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The Use Of Wet Cupping For Persistent Nonspecific Low Back Pain: Randomized Controlled Clinical Trial

Conference: 5th International Conference on Quality and Evidence Based in Prophetic Medicine

Keywords: Prophetic Medicine

Objectives: To evaluate the effectiveness and safety of wet cupping therapy as a single treatment for persistent nonspecific low back pain (PNSLBP).

Design: Randomized controlled trial comparing wet cupping versus no treatment in PNSLBP.

Setting: Outpatient clinics in three secondary care hospitals in Saudi Arabia (King Fahd hospital in Jeddah, King Fahd hospital in Medina and King Salman hospital in Riyadh).

Patients: Eighty eligible participants with PNSLBP for at least 3 months were randomly allocated to an intervention group (n = 40) or to a control group (n = 40).

Interventions: Six triple stage wet cupping sessions within 2 weeks, each of which were done at two bladder meridian (BL) acupuncture points among BL23, BL24, and BL25. Medium sized plastic cups (4.3 cm) in diameter and 6 scarifications using autolancet were done. Acetaminophen was allowed as a rescue treatment in both groups.

Outcome Measures: The Numeric Rating Scale (NRS), McGill Present Pain Intensity (PPI), and Oswestry Disability Questionnaire (ODQ) were used as outcome measures. Numbers of acetaminophen tablets taken were compared at 4 weeks from baseline. Adverse events were recorded.

Results: At the end of the intervention, statistically significant differences in the three outcome measures favoring the wet cupping group compared with the control group were seen: NRS score, 29.2 (95% confidence interval [CI], 24.6–33.8) versus 57.9 (95% CI, 53.3–62.6), respectively; PPI score, 1.17 (95% CI, 0.96–1.4) versus 2.3 (95% CI, 2.1– 2.7); and ODQ score, 19.6 (95% CI, 16.5–22.7) versus 35.4 (95% CI, 32.3–38.5) (p = 0.0001). This improvement continued for another 2 weeks after the end of the intervention. Acetaminophen was used less in the wet cupping group, but this difference was not statistically significant. No adverse events were reported.

Conclusions: Wet cupping is potentially effective in reducing pain and improving disability associated with PNSLBP at least for 2 weeks after the end of the wet cupping period. Further follow-up studies are important to determine how frequent wet cupping must be to sustain a longer period of improvement. In the absence of placebo, the actual effect size of wet cupping cannot be determined. Placebo-controlled clinical trials are needed.

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