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The effect of cupping therapy for low back pain: A meta-analysis based on existing randomized controlled trials


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Background: LBP is one of the most common symptoms with high prevalence throughout the world. Conflicting conclusions exist in RCTs on cupping for LBP. Objective: To assess the effects and safety of cupping for the patients with LBP. Methods: Pubmed, Cochrane Library databases, and Embase database were electronically researched. RCTs reporting the cupping for the patients with LBP were included. The meta-analysis was conducted using Review Manager software (version 5.3, Nordic Cochrane Centre). The primary outcome was VAS scores. The secondary outcomes included ODI scores, MPPI scores and complications. Results: Six RCTs were included in this synthesized analysis. The results showed that cupping therapy was superior to the control management with respect to VAS scores (SMD: -0.73, [95% CI: -1.42 to -0.04]; P= 0.04), and ODI scores (SMD: -3.64, [95% CI: -5.85 to -1.42]; P= 0.001). There was no statistical significant difference as regard to MPPI scores. No serious adverse event was reported in the included studies. Conclusions: Cupping therapy can significantly decrease the VAS scores and ODI scores for patients with LBP compared to the control management. High heterogeneity and risk of bias existing in studies limit the authenticity of the findings.
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Journal of Back and Musculoskeletal Rehabilitation 30 (2017) 1187–1195 1187
DOI 10.3233/BMR-169736
IOS Press
Review Article
The effect of cupping therapy for low back
pain: A meta-analysis based on existing
randomized controlled trials
Yun-Ting Wanga,1, Yong Qib,1, Fu-Yong Tanga,1, Fei-Meng Lic,1, Qi-Huo Lid, Chang-Peng Xub,
Guo-Ping Xiedand Hong-Tao Sunb,
aGuangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
bDepartment of Orthopaedics, Guangdong No.2 Provincial People’s Hospital, Guangzhou, Guangdong, China
cGuangdong Traditional Medical and Sports Injury Rehabilitation Research Institute, Guangdong No.2 Provincial
Peopie’s Hospital, Guangzhou, Guangdong, China
dThe First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
BACKGROUND: LBP is one of the most common symptoms with high prevalence throughout the world. Conflicting conclu-
sions exist in RCTs on cupping for LBP.
OBJECTIVE: To assess the effects and safety of cupping for the patients with LBP.
METHODS: Pubmed, Cochrane Library databases, and Embase database were electronically researched. RCTs reporting the
cupping for the patients with LBP were included. The meta-analysis was conducted using Review Manager software (version 5.3,
Nordic Cochrane Centre). The primary outcome was VAS scores. The secondary outcomes included ODI scores, MPPI scores
and complications.
RESULTS: Six RCTs were included in this synthesized analysis. The results showed that cupping therapy was superior to the
control management with respect to VAS scores (SMD: 0.73, [95% CI: 1.42 to 0.04]; P=0.04), and ODI scores (SMD:
3.64, [95% CI: 5.85 to 1.42]; P=0.001). There was no statistical significant difference as regard to MPPI scores. No
serious adverse event was reported in the included studies.
CONCLUSIONS: Cupping therapy can significantly decrease the VAS scores and ODI scores for patients with LBP compared
to the control management. High heterogeneity and risk of bias existing in studies limit the authenticity of the findings.
Keywords: Low back pain, cupping therapy, meta-analysis
1Yun-Ting Wang, Yong Qi, Fu-Yong Tang and Fei-Meng Li con-
tributed equally to this study and should be considered co-first au-
thors. Hong-tao Sun and Guo-ping Xie are co-corresponding au-
Corresponding author: Hong-Tao Sun, Department of Or-
thopaedics, Guangdong No.2 Provincial People’s Hospital, No. 466
courtyard, Xing Gang Middle Road, Haizhu District, Guangzhou
510317, Guangdong, China. Tel.: +86 20 8916 8085; Fax: +86 20
8916 8085; E-mail:
1. Introduction
Low back pain (LBP) is one of the most common
symptoms affecting innumerable individuals through-
out the world. A global review of the prevalence of
LBP in the general adult population has shown its point
prevalence to be approximately 12%, with a one-month
prevalence of 23%, a one-year prevalence of 38%, and
a lifetime prevalence of approximately 40% [1]. It is a
generic term of kinds of back pains characterized by no
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1188 Y.-T. Wang et al. / Cupping therapy for LBP
identified histopathological changes and cannot clear
its etiology from objective determinations. The symp-
toms of LBP could be acute/chronic lumbosacral pain
accompanied with/without pain or numbness of legs.
Female or older workers were at increased risk of ex-
periencing LBP [2], students who sat with the spine
positioned wrongly, or stood incorrectly, were more
likely to present with LBP [3]. The risk factors of LBP
included postmenopausal female, work-family imbal-
ance, exposure to a hostile work environment, job in-
security, long work hours, certain occupation groups,
unemployment, and sleep disturbances [4–6].
The current therapeutics of LBP consist of absolute
bed rest at acute phase, analgesic or anti-inflammatory
medications, physiotherapy, traction, alternative treat-
ments and education regarding the prevention of LBP.
Cupping therapy is a common therapy in Traditional
Chinese Medicine (TCM) field with a long history,
which could be used to reduce the local chronic pain
symptoms. Nowadays, more and more patients have
shown an interest in using cupping therapy for the
treatment of LBP due to their belief that it is more
effective and safe than the current therapeutics. Al-
though the cupping is safe ussually, it would leave lo-
cal site skin pigmentation which would gradually van-
ish in a few days, and has been reported a complica-
tion of anaemia after excessive cupping therapy by an
unqualified therapist in Korea in a case report [7].
