Cupping Therapy (CT) is an ancient method and currently used in the treatment of a broad range of medical conditions. Nonetheless the mechanism of action of (CT) is not fully understood. This review aimed to identify possible mechanisms of action of (CT) from modern medicine perspective and offer possible explanations of its effects. English literature in PubMed, Cochrane Library and Google Scholar was searched using key words. Only 223 articles identified, 149 records screened, and 74 articles excluded for irrelevancy. Only 75 full-text articles were assessed for eligibility, included studies in this review were 64. Six theories have been suggested to explain the effects produced by cupping therapy. Pain reduction and changes in biomechanical properties of the skin could be explained by “Pain-Gate Theory”, “Diffuse Noxious Inhibitory Controls” and “Reflex zone theory”. Muscle relaxation, changes in local tissue structures and increase in blood circulation might be explained by “Nitric Oxide theory”. Immunological effects and hormonal adjustments might be attributed to “Activation of immune system theory”. Releasing of toxins and removal of wastes and heavy metals might be explained by “Blood Detoxification Theory”. These theories may overlap or work interchangeably to produce various therapeutic effects in specific ailments and diseases. Apparently, no single theory exists to explain the whole effects of cupping. Further researches are needed to support or refute the aforesaid theories, and also develop innovative conceptualizations of (CT) in future.

There is a high prevalence and increased public interest in CAM use in the Riyadh region. There is a positive attitude towards CAM, yet most participants are reluctant to share and discuss CAM information with their physicians.

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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 clinic in three secondary care hospitals in Saudi Arabia.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 wet cupping sessions within 2 weeks, each of which were done at two bladder meridian (BL) acupuncture points among BL23, BL24, and BL25. Only 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. Placebo-controlled trials are needed.

BACKGROUND AND OBJECTIVESThe current picture of the Saudis’ use of complementary and alternative medicine (CAM) has not yet been developed. The aim of this study was to assess the feasibility of using the international questionnaire to measure use of complementary and alternative medicine (I-CAM-Q) in Saudi Arabia to evaluate the use of and out-of-pocket spending on CAM.DESIGN AND SETTINGSIt was a cross-sectional study, conducted in 2011, in primary health care centers in Qassim.METHODSIn a multistage sampling technique, 12 primary health care centers were selected randomly in the Al-Qassim province in Saudi Arabia. From each center, 100 attendants were interviewed for a total of 1160 completed questionnaires.RESULTSA total of 74% of subjects had visited CAM providers in 12 months before the survey. This percentage decreased to 47.6% when spiritual healers were excluded. The specific CAM providers who were visited were spiritual healers (26.7%), herbalists (23.2%), providers of honeybee products (14.9%), and hijama (wet cupping; 13%). Chronic illnesses were the main reason for the visits. A total of 50% of subjects were satisfied with their visit. Physicians were the providers of CAM for 11.3% of the participants. More than 75% of the subjects used herbs in the previous 12 months for medical and health reasons, while only 25% used vitamins or minerals. Self-help was used in 26% of the participants. Relaxation (10.3%) was the most common self-CAM practice followed by meditation (6.7%). The subjects spent 350 000 (US$) on CAM visits and 300 000 (US$) purchasing CAM products.CONCLUSIONSI-CAM-Q can be used in different populations and cultures in the East including Saudi Arabia after customization to overcome its limitations, as the questionnaire was developed in Western societies.

Hijama means cupping, but in Arab and Muslim culture it refers to wet cupping. At present, there is much controversy around the practice of wet cupping. To evaluate the current scientific evidence for Hijama, specifically wet cupping, we searched for relevant literature using CAM on PubMed, ACP journal club, Cochrane controlled trials register, Cochrane database of systematic reviews, Cochrane methodology register, database of abstracts of reviews of effects, health technology assessment database, Journals@Ovid, MEDLINE and the NHS economic evaluation database. Three systematic reviews investigated the effectiveness of wet and dry cupping. Two of the reviews found some evidence of effectiveness for cupping and pain. Favourable effects were reported for wet cupping when used as an adjuvant to conventional drugs. The third systematic review found very little evidence of effectiveness for cupping and stroke rehabilitation. Other clinical and observational studies were of limited quality. Few randomised controlled trials have examined the effectiveness of cupping (specifically wet cupping), and those that have been published were generally of low quality, with many limitations.

Background:Complementary and alternative medicine (CAM) is a popular treatment option for many populations. The present work is aimed at studying the knowledge and attitude of health professionals in the Riyadh region, Saudi Arabia, toward CAM.Material and Methods:In this cross-sectional survey, a multistage random sample was taken from health professionals working in hospitals in Riyadh city and surrounding governorates. Data were collected through a self-administered questionnaire, from 306 health professionals working in 19 hospitals, on socio-demographic data, knowledge about CAM and their sources, and attitudes toward CAM practices.Results:Of the participants, 88.9% had some knowledge about CAM. Respondents with a doctorate degree (94.74%) and 92.53% of those with a bachelor's degree had significantly higher knowledge of CAM than subjects with a diploma, a fellowship, or a master's degree (68.75%, 76.67%, and 85.41%, respectively, P = 0.004). Mass media represented 60.1% of sources of the knowledge of CAM followed by family, relatives, and friends (29.08%) and health educational organizations (14.71%). Participants estimated that prophetic medicine including prayer, honey and bee products, medical herbs, Hijama, nutrition and nutritional supplements, cauterization, and camel milk and urine were the most commonly used CAM practices (90.5%, 85%, 76.9%, 70.6%, 61.4%, 55.9%, and 52.5%, respectively) in addition to medical massage (61.8%) and acupuncture (55%). One hundred and fifteen (80%) physicians were ready to talk with their patients on CAM.Conclusion:The willingness to improve knowledge and create a positive attitude in health professionals toward CAM has increased. Religious practices, especially those related to prophetic medicine, are more common in the region. Health educational organizations have to play a greater role by being the source of evidence-based knowledge of CAM. Talking on CAM with patients should be improved by rooting them on evidence-based practices.

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