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The Effectiveness of Cupping Therapy on Relieving Chronic Neck and Shoulder Pain: A Randomized Controlled Trial

Lee-Mei Chi, Li-Mei Lin, Chien-Lin Chen, Shu-Fang Wang, Hui-Ling Lai, and Tai-Chu Peng. (2016). Evidence-Based Complementary and Alternative Medicine, 1-7.

Article Summary by Isaac Ervin, MS, SPT from Missouri State University, Springfield, MO

The goal of this single-blind, randomized controlled trial is to assess the effects cupping therapy has on improving chronic neck and shoulder pain in full-time members of the work force.  The cupping therapy was specifically utilized on three sites commonly treated in acupuncture therapy to relieve neck and shoulder pain.  These three sites are SI 15, GB 21, and LI 15.  SI 15 is located 3-4 cm lateral to the 7th cervical vertebrae on the upper trapezius musculature.  GB 21 is located midway between the SI 15 location and the acromion on the upper trapezius musculature.  LI 15 is located laterally on the middle deltoid musculature.  

The study included 62 participants.  The inclusion criteria for the study was 1) had to work at least 40 hours per week and 2) had to have work-related neck 2) shoulder pain continuously for at least the previous three consecutive months and 3) a pain intensity of at least a 3 on the VAS.  The exclusion criteria for the study included 1) infection, injury, or bleeding surrounding the cupping area, 2) cervical neuropathy, 3) analgesic ingestion 4 hours or less before treatment, 4) had ingested coffee, tea, or any caffeinated beverage 4 hours or less before treatment, and 5) no tobacco products smoked 30 minutes or less before treatment.  The subjects were broken up into a resting or cupping group, and the subjects received a 10-minute treatment to both the right and left sites independently.  

Skin surface temperatures were measured at each cupping site pre-treatment, 5 minutes into treatment, post-treatment, and 5 minutes post-treatment using the FLIR infrared camera.  The results indicated that there were significant temperature differences between both groups during treatment and at both post-treatment measures, with the cupping group having higher skin surface temperatures.  The VAS was recorded pre-treatment and post-treatment.  When comparing the two groups, the cupping group’s average pain measures significantly decreased (8.5 to 2.6) compared to the resting group (8.5 to 7.9).  Overall, the authors concluded that cupping therapy could be used to treat chronic neck and shoulder pain with minimal side effects.

Personal Commentary:

Cupping is a treatment method utilized by physical therapists to alleviate musculoskeletal pain by relieving trigger points and acupuncture sites as well as increasing blood flow to the affected area (Kim et al, 2011).  In the above study by Chi et al, there was a significant decrease in pain after one cupping treatment.  One of the issues with this trial is there were no follow-up measurements to assess the long lasting effects of treatment.  While cupping may have a short-term effect on pain modulation, this treatment may not fully address the primary issue.  In this case, I would expect the pain to increase in intensity post-treatment if the underlying issue is not addressed and cupping is not continued.

Another issue with this article is the absence of a clinical examination to identify the pain generator.  Through performance of the basic physical therapy examination, we would be able to narrow our potential diagnoses and identify the primary issues causing pain generation.  Identifying and treating the primary cause of neck and shoulder pain will not only allow us to improve the patient’s symptoms, but also allows physical therapists to provide them with the education and a specific treatment protocol that could potentially prevent pain from reoccurring.  While there is clinical evidence to support the use of cupping therapy for neck and shoulder pain in these specific sites, it would be best to first identify the primary issue and then utilize cupping therapy, when it is indicated, as a beneficial tool in an individualized, holistic treatment approach.

References

  • Lee-Mei Chi, Li-Mei Lin, Chien-Lin Chen, Shu-Fang Wang, Hui-Ling Lai, and Tai-Chu Peng, “The Effectiveness of Cupping Therapy on Relieving Chronic Neck and Shoulder Pain: A Randomized Controlled Trial,” Evidence-Based Complementary and Alternative Medicine, vol. 2016, Article ID 7358918, 7 pages, 2016. doi:10.1155/2016/7358918
  • Jong-IN Kim, Myeong Soo Lee, Dong-Hyo Lee, Kate Boddy, and Edzard Ernst. “Cupping for Treating Pain: A Systematic Review.” Evidence-Based Complementary and Alternative Medicine, vol. 2011, Article ID 467014, 7 pages, 2011, doi: 10.1093/ecam/nep035.

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