There are many types of cupping including dry cup-
ping, wet cupping, cupping with retention, moving
cupping, shaking cupping, quick cupping and balance
cupping. All of these types of cupping were frequently
used in China, while dry cupping and wet cupping
were widely used in Asian and Middle Eastern coun-
tries [8]. Dry cupping is using the negative pressure
conditions of the cup to suck the skin into the cup with-
out drawing blood. Wet cupping should prick the skin,
so that blood of local site could be drawn into the cup.
Cupping with retention is that cup is retained for a pe-
riod of time on the skin after the dry cupping process
completed. Moving cupping is characterized by mov-
ing on the skin by pre-daubing lubricating oil on the
skin. Shaking cupping is a kind of cupping that after
the cup sucked on the skin, the manipulator hold the
body of cup to shake it. Quick cupping is character-
ized by quickly removing the cup once it sucks on the
skin, which is on the contrary to cupping with reten-
tion. Balance cupping is a combination of cupping with
retention, shaking cupping, quick cupping and moving
cupping with established procedures.
Although cupping therapy has been used for LBP for
a long time, it has been limited to assess its efficacy due
to lack of high-quality, well-designed randomized con-
trolled trials (RCTs). Nowadays, more and more RCTs
concerning cupping therapy for LBP written in Chi-
nese or English have been published. At present, there
were 5 studies published in English were searched con-
taining a description of systematic review on this topic.
In 2011, a systematic review conducted by Kim of
South Korea drew a conclusion that the current RCTs
were few and showed low methodological quality [9].
In 2013 and 2015, there were two systematic reviews
drew a conclusion that cupping therapy is promising
for pain [10,12]. In 2014, a systematic review of tra-
ditional medicine in east asian countries weakly rec-
ommended cupping therapy for both sub-acute and
chronic LBP [11]. In 2015, a review about all aspects
of TCM for neck pain (NP) and LBP indicated that
cupping could be efficacious in pain and disability for
chronic NP or chronic LBP in the immediate term [13].
Since there is no consensus on cupping therapy for
LBP, we searched the existing RCTs published in En-
glish or Chinese language to make a synthesized anal-
ysis to test its effectiveness in patients with LBP.
2. Materials and methods
We conducted this meta-analysis according to the
PRISMA (Preferred reporting items for systematic re-
views and meta-analyses) statement [14].
2.1. Literature search strategy
The strategy of literature search was according to
the guidance of the Cochrane Handbook. We electroni-
cally searched the Pubmed database, Cochrane Library
databases, and Embase database from their inception
up to 31st August 2016 to identify studies meeting the
inclusion criteria. RCTs concerning cupping therapy
for subacute or chronic LBP were searched in elec-
tronic databases by two authors independently. The
search terms were as follows: ((Low back pain*) OR
(back pain*, low) OR (pain*, low back) OR (lumbago)
OR (lower back pain*) OR (back pain*, lower) OR
(pain*, lower back) OR (low back ache*) OR (ache*,
low back) OR (back ache*, low) OR (low backache*)
OR (backache*, low) OR (recurrent low back pain*)
OR (low back pain*, postural) OR (postural low back
pain*) OR (low back pain*, mechanical) OR (mechan-
ical low back pain*) OR (low back pain*, posterior
compartment) OR (lumbar sprain) OR (lumbar my-
ofasciitis) OR (lumbosacral pain*)) AND (cupping OR
Y.-T. Wang et al. / Cupping therapy for LBP 1189
(cupping therapy) OR (dry cupping) OR (wet cupping)
OR (cupping with retention) OR (moving cupping) OR
(shaking cupping) OR (quick cupping) OR (balance
cupping)). To ensure retrieval comprehensive, we man-
ually searched the reference lists of all retrieved studies
and published systematic reviews/meta-analysis, and
included all identified relevant articles.
2.2. Eligibility criteria
2.2.1. Inclusion criteria
(1) Randomized controlled trial. (2) Participants en-
rolled in trials were diagnosed as nonspecific subacute
or chronic LBP. (3) Intervention in experimental group
was a kind of cupping therapy, which could be dry
cupping, wet cupping, cupping with retention, moving
cupping, shaking cupping, quick cupping or balance
cupping. (4) Intervention in control group was medi-
cation or usual care. (5) The interested outcomes in-
cluded one of the VAS (visual analogue scale) scores,
ODI (Oswesty pain disability index) scores and MPPI
(McGill present pain index) scores. (6) Language of
included trials were published in English or Chinese.
2.2.2. Exclusion criteria
(1) Comorbid factors such as fracture, dislocation,
tumor of lumbar spine which directly deduce the LBP
symptom in participants. (2) non-RCT. (3) Sample size
less than 15. (4) Studies without available data for
statistics were excluded.
2.3. Study identification
Firstly, all titles of searched articles were viewed by
two investigators independently. At this step, articles
obviously unrelated to the topic were removed. Sec-
ondly, full articles were reviewed to remove the non-
RCTs and articles without comparison group. Thirdly
articles were removed due to the lack of interested out-
come. The third investigator was involved in the study
when there existed divergence on eligibility of enrolled
2.4. Methodological quality assessment
The methodological scores of eligible studies were
assessed by using Jadad scale [15]. Two indepen-
dent investigators performed the methodological eval-
uation. The third investigator was consulted to resolve
it once divergence occurs.
Fig. 1. Flow diagram of study selection.
2.5. Outcome measures
The primary outcome was VAS scores. The Sec-
ondary outcomes included ODI scores, MPPI scores
and complications.
2.6. Data extraction
The following data from each study were extracted
independently by two authors: first author’s family
name, year of publication, diagnosis, interventions,
sample size, mean age, interested outcomes, follow-
up times, lost follow or withdraw, adverse events, the
baseline of interested outcome before interventions,
the interested outcomes at the chosen time point and
end of follow-up period. Any disagreements were re-
solved by consensus.
