Adding dry cupping therapy to conventional treatments for non-specific chronic low back pain doesn’t improve outcomes. A recent randomized trial found no difference in pain relief, disability reduction, or pressure pain threshold between those receiving only conventional therapy and those adding dry cupping. Both groups showed similar improvements over four weeks, but dry cupping increased costs and session time without any long-term benefit.
Key Findings:
- Pain Relief: Both groups experienced significant improvement, but adding dry cupping made no difference.
- Disability Scores: No measurable improvement with dry cupping.
- Pressure Pain Threshold: A brief improvement with dry cupping, but it didn’t last.
- Cost: Dry cupping added unnecessary expense without added value.
- Safety: Minimal side effects, such as mild skin itchiness in a few participants.
For managing chronic low back pain, sticking to proven conventional therapies – like core stabilization exercises, spinal manipulation, and patient education – is effective and cost-efficient. Dry cupping may appeal to some, but it doesn’t add value to treatment outcomes.
Study Details: Design, Goals, and Methods
Trial Goals
This study set out to explore whether adding dry cupping therapy to standard treatments could improve outcomes for patients dealing with chronic non-specific low back pain (CNLBP). Specifically, the researchers wanted to see if combining these therapies would lead to better results in terms of pain relief, physical function, and pressure pain threshold. CNLBP represents a significant challenge, making up 80–90% of chronic low back pain cases globally and ranking as a major cause of disability among musculoskeletal disorders. These factors shaped the design and focus of the research.
Study Methods
To tackle these questions, the researchers designed a rigorous randomized trial with a single-blind, parallel-group setup, conducted from March to June 2023. Participants were recruited through various channels to ensure a diverse pool. Adults aged 18 to 48 years with chronic pain lasting over three months were eligible if their pain was localized between the costal margin and the buttock transverse lines, and their Visual Analog Scale (VAS) scores ranged from 3 to 8. However, individuals were excluded if they had recent rehabilitation, skin conditions in the treatment area, recent use of painkillers, a history of spinal surgery, radiating pain, or diagnoses of inflammatory, rheumatic, or other identifiable spinal conditions.
Out of 52 patients initially screened, 12 did not meet the criteria, leaving 40 participants who were randomized. Although the study aimed for a sample size of 34, the researchers recruited slightly more to account for potential dropouts. Ultimately, 36 participants completed the trial. Randomization was done by drawing treatment assignments from an opaque jar, ensuring that outcome evaluators remained blinded to group allocations. Baseline characteristics were well-matched between groups: the intervention group had an average age of 32.11 years and an average pain duration of 5.50 years, while the control group averaged 35.83 years with a pain duration of 5.61 years [4].
Main Results: No Extra Benefits from Dry Cupping Therapy
Primary Results
The trial results revealed that adding dry cupping therapy to standard treatment offered no noticeable improvement compared to conventional therapy alone. Both groups in the study showed significant reductions in pain after four weeks. When pain intensity was assessed using the Visual Analog Scale (VAS), the difference between the two groups at rest was minimal (median difference of 0.0 cm, 95% confidence interval: –1.0 to 1.0) [5].
For the control group, VAS scores dropped from 4.00 (2.75, 6.25) to 1.50 (0.75, 3.00), while the intervention group’s scores decreased from 5.00 (3.75, 7.25) to 1.00 (0.00, 3.00) over the four-week period [5]. Measures of disability levels and pressure pain thresholds (PPT) also showed no statistically significant differences between the two groups by the end of the treatment. Additional sensory outcomes were analyzed, but these findings reinforced the lack of added benefit from dry cupping.
Secondary Results
The intervention group did experience a brief improvement in PPT after the first session, suggesting a short-term neuromodulatory effect. However, this effect did not persist throughout the four-week trial. These secondary observations align with the primary conclusion that dry cupping does not contribute to long-term therapeutic benefits.
