Papers of the Week

There is a growing interest in non-pharmacological pain treatment options such as cupping. This meta-analysis aimed to assess the effectiveness and safety of cupping in chronic pain. PubMed, Cochrane Library, and Scopus were searched through November 2018 for randomized controlled trials on effects of cupping on pain intensity and disability in patients with chronic pain. Risk of bias was assessed using the Cochrane risk-of-bias tool. Of the 18 included trials (n=1,172), most were limited by clinical heterogeneity and risk of bias. Meta-analyses found large short-term effects of cupping on pain intensity compared to no treatment (standardized mean difference [SMD]=-1.03; 95% confidence interval [CI]=-1.41,-0.65), but no significant effects compared to sham cupping (SDM=-0.27; 95%CI=-0.58,0.05) or other active treatment (SMD=-0.24; 95%CI=-0.57,0.09). For disability, there were medium-sized short-term effects of cupping compared to no treatment (SMD=-0.66; 95%CI=-0.99,-0.34), and compared to other active treatments (SMD=-0.52; 95%CI=-1.03,-0.0028), but not compared to sham cupping (SMD=-0.26; 95%CI=-0.57, 0.05). Adverse events were more frequent among patients treated with cupping compared to no treatment; differences compared to sham cupping or other active treatment were not statistically significant. Cupping might be a treatment option for chronic pain, but the evidence is still limited by the clinical heterogeneity and risk of bias. Perspective: This article presents the results of a meta-analysis aimed to assess the effectiveness and safety of cupping with chronic pain. The results suggest that cupping might be a treatment option; however, the evidence is still limited due to methodical limitations of the included trials. High quality trials seem warranted.