2.7. Statistical analysis
Data analyses were conducted by using the Re-
view Manager statistical software (version 5.3, Nordic
Cochrane Centre). Standard Mean Difference (SMD)
with 95% confidence intervals (CIs) was selected to
describe the mean differences between cupping group
and control group. A P-value less than 0.05 was
judged as statistically significant. The potential hetero-
geneity among studies was examined via Cochran’s Q-
statistic [16] and I2statistics [17]. When there was
no statistically significance on heterogeneity test of
outcomes (I2<50% and P > 0.1), a fixed-effect
model was adopted in the meta-analysis. Otherwise, a
random-effect model was used.
1190 Y.-T. Wang et al. / Cupping therapy for LBP
Table 1
The demographic characteristics of the patients of the included studies (cupping vs. control)
Study Diagnosis Intervention Sample Mean age Outcomes Follow Lost Adverse
Cupping Control size up time follow events
Hong et al.
2006 [18]
NLBP Moving cupping,
q.o.d, for 11 days
0.15 g, po, tid for
12 days
37/33 38.89 ±11.03/
36.0 ±10.21
VAS After treat-
0/0 NR
Liu et al.
2008 [19]
NLBP Dry cupping, qd,
21 days
sodium, po, qd
25/25 38.6 ±18.5/
35.2 ±14.3
VAS; ODI 3 weeks 0/0 NR
Li and Chen
2009 [20]
NLBP Dry cupping,
q.o.d, for
3 weeks
sodium, po, qd
30/30 31.7 ±9.7/
30.9 ±9.3
VAS; ODI 9.2 ±2.5
0/0 NR
Farhadi et al.
2009 [21]
NLBP Wet-cupping; 0,
3, and 6 days
Usual care 48/50 44.0 ±14.8/
41.8 ±13.9
MPPI; ODI 3 months 7/5 3/0
Akbarzadeh et
al. 2014 [22]
PLBP Dry cupping; qd;
for 4 days
Usual care 50/50 25.0 ±4.2/
27.0 ±3.8
VAS; MPPI 2 weeks 0/0 None
AlBedah et al.
2015 [23]
NLBP Wet-cupping, 3
times per weeks
for 2 weeks
Usual care 40/40 36.48 ±9.3/
36.43 ±9.4
MPPI; ODI 2, 4 weeks 0/0 None
Abbreviations: NLBP, nonspecific low back pain; PLBP, postpartum low back pain; VAS, visual analogue scale; ODI, Oswesty pain disability
index; MPPI, McGill present pain index; NR, not report.
Table 2
Comparisons of interested outcomes (cupping vs. control)
Study VAS score MPPI score ODI score
Baseline Post-treatment Baseline Post-treatment Baseline Post-treatment
Hong 2006 6.11 ±2.08/
5.86 ±1.99
1.29 ±1.62/
3.57 ±2.96
Liu 2008 5.97 ±1.5/
5.86 ±1.64
1.79 ±0.53/
1.88 ±0.41
NA NA 28.69 ±9.57/
29.72 ±9.43
14.69 ±5.57/
15.72 ±4.43
Li 2009 5.6 ±2.0/
5.9 ±2.1
2.1 ±1.1/
2.3 ±1.4
NA NA 30.2 ±6.3/
29.8 ±6.1
14.6 ±3.2/
15.7 ±3.8
Farhadi 2009 NA NA 2.7 ±0.8/
2.7 ±0.9
3 months
0.7 ±0.9/
2.8 ±1.3
31.4 ±6.6/
30.9 ±9.8
3 months
15.6 ±6.7/
30.6 ±11.6
Akbarzadeh 2014 7.8 ±2.7/
7.6 ±2.7
3.7 ±1.8/
6.4 ±2.3
24 hrs:
2.5 ±1.7/
5.0 ±2.0
2 weeks:
1.4 ±1.4/
3.7 ±1.5
31.8 ±10.8/
31.8 ±9.8
9.0 ±6.7/
29.2 ±8.0
24 hrs:
7.5 ±6.6/
21.7 ±6.2
2 weeks:
4.1 ±3.6/
14.0 ±5.2
AlBedah 2015 NA NA 2.35 ±1.2/
2.13 ±0.96
2 weeks:
1.17 (0.96–1.4)/
2.3 (2.1–2.7)
4 weeks:
0.98 (0.7–1.2)/
2.3 (2.1–2.6)
38.33 ±19.2/
32.05 ±15.9
2 weeks:
19.6 (16.5–22.7)/
35.4 (32.3–38.5)
4 weeks:
15.2 (11.6–18.8)/
35.9 (32.3–39.5)
Abbreviations: VAS, visual analogue scale; ODI, Oswesty pain disability index; MPPI, McGill present pain index; NA, not available.
3. Results
3.1. Literature search and study selection
A total of 87 studies were searched from electronic
and manual searching. Specifically, 14 from Pubmed,
21 from Cochrane library, 38 from Embase, and 14
were manually searched from the reference lists of
published systematic review or meta-analysis. After
duplicated, 39 studies were removed and 48 studies re-
mained for screening. Then 29 studies were excluded
for obviously unrelated to the research topic after re-
view the titles and abstracts, 19 studies remained for
next full-text review. After full-text articles assessed
for eligibility, 13 articles were excluded for reasons as
follows: cupping combined with acupuncture (n=7),
conference abstract (n=1), without comparison group
Y.-T. Wang et al. / Cupping therapy for LBP 1191
Table 3
Jadad scores of the enrolled studies
Study Study Random Appropriate Blinding of Blinding of Withdrawl Sum
type sequence randomization participants outcomes and dropouts
generation or personnel assessors
Hong 2006 RCT 1 0 0 0 1 2
Liu 2008 RCT 1 0 0 0 1 2
Li 2009 RCT 1 0 0 0 1 2
Farhadi 2009 RCT 1 1 0 0 1 3
Akbarzadeh 2014 RCT 1 1 0 0 1 3
AlBedah 2015 RCT 1 1 0 0 1 3
Abbreviations: RCT, randomized controlled trial.
