain: Cupping appeared more effective for "non-specific low back pain" and "persistent non-specific low back pain" (where no clear cause like a disc herniation is found) compared to general "chronic low back pain."
- Variability in Studies: The researchers noted a "high degree of heterogeneity" across the studies. This means there were a lot of differences in how the cupping was done (e.g., how long cups were left on, how many sessions), how participants were selected, and how outcomes were measured. This variability makes it a bit harder to draw very firm conclusions across all studies.
What Does This Mean for Professionals?
This review provides valuable evidence supporting the use of cupping therapy as a complementary approach for managing low back pain, particularly for short-term pain relief and when applied to specific acupoints. It also suggests that cupping might be a good option for patients who haven't found sufficient relief with medication or usual care alone.
However, because of the differences found between studies, it's clear that more research is needed to standardise cupping treatment protocols (like how often, how long, and exactly where to apply cups) and to confirm its effects with more objective pain measures. For now, it offers a promising avenue for discussion with patients experiencing low back pain.
Reference: Zhang, Z., Pasapula, M., Wang, Z., Edwards, K. and Norrish, A., 2024. The effectiveness of cupping therapy on low back pain: A systematic review and meta-analysis of randomized control trials. Complementary therapies in medicine, 80, p.103013.