A randomized controlled trial conducted at Charité Universitätsmedizin in Berlin, Germany (March 2014–February 2015) provided safety data. Moderate adverse events were reported in two patients from the pulsatile cupping group, who experienced a temporary worsening of low back pain lasting a few hours after the sessions. Additionally, mild muscular backache within 24 hours was noted in six patients from the pulsatile group and two patients in the minimal cupping group [6].
Cupping therapy for back pain
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Side-by-Side Comparison: Dry Cupping Plus Conventional vs. Conventional Therapy Alone
The trial results provide a clear look at how these two treatment approaches stack up. While both methods delivered similar outcomes, dry cupping added extra sessions, increasing both time and cost.
In the control group, VAS (Visual Analog Scale) pain scores decreased from 4.00 to 1.50, and disability scores dropped from 4.00 to 1.00. The intervention group showed similar progress, with VAS scores improving from 5.00 to 1.00 and disability scores also shifting from 5.00 to 1.00. The median difference for both outcomes was 0.0 (95% CI -1.0 to 1.0) [5][4].
Below is a detailed comparison of the results for conventional therapy alone versus its combination with dry cupping.
Comparison Table
| Treatment Outcome | Conventional Therapy Alone | Conventional + Dry Cupping | Clinical Significance |
|---|---|---|---|
| Pain Reduction (VAS) | 4.00 → 1.50 (median scores) | 5.00 → 1.00 (median scores) | No difference (MD 0.00, 95% CI -1.00 to 1.00) |
| Disability Improvement (RMDQ) | 4.00 → 1.00 (median scores) | 5.00 → 1.00 (median scores) | No difference (MD 0.00, 95% CI -1.00 to 1.00) |
| Treatment Duration | 4 weeks | 4 weeks | Same timeframe |
| Safety Profile | Low risk | Low risk with mild skin itchiness in 2 participants | Minimal additional risk |
| Cost Considerations | Standard therapy costs | Higher due to additional cupping sessions | Increased expense without added benefit |
| Pressure Pain Threshold (PPT) | Steady improvement | Transient improvement, then similar to control | Temporary effect only |
The intervention group experienced a brief improvement in pressure pain threshold immediately after the first session, but this effect faded over the four-week period [7].
Both groups reported a low risk of side effects. In the dry cupping group, two participants experienced mild skin itchiness, which resolved on its own [7].
These results suggest that conventional therapy – comprising core stabilization exercises, spinal manipulation, and patient education – provides sufficient therapeutic benefits. Adding dry cupping sessions appears to increase costs without offering additional long-term advantages [7].
What This Means for Chiropractic and Physical Therapy Care
These trial results provide valuable insights for healthcare providers managing chronic low back pain. At Portland Chiropractic Group, they strengthen our dedication to offering treatments grounded in scientific evidence while being upfront with patients about what is effective and what is not. The findings emphasize the importance of sticking to well-established conventional therapies.
Evidence-Based Treatment Planning
The study underscores why conventional therapies should remain the cornerstone for addressing non-specific chronic low back pain. Treatments like core stabilization exercises, spinal manipulation, and patient education showed significant improvements in pain and disability scores over a four-week period. These results align with Portland Chiropractic Group’s focus on trusted methods such as chiropractic adjustments, functional training, and thorough patient education, which are effective for the majority (80–90%) of chronic low back pain cases [4].
Notably, the trial revealed that adding dry cupping to conventional therapy did not enhance pain relief, disability improvement, or pressure pain threshold (PPT).
The American College of Physicians advises prioritizing treatments that minimize risks and costs when multiple options offer similar outcomes. Dr. Nitin S. Damle, president of ACP, states:
"For the treatment of chronic low back pain, physicians should select therapies that have the fewest harms and costs, since there were no clear comparative advantages for most treatments compared to one another." [8]
This perspective highlights that complementary treatments should be viewed as optional rather than essential.