(n=2), sample size <15 (n=1), and acute LBP
(n=2). Finally 6 RCTs [18–23] accorded with eli-
gibility criteria were included qualitative synthesis, 3
published in Chinese, 3 published in English (See flow
diagram of study selection, Fig. 1).
3.2. Study characteristics
Six RCTs were included in this meta-analysis,
3 RCTs [18–20] published in Chinese were from
China, 2 RCTs [21,22] published in English were from
Iran, 1 RCT [23] published in English was from Saudi
Arabia. All the trials included were RCTs.
A total of 458 participants enrolled in this study,
including 230 participants in cupping groups and
228 participants in control (medication or usual care)
groups respectively. The participants in 4 RCTs [18–
21,23] were diagnosed as nonspecific low back pain
(NLBP), and participants in 1 RCT [22] were diag-
nosed as low back pain among postpartum women (Ta-
ble 1).
As for the intervention aspect, there are many types
of cupping therapy reported in cupping groups. Three
RCTs [19,20,22] adopted dry cupping, 2 RCTs [21,23]
using wet cupping, and 1 RCTs [18] applied mov-
ing cupping. As for control groups, 3 RCTs [18–20]
adopted oral medications (diclofenac sodium in 2
RCTs [19,20] and dexibuprofen in 1 RCT [18]), and
3 RCTs [21–23] applied usual care. The treatment ses-
sions were from 11 days to 3 weeks with different fre-
quencies (Table 1).
All the included RCTs at least reported one of the
interested outcomes. Four RCTs [18–20,22] reported
VAS score as their important indicator to evaluate the
level of pain. Four RCTs [19–21,23] adopted ODI
score to evaluate the degree of limitation of daily life
and activity ability. And 3 RCTs applied the McGill
pain index to assess the present pain level. But among
these 3 RCTs [21–23], there was 1 RCT [22] adopted
the short-form McGill pain questionnaire which is
quite different to the McGill present pain index. The
data at baseline and each point of follow-up were ab-
stracted in Table 2. There was no report of serious ad-
verse event in the included RCTs.
3.3. Methodological quality assessment
As for the randomization aspect, all RCTs reported
the method of random sequence generation, but only
3 RCTs [21–23] reported the appropriate randomiza-
tion or allocation concealment process. Thus other 3
RCTs [18–20] existed a moderate degree of selection
bias. Considering the specialization of the cupping pro-
cess, all the RCTs did not use blinding of participants
or personnel. So there exists high performance bias in
all trials. Blinding of outcomes assessors was not ap-
plied in all these RCTs, so all the trials exist a high de-
tection bias. Due to the relative short term of follow up,
all the studies reported the situation of withdrawl and
dropouts, and achieved high follow up rate. So there
exists low risk of withdraw bias in all trials. The spe-
cific Jadad score of the enrolled studies were listed in
Table 3.
3.4. Meta-analysis of interested outcomes
3.4.1. VAS scores
Four RCTs including 280 participants reported the
follow-up end VAS scores. The results of pooled anal-
ysis showed that cupping therapy was superior to the
control (medication or usual care) on decreasing VAS
score (SMD: 0.73, [95% CI: 1.42 to 0.04]; P=
0.04) with high heterogeneity (I2=87%, P <
0.0001) [18–20,22] (Fig. 2).
3.4.2. ODI scores
Four RCTs [19–21,23] adopted ODI score to eval-
uate the degree of limitation of daily life and activity
ability. 1 RCT [23] reported the ODI scores in the form
of median and range. So we estimated the mean and
1192 Y.-T. Wang et al. / Cupping therapy for LBP
Fig. 2. Forest plot of VAS score.
Fig. 3. Forest plot of ODI score.
Fig. 4. Forest plot of MPPI score.
variance from the median, range, and the sample size
according to the calculation method reported by Hozo
et al. [24]. The sample of this trial was 40, so the mean
was equal to the median, and the variance is equal to
the quarter of range [24]. The results of meta-analysis
involving 288 participants revealed that the cupping
therapy showed significant advantages over the con-
trol (medication or usual care) on reducing the follow-
up end ODI score (SMD: 3.64, [95% CI: 5.85 to
1.42]; P=0.001) with high heterogeneity (I2=
98%, P < 0.00001) [19–21,23] (Fig. 3).
3.4.3. MPPI scores
Three RCTs applied the McGill pain index to assess
the present pain level. But among these 3 RCTs [21–
23], there was 1 RCT [22] adopted the short-form
McGill pain questionnaire which is quite different to
the McGill present pain index. So only 2 RCTs [21,23]
were included in meta-analysis. Albedah’s study [23]
reported MPPI scores in the form of median and range,
we also used Hozo’s method [24] to calculate the data
in the form of mean and variance. The results of meta-
analysis found that there was no significant difference
between two groups on MPPI scores (SMD: 6.12,
[95% CI: 14.54 to 2.31]; P=0.15) with high het-
erogeneity (I2=98%, P < 0.00001) [21,23] (Fig. 4).
