Cupping-

This alternative therapy has been practiced for over 3,000 years and is performed frequently in Muslim countries as a treatment for anemia, hemophilia, rheumatic diseases, back pain, fertility disorders, and skin disorders.  It has almost no scientific study backing its use, but is a traditional medicine method that uses closed cups or bowls with a vacuum inside, placed on the skin to suck part of the soft tissues inward, breaking the capillaries at the point of contact with the skin. 

   Dry cupping involves the use of cups 1-3 inches wide made of plastic or glass in modern times.  There are two types of dry cupping: fire cupping and vacuum cupping.  Fire cupping involves suction created by heating the cup or air inside with an open flame or a bath in hot scented oils or an using alcohol soaked cotton ball that is set on fire in the cup heating the interior.  In fire cupping, the fires is extinguished, then then the cup is placed against the skin.  As the air inside cools, a suction is created, holding the cups onto the skin.  Vacuum cupping is the other type of dry cupping that uses rubber cups used to squeeze out the air inside or vacuum cups that have a one way evacuation valve or evacuation tube connected to a suction device.  The skin may be lubricated and the cups may slowly move across the skin on their own.         Wet cupping (also called Hijama) is used primarily in Muslim countries.  It involves making several small incisions in the skin, then placing the fire cupping over the incised area.  This sucks blood from the wounds and partially fills the cups with blood.  This is neither safe or effective, and strongly resembles the bleeding procedures used in the 1600s and 1700s in Europe that weakens and kills.  There have been reports of hospitalizations after wet cupping, so it should be completely avoided.  Wet cupping results in scarification of the skin or may use suction followed by use of a scalpel to make small cuts in the skin to let blood, followed by a second suction cupping treatment.  This is thought to eliminate scar tissue.  Because cupping was described as having been used by Mohammed, many Muslim countries still use cupping and wet cupping (fire cupping) with its bloodletting is used in China frequently..  The American Cancer Society and most guidelines for use of alternative therapies have concluded cupping has no health benefits at all.   

Alpha levels of evidence- No recommendation for or against due to widely varying outcomes (J Altern Complement Med. 2017 Nov 29);  for low back pain, cupping in a meta-analysis demonstrated mild reduction in VAS pain scores and significant reduction in disability (J Back Musculoskelet Rehabil. 2017 Nov 6;30(6):1187-1195).  Cupping therapy only minimally improves knee arthritis (Complement Ther Clin Pract. 2017 Aug;28:152-160)  The latter two studies are Chinese studies, and therefore highly suspect.  With regard to wet cupping 9 RCTs favored wet cupping while 5 did not. ( Altern Complement Med. 2016 Oct;22(10):768-777. Epub 2016 Aug 24. Review.)  A Chinese study demonstrated wet cupping reduces pain due to Shingles (Altern Ther Health Med. 2010 Nov-Dec;16(6):48-54).  Wet cupping was not found to be recommended in a Cochrane database for acne vulgaris (Cochrane Database Syst Rev. 2015 Jan 19;1:CD009436)  Cupping was found to be efficacious than waitlist in reduction of neck pain (MD=-19.10) and more efficacious than NSAIDs (MD=-5.4) for chronic low back pain (PLoS One 2015 Feb 24;10(2):e0117146. doi: 10.1371)  Other studies: 

• J Back Musculoskelet Rehabil. 2017 Nov 6;30(6):1187-1195 A meta-analysis of randomized trials demonstrated significant effectiveness for the treatment of low back pain

• J Pain. 2009 Jun;10(6):601-8. Cupping of the trapezius for carpal tunnel syndrome led to significant reduction in pain (RCT)

• A systematic review of studies in 2011 (Evid Based Complement Alternat Med. 2011;2011:467014) it was found there were two randomized controlled trials showing some benefit in pain treatment and one that found no benefit. Overall, the quality of the available studies being conducted by those using cupping are so poor that no conclusions may be drawn about efficacy. 

Injuries from cupping, while rare, may be serious.

• Interv Neuroradiol. 2016 Dec;22(6):728-731 Cupping was associated with a vertebral artery rupture and large hematoma on the back of the neck

• Wounds. 2014 Jul;26(7):214-20.  Burn injuries from cupping in China are not uncommon, more often seen with wet vs. dry cupping

• J Dtsch Dermatol Ges. 2015 Apr;13(4):337-8  Cupping may cause permanent dermal scarring

• J Cutan Med Surg. 2015 May-Jun;19(3):320-2  Cupping may induce psoriasis in areas under the cups

• J Burn Care Res. 2011 Mar-Apr;32(2):e31  Burn injuries due to cupping

• J Altern Complement Med. 2009 Nov;15(11):1243-5.  Cupping may create severe blistering as well as bruising