Clear Patient Communication
Effective communication is crucial when discussing treatment options with patients suffering from chronic low back pain. Patients need to understand that conventional therapies alone, as provided by Portland Chiropractic Group, deliver significant benefits. The trial demonstrated that both groups experienced meaningful improvements from baseline, proving that well-executed conventional care can yield strong results.
Healthcare providers should also clarify that while complementary treatments like cupping might claim theoretical benefits, such as improved blood circulation or endorphin release, they do not enhance outcomes when added to already effective conventional therapies. Being transparent about this helps patients make informed decisions about their care and financial commitments.
With low back pain costing the United States an estimated $100 billion annually [9], conventional therapies stand out as a cost-effective option that delivers comparable relief without unnecessary expenses. When patients understand that these treatments alone are sufficient, they can make smarter choices about their healthcare spending.
Summary: Key Points for Patients and Practitioners
This trial highlights that adding dry cupping to standard treatments does not enhance outcomes for chronic low back pain. According to Xu et al., there was a 0.0 cm median difference in resting pain at week 4 between the two treatment groups [1].
The findings emphasize that conventional therapies – such as health education, core stabilization exercises, and spinal manipulation – are effective on their own. These approaches provide significant relief without the need for additional interventions, offering clear guidance for both patient decisions and clinical recommendations.
"In this randomized trial, adding dry cupping to conventional therapy offered no additional benefit over conventional therapy alone for pain, disability or PPT in CNLBP." – Xu et al. [1]
This study reinforces the effectiveness of established chiropractic and physical therapy practices. For healthcare providers, it underscores the importance of sticking to evidence-based treatment plans. With chronic low back pain costing the U.S. over $100 billion annually, prioritizing proven therapies is both clinically effective and economically sensible [2]. It’s worth noting that around 90% of low back pain cases lack an identifiable pathoanatomical cause, further emphasizing the need for research-backed approaches [2].
For patients, this means conventional therapies often provide meaningful relief. At Portland Chiropractic Group, the findings support our focus on treatments like chiropractic adjustments, functional training, and thorough patient education – cornerstones of effective chronic low back pain management.
Patients are encouraged to work closely with their healthcare providers to design personalized treatment plans with clear goals and regular follow-ups [3]. Even short educational sessions – as brief as five minutes – can have lasting benefits, improving outcomes for up to a year. This highlights the critical role of patient education in managing back pain [2]. Instead of turning to unproven complementary treatments, the priority should be optimizing conventional care through proper assessment, goal-setting, and consistent monitoring.
FAQs
Why doesn’t combining dry cupping therapy with conventional treatment improve chronic low back pain outcomes?
Research indicates that combining dry cupping therapy with standard treatments doesn’t lead to noticeable improvements in pain relief or disability reduction for individuals dealing with chronic low back pain. Studies reveal that dry cupping doesn’t outperform conventional therapy on its own, with results comparable to placebo treatments. While some may find the experience of dry cupping soothing, it doesn’t appear to offer extra clinical benefits for managing this condition.
How do the cost and time requirements of dry cupping therapy compare to conventional treatments for chronic low back pain?
Dry cupping therapy in the United States generally costs between $30 and $150 per session, with sessions lasting about 5 to 15 minutes. By comparison, treatments like physical therapy or chiropractic care typically range from $50 to $200 per session and often take 30 to 60 minutes.
Though dry cupping might seem quicker and sometimes less expensive per session, the overall cost and time commitment will depend on how many treatments are required. To figure out the best option for managing chronic low back pain, it’s a good idea to consult with a healthcare provider who can tailor a treatment plan to your needs.
Can dry cupping still help with managing back pain in certain cases?
Dry cupping can be a helpful option for addressing back pain in certain cases, such as chronic aches, arthritis, or muscle tension. Although pairing it with conventional therapy might not enhance its effects, some research indicates that it may ease pain and improve movement, particularly when inflammation or muscle tightness is involved.
Be sure to consult your healthcare provider to determine if dry cupping aligns with your condition and treatment objectives.
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