3.5. Sensitivity analysis
Statistical tests of heterogeneity revealed that there
were high heterogeneity with respect to all the in-
terested outcomes. So we performed the sensitivity
analysis to explore the source of high heterogene-
ity. We found that when we remove the trial of Ak-
barzadeh et al. [22], the heterogeneity of VAS score
was turned to moderate (I2=68%, P=0.05) accom-
panying with pooled-P value turning to un-significance
(Fig. 5). As for ODI score aspect, when we removed
the trial of Albedah et al. [23], the heterogeneity was
decreased accompanying with pooled-P value turning
to un-significance (Fig. 6).
4. Discussion
The main findings of this study are that cupping ther-
apy can significantly decrease the VAS scores and ODI
Y.-T. Wang et al. / Cupping therapy for LBP 1193
Fig. 5. Forest plot of sensitivity analysis of VAS score.
Fig. 6. Forest plot of sensitivity analysis of ODI score.
scores compared to the control management (usual
care/medication) for patients with LBP. And there is
no significant difference between cupping therapy and
the control management on MPPI scores for patients
with LBP. However the results of VAS scores and ODI
scores are unstable according to the results of sensitiv-
ity analysis.
The VAS scores is a scale with 10 numbers, and elu-
cidated as follows: no pain (0), mild (1 to 3), moder-
ate pain (4 to 6), severe pain (7 to 9), and the worst
pain possible (10), and is frequently used in patients
with chronic musculoskeletal pain [25]. In this study,
we found cupping therapy was superior to the control
management on decreasing VAS scores. That means
cupping therapy shows advantages on alleviating pain
over the control management (medication or usual
care) for patients with LBP. In the included RCTs,
there were 2 RCTs’s results showed a negative results
as regards to VAS scores between dry cupping and di-
clofenac sodium for LBP [19,20]. And there were 2
RCTs’s results reported cupping therapy can signifi-
cantly decrease the VAS scores compared to the con-
trol management [18,22]. The trial of Hong et al. [18]
reported moving cupping was superior to dexibupro-
fen on decreasing the VAS scores. The moving cupping
therapy method might be the key factor contributing to
the positive result. The trial of Akbarzadeh et al. [22]
reported dry cupping was superior to usual care on de-
creasing the VAS scores.
The ODI scores is an important tool to measure a pa-
tient’s permanent functional disability in the manage-
ment of spinal disorders [26]. The test is considered
the “gold standard” of low back functional outcome
tools [27]. In our study, the result revealed that cup-
ping therapy showed more advantages over the con-
trol management on decreasing ODI scores. It is sug-
gested that in the aspect of improving the disability
condition induced by LBP, cupping therapy is better
than the control management. In the included RCTs,
there were 2 RCTs’s results showed a negative results
as regards to ODI scores between dry cupping and di-
clofenac sodium for LBP [19,20]. And there were 2
RCTs’s results reported wet cupping therapy can sig-
nificantly decrease the ODI scores compared to the
usual care [21,23]. The advantage of dry cupping com-
pared to diclofenac sodium on decreasing ODI scores
didn’t show a significant difference.
The MPPI scores is a standard and well-used index
of current pain. Patients rate their current pain on a 6-
point scale from “no pain” to “excruciating” [28]. Al-
though there exists significant advantages of cupping
therapy on down-regulating the MPPI scores compared
to the usual care in both 2 included RCTs, the result of
meta-analysis showed no statistical significance. The
Hozo’s calculation method [24] and the high hetero-
geneity between 2 RCTs might contribute to this result.
There were high heterogeneity in the results of all
interested outcomes. Although, sensitivity analysis can
find the main source of the heterogeneity, there still
exists statistical significant difference in heterogene-
ity. We noted possible causes as follows: firstly, al-
though all the included participants were patients with
1194 Y.-T. Wang et al. / Cupping therapy for LBP
LBP, the patients enrolled in the study of Akbarzadeh
et al. [22] were postpartum women with nonspecific
LBP. Generally postpartum women have higher preva-
lence and level of pain compared to the normal [29,30].
Secondly, as for experimental interventions, there were
many types of cupping therapy, and the treatment ses-
sion and frequency were not the same in trials (see Ta-
ble 1). Thirdly, as for the control interventions, there
also existed different types of medication and usual
care (see Table 1). Fourthly, the drawback of design
of RCTs (such as without blinding of participants or
personnel due to the cupping therapy was well-known
by participants and particularity of the cupping for the
personnel) also contributed to the high heterogeneity.
Fifthly, the calculation method used on the data of
MPPI scores and ODI score in Albedah’s study might
create heterogeneity.
There existed different degrees of risk of bias in tri-
als. According to the situation of methodological qual-
ity assessment, moderate degree of selection bias in
some trials, high performance bias, high detection bias,
and low risk of withdraw bias in all trials were found.
All trials did not involve independent examiners, which
may have contributed some observer bias, a distortion,
conscious or unconscious, in the perception or report-
ing of measurements [31]. And at the process of cal-
culation on the data of MPPI scores and ODI score in
Albedah’s study, calculation bias might exist.
The findings need to be further confirmed by sub-
group analysis based on different types of cupping
and control management, and meta-regression to find
the source of high heterogeneity based on more well-
designed and high-quality RCTs.
There also exist some limitations in this meta-
analysis. Firstly, many types of cupping therapy and
different control managements were included in cup-
ping groups and control groups respectively, and it is
difficult to conduct subgroup analysis or Meta regres-
sion due to the lack of enough trials. Secondly, the
frequency of cupping, duration of each session, loca-
tion of acupoints, experience of manipulators in each
trial were different. These factors might strongly in-
fluence the clinical effects of cupping. Thirdly, the in-
cluded Chinese RCTs [18–20] showed low-scoring of
Jadad scores, and the inlcuded English RCTs [21–23]
showed fair-scoring of Jadad scores. The qualities of
original trials may potentially impact results of each
trial and meta-analysis. Additionally, we did not test
the publication bias due to the limitation of number of
5. Conclusion
Cupping therapy is a promisingly effective and safe
therapy method for subacute or chronic low back pain.
