Cupping therapy versus acupuncture for pain-related conditions: a systematic review of randomized controlled trials and trial sequential analysis

Abstract

BackgroundBoth cupping therapy and acupuncture have been used in China for a long time, and their target indications are pain-related conditions. There is no systematic review comparing the effectiveness of these two therapies.ObjectivesTo compare the beneficial effectiveness and safety between cupping therapy and acupuncture for pain-related conditions to provide evidence for clinical practice.MethodsProtocol of this review was registered in PROSPERO (CRD42016050986). We conducted literature search from six electronic databases until 31st March 2017. We included randomized trials comparing cupping therapy with acupuncture on pain-related conditions. Methodological quality of the included studies was evaluated by risk of bias tool. Mean difference, risk ratio, risk difference and their 95% confidence interval were used to report the estimate effect of the pooled results through meta-analysis or the results from each individual study. Trial sequential analysis (TSA) was applied to adjust random errors and calculate the sample size.ResultsTwenty-three randomized trials with 2845 participants were included covering 12 pain-related conditions. All included studies were of poor methodological quality. Three meta-analyses were conducted, which showed similar clinical beneficial effects of cupping therapy and acupuncture for the rate of symptom improvement in cervical spondylosis (RR 1.13, 95% CI 1.01 to 1.26; n = 646), lateral femoral cutaneous neuritis (RR 1.10, 95% CI 1.00 to 1.22; n = 102) and scapulohumeral periarthritis (RR 1.31, 95% CI 1.15 to 1.51; n = 208). Results from other outcomes (such as visual analogue and numerical rating scale) in each study also showed no statistical significant difference between these two therapies for all included pain-related conditions. The results of TSA for cervical spondylosis demonstrated that the current available data have not reached a powerful conclusion. No serious adverse events related to cupping therapy or acupuncture was found in included studies.ConclusionCupping therapy and acupuncture are potentially safe, and they have similar effectiveness in relieving pain. However, further rigorous studies investigating relevant pain-related conditions are warranted to establish comparative effectiveness analysis between these two therapies. Cost-effectiveness studies should be considered in the future studies to establish evidence for decision-making in clinical practice.

Cupping for Patients With Chronic Pain: A Systematic Review and Meta-Analysis

“…This applies particularly to the reviews on neck pain, 20 ankylosing spondylitis, 29 comparing cupping and acupuncture in pain in general. 53 Overall, findings regarding diversity of trials, methodological problems and clinical findings are broadly consistent with those of our review.…”

“…When we planned our project, systematic reviews including meta-analysis were not available. However, between 2017 and November 2018 no less than seven systematic reviews have been published addressing chronic back pain (Moura, 16 trials), 34 neck pain (Kim, 18 trials), 20 twice knee osteoarthritis (Wang, 5 trials; Li, 7 trials), 27,50 low back pain (Wang, 7 trials), 51 ankylosing spondylitis (Ma; 5 trials) 29 , or more generally pain restricted to the comparison of cupping versus acupuncture (Zhang, 23 trials), 53 reflecting the rapid increasing interest in cupping. A number of the trials included these reviews were not in patients with chronic pain or failed to meet other criteria of our review.…”

Analysis of clinical efficacy of Si Miao decoction combine with acupuncture and cupping treatment for gout: a systematic review and meta-analysis

“…There was also a high uncertainty in the methodology that led to publication bias. This evidence had been supported and verified in another systematic review on cupping therapy versus acupuncture for pain-related conditions 36 . Further research on the same formulation is recommended with an improved clinical protocol using Consolidated Standards of Reporting Trials (CONSORT) 37 .…”

Acupuncture methods for allergic rhinitis: a systematic review and bayesian meta-analysis of randomized controlled trials

“…Therefore, future research should be geared towards standardizing and generalizing acupuncture methods, acupoint, duration, and frequency of AR treatment. Moreover, since the methodological quality in our study was low to moderate, a well-designed RCTs should be implemented with the Consolidated Standards of Reporting Trials (CONSORT), Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA), Standards for Reporting Interventions in Clinical Trials of Moxibustion (STRICTOM) and Cochrane Handbook for Systematic Reviews of Interventions [ 79 – 81 ] to command the quality of future studies [ 82 , 83 ]. Moreover, we suggest that protocols should be registered.…”