Cupping therapy can significantly decrease the VAS
scores and ODI scores compared to the control man-
agement (usual care/medication). High heterogeneity
and risk of bias existing in trials limited the authentic-
ity of the findings.
This work was supported by Guangdong province
natural science foundation of China (Grant No. 2015A
030313724), and Production, study and research pro-
ject of Guangdong province department of science of
China (Grant No. 2013B090600144).
Conflict of interest
The authors declare that they have no conflict of in-
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... Five studies (23,26,28,30,31) contained less than ten original studies, while twelve (85.7%) studies (23-30, 32-35) had a combined total sample of over 500 participants. The majority of studies, eight (57.1%) in total (23,26,(29)(30)(31)(33)(34)(35), were conducted in China, followed by two (25,28) in Korea, and one each in Germany (24), Brazil (27), Australia (32), and Iran (22). ...
... Five studies (23,26,28,30,31) contained less than ten original studies, while twelve (85.7%) studies (23-30, 32-35) had a combined total sample of over 500 participants. The majority of studies, eight (57.1%) in total (23,26,(29)(30)(31)(33)(34)(35), were conducted in China, followed by two (25,28) in Korea, and one each in Germany (24), Brazil (27), Australia (32), and Iran (22). The included studies investigated various conditions, including low back pain (n = 4), neck pain (n = 3), knee osteoarthritis (n = 2), chronic back pain (n = 1), migraine (n = 1), chronic pain (n = 1), pain-related conditions (n = 1), musculoskeletal pain (n = 1), and herpes zoster (n = 1). ...
... One high-quality study (24) and one moderate-quality study (26) were included. However, five studies (22, 23,25,27,32) were rated as critically low quality, and seven studies (28)(29)(30)(31)(33)(34)(35) were rated as low quality. The primary reasons for these downgraded ratings were noted as the absence of registration and protocols (item 2), poor information regarding the source of funding for the original studies in the systematic review and meta-analysis (item 10), and an inadequate explanation of the risk of bias when discussing the results of the review (item 13). ...
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Objective Cupping therapy is an ancient technique of healing used to treat a variety of ailments. An evidence-mapping study was conducted to summarize the existing evidence of cupping therapy for pain-related outcomes and indicate the effect and the quality of evidence to provide a comprehensive view of what is known. Methods PubMed, Cochrane Library, Embase, and Web of Science were searched to collect the meta-analyses investigating the association between cupping therapy and pain-related outcomes. The methodological quality was assessed by using the AMSTAR 2 tool. Significant outcomes ( p < 0.05) were assessed using the GRADE system. The summary of evidence is presented by bubble plots and human evidence mapping. Results Fourteen meta-analyses covering five distinct pain-related conditions were identified and assessed for methodological quality using the AMSTAR 2, which categorized the quality as critically low (36%), low (50.0%), moderate (7%), and high (7%). In accordance with the GRADE system, no high-quality evidence was found that demonstrates the efficacy of cupping therapy for pain-related outcomes. Specifically, for neck pain, there were two moderate-quality, four low-quality, and two very low-quality evidence, while only one very low-quality evidence supports its efficacy in treating herpes zoster and one low-quality evidence for chronic back pain. Additionally, for low back pain, there were two moderate-quality, one low-quality, and four very low-quality evidence, and for knee osteoarthritis, three moderate-quality evidence suggest that cupping therapy may alleviate pain score. Conclusion The available evidence of very low-to-moderate quality suggests that cupping therapy is effective in managing chronic pain, knee osteoarthritis, low back pain, neck pain, chronic back pain, and herpes zoster. Moreover, it represents a promising, safe, and effective non-pharmacological therapy that warrants wider application and promotion. Systematic review registration : , identifier: CRD42021255879.
... Also, cupping therapy improves blood circulation and removes toxins and wastes from the body. This could be done by improving microcirculation, maintaining capillary endothelial cell repair, and stimulating angiogenesis in the local tissues, all of which would decrease pain severity and improve the patient's functional status (13) . ...
... It contributes to multiple benefits for patients with LBP as it can stimulate circulation, reduce pain, improve tissue perfusion, and enhance healing process. Moreover, cupping therapy relieves painful muscle tension, reduces stiffness, improves tolerance to range of motion exercises, and improve motor output which in turn result in reducing pain severity and maximizing functional abilities (13,14) . ...
... This finding is accordance with those of other studies done in Koreaby Kim et al. (2011) (27) , in China by Markowski et al. (2014) (28) , in Saudi Arabia by Albedah et al. (2015) (29) , in India by Imam et al. (2016) (30) , in China by Wang et al. (2017) (13) , and in India by Jain et al. (2022) (31) who reported significant effect of wet cupping therapy on reducing LBP severity. In the same line, a systemic review done in Brazil included 611 studies concluded that cupping therapy is effective in treatment of LBP (32) . ...
... Sometimes the search for de-medicalization results in an increase in the usage of integrative and complementary practices, such as the traditional Chinese medicine (TCM) in order to complement the pain related to allopathic care (10). One of the recommended therapies of TCM for reducing chronic pain is cupping therapy (11). Cupping therapy involves application of cups of different materials (12) placed at acupoint or any area causing pain with the help of heat or any vacuum apparatus (13). ...
... Manual therapy is one of the most commonly used and applicable among the various physical therapy procedures. It aims at relieving pain through the use of the vertebral manipulations along with relaxation of the muscles and hence improving the biomechanical functions present in the tissues (11). Besides the manual therapy, the physical therapy can also depend upon various types of resources and different techniques which are mainly used for analgesic purposes, which include kinesiotherapy, electrotherapy. ...
... There is a history of applying it in order to minimize the symptoms experienced due to the chronic pain. Currently, an increasing number of patients are displaying their interest in the use of cupping therapy in treatment of the reducing pain in the low back region, as it is believed to be very effective and a lot safer (11). Many techniques utilizing the cupping therapy procedure which may include both dry and wet suction cups, holding the cups, stirring fast cups, setting in motion and balancing the cups. ...
... Stimulating increased tissue blood flow. Evidence proves that the effects are local and systemic (Lowe, 2017;Wang et al., 2017). Campos and Santos (2015), confirm these factors when they report that the use of suction cups reduces pain and is beneficial when used with prior knowledge of the method, as well as, causes patients who use it, pain reduction, muscle relaxation and increased blood flow. ...
... Campos and Santos (2015), confirm these factors when they report that the use of suction cups reduces pain and is beneficial when used with prior knowledge of the method, as well as, causes patients who use it, pain reduction, muscle relaxation and increased blood flow. This is in line with the studies of Moura et al. (2018) and Wang et al. (2017), but both emphasize that there is still the need to establish standardized application protocols for a more effective implementation of this intervention. ...
Introduction: Postural changes due to muscle tensions also generate muscle pain and are increasingly common nowadays, affecting mainly the young-adult population. The manual vacuum suction cup is an ancient technique, capable of promoting tension reduction, generating muscle relaxation and consequently relieving pain. Objective: To evaluate the acute and chronic effects of massage therapy with a manual vacuum cup in sliding mode on muscle relaxation in the trapezius muscle by evaluating the position of the scapulae and on pain. Methodology: This is an quasi-experimental quantitative longitudinal clinical study, with a sample of 25 individuals, both sexes, aged between 18 and 35 years, residents of the city of Porto Alegre-RS and metropolitan region and who do not have diseases associates. The method used for data collection consisted of a postural examination and an assessment of pain classification through: the application of the Visual Analog Scale (VAS); b) subjective clinical observation; c) the reference measurements of the scapula. Results: There was a significant improvement in pain reduction and scapular postural alignment, both in height and in the tipper. Conclusion: Suction cup therapy proved to be a safe method, easy to apply and with good results in terms of reducing muscle tension improving postural alignment and reducing pain in the individuals evaluated.
... In contrast, substantial evidence has illustrated that compared to no treatment or active controls, cupping can reduce pain intensity in musculoskeletal pain disorders such as chronic back pain [49,50], knee osteoarthritis [51], and neck pain [52]. A review suggested that the therapeutic effect of cupping is the result of regulation in the neuro-immunity system, incorporating a range of mechanisms, e.g. ...
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Background Chronic low back pain (cLBP) is a global health complaint, and a dominant cause of disability. Acupuncture is an effective therapy for cLBP; however evidence for an optimal acupuncture practice scheme is limited. Choosing the most suitable acupoints for stimulation is an essential part of treatment; this not only includes the optimal prescription of points, but also requires accuracy in locating points. The Foundational Chinese medicine classic The Inner Canon of yellow emperor instructs practitioners to palpate the acupoint to find the most sensitive site before inserting needles. Nonetheless, nowadays, palpation is neglected in routine acupuncture practice. The purpose of this study is to determine the feasibility of conducting a randomised controlled trial to assess the potential of sensitised-point acupuncture as non-inferior compared with routine integrative acupuncture for cLBP. Methods This will be a two-arm, assessor-blind, non-inferiority feasibility study. Participants will be randomly assigned in a 1:1 ratio into two groups. Each group will receive 8 sessions of sensitised-points acupuncture or routine integrative acupuncture, respectively. Treatments will be conducted twice per week. Primary outcomes will be the feasibility of the study; secondary outcomes will include back pain-related symptoms, expectation and satisfaction towards the treatment. Outcomes will be assessed at baseline (week 0), on a weekly basis during treatment, post-treatment (week 4), and follow-up (week 12). Discussion The findings of this study will inform the feasibility and study design of a subsequent fully powered trial. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), Ref no.: ACTRN12621001426875. Registered on 21 October 2021
Technical Report
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Este Mapa foi produzido para a Representação Brasil da Organização Panamericana de Saúde/ Organização Mundial da Saúde (OPAS/OMS). Projeto 20BRA02 01.01 - Política da OMS de promoção da medicina tradicional, complementar e integrativa, implementada e fortalecida; Atividade: Fortalecer a agenda de pesquisa, gestão, disseminação de informação e qualificação do cuidado em PICS (Project Plan Task ID: PROJECT_PLAN_ TASK-3-64082) Com o apoio de um grupo de trabalho, o Consórcio Acadêmico Brasileiro de Saúde Integrativa (CABSIN) e o Centro Latino-Americano e do Caribe de Informação em Saúde (BIREME/OPAS/OMS) conduziram o desenvolvimento deste Mapa de Evidências tendo como principal referência metodológica o Evidence Gap Map 3iE – International Initiative.
Athletes can experience loss of muscle mass and function for multiple reasons following a sports injury, surgery, fracture, or joint degeneration. High load resistance training is often contraindicated early on in rehabilitation. Low-load blood flow restriction (BFR) training has beneficial effects on skeletal muscle strengthening while avoiding the risks of heavy loads. BFR can be used in a wide range of clinical applications including prehabilitation, rehabilitation, potentially reducing return to sport timelines. It may assist athletes looking for those marginal gains when their current training program has plateaued. Managing or preventing musculoskeletal injuries in a sports setting can be challenging with a plethora of modalities and options to facilitate rehabilitation and recovery. Dry Needling and Cupping Therapy may be beneficial in reducing pain. While cryotherapy can be used for pain relief and recovery, it has recently been discouraged in the management of acute soft tissue injuries. New innovations in manual therapy, including foam rolling, percussive massage devices, and instrument-assisted soft tissue mobilization, extrapolate their benefit primarily from sports massage promoting pain relief, increased flexibility, and faster recovery. They are popularized for allowing “self-massage.” Muscle energy and active release techniques aim to reduce pain, increase range of motion (ROM) and facilitate optimal tissue healing. All these innovations may have a role in managing an endurance athlete through rehabilitation, training, competition, recovery, and injury prevention; however most require more high quality research with greater homogeneity across samples, methods, measurements, and treatment protocols in the future.KeywordsBlood flow restrictionCuppingDry needlingPercussive massageInstrument-assisted massageCryotherapyFoam rollingMETRecoverySelf-massageMassage device
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Geleneksel sağlık uygulamaları, toplumların inanç, değer ve gelenekleri ile ilgili tıbbi uygulamaları ifade etmektedir. Dünya Sağlık Örgütü (DSÖ), dünya nüfusunun dörtte üçünün tamamlayıcı alternatif tedavilere güvendiğini ve modern tıbbın yeterli olmadığı başta kronik hastalıklar olmak üzere birçok hastalıkta da kullanımını önerdiği bilinmektedir. Ülkemizdeki yasal düzenlemelere göre Geleneksel ve Tamamlayıcı Tıp Uygulamalarının yapılabileceği yerler ve yetkili kişiler T.C. Sağlık Bakanlığı tarafından yetkilendirilmiş tabip tarafından yapılabilmektedir. Geleneksel tedavinin uzman olmayan kişi ya da kişiler tarafından uygulanmasının son derece riskli olduğu bilinmektedir. Bu olguda, geleneksel tedavinin yetkilendirilmemiş kişiler tarafından yapılmasının yol açtığı zararın vurgulanması amaçlanmıştır. Bu bağlamda Nekrotizan faasiit tanılı olgu, NANDA (North America Nursing Diagnosis Association hemşirelik tanıları) ve NIC (Hemşirelik Girişimleri Sınıflandırması) girişimlerine göre sunulmuştur.
Technical Report
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O mapa apresenta uma visão geral das evidências sobre os efeitos da Ventosaterapia. A partir de uma ampla busca bibliográfica foram incluídos no mapa 25 estudos de revisão. Todos os estudos foram avaliados, caracterizados e categorizados por um grupo de pesquisadores da área de acupuntura e Medicina Tradicional Chinesa. Principais Achados: As revisões avaliaram o efeito da ventosaterapia em 4 tipos apenas ventosa, Ventosa multimodal com MTC, Ventosa multimodal com MTC e não-MTC e Ventosa multimodal com não-MTC. As intervenções foram associadas a 19 desfechos de saúde distribuídos em 5 grupos Bem-Estar, Vitalidade e Qualidade de Vida, Dor, Doenças Crônicas Não Transmissíveis, Doenças Infectocontagiosas e Doenças Não Transmissíveis. No total foram 40 associações entre intervenção e desfecho, sendo a maior parte (22) com Ventosa multimodal com MTC e não-MTC e para desfechos do grupo Dor (20). O grupo dos desfechos Dor recebeu a maioria das associações (20), seguido do grupo Doenças Crônicas Não Transmissíveis (10). Dentre os desfechos, destaque para dor cervical (6), dor lombar (4), alívio da dor (4), dor muscular (3) e herpes zoster (3). Os outros 15 desfechos foram associados 2 ou 1 vez. Implicações para a prática e pesquisa: Os efeitos positivos de 14 associações foram reportados principalmente para os desfechos dor cervical (3), dor lombar (3), acne vulgar (2) e herpes zoster (2). Os efeitos potencialmente positivos foram reportados para 20 associações principalmente para os desfechos dor cervical (3), alívio da dor (2), Hipertensão Arterial (2), Osteoartrite (2) e Capacidade Funcional (2). Foram reportados efeitos inconclusivos/misturados para 6 associações, sendo 2 para o desfecho dor muscular e 1 associação para outros 4 desfechos (acne vulgar, acidente vascular cerebral, alívio da dor e mobilidade). Efeitos negativos não foram reportados.
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Female sex hormones play an important role in the etiology and pathophysiology of a variety of musculoskeletal degenerative diseases. Postmenopausal women show accelerated disc degeneration due to relative estrogen deficiency. This literature review aims to validate or falsify this hypothesis, i.e., while overall females have higher prevalence of low back pain (LBP) across all age groups, this male vs. female difference in LBP prevalence further increases after female menopause age. The literature search was performed on PubMed on January 2, 2016. The search word combination was (low back pain) AND prevalence AND [(males OR men) AND (females OR women)]. The following criteria were taken to include the papers for synthetic analysis: (I) only English primary literatures on nonspecific pain; (II) only prospective studies on general population, but not population with occupational LBP causes, of both males and female subjects studied using the same LBP criterion, ages-specific information available, and males and female subjects were age-matched; (III) studies without major quality flaws. In total 98 studies with 772,927 subjects were analyzed. According to the information in the literature, participant subjects were divided into four age groups: (I) school age children group: 6-19 years; (II) young and middle aged group: 20-50 years; (III) mixed age group: data from studies did not differentiate age groups; (IV) elderly group: ≥50 years old. When individual studies were not weighted by participant number and each individual study is represented as one entry regardless of their sample size, the median LBP prevalence ratio of female vs. males was 1.310, 1.140, 1.220, and 1.270 respectively for the four age groups. When individual studies were weighted by participant number, the LBP prevalence ratio of female vs. males was 1.360, 1.127, 1.185, and 1.280 respectively for the four groups. The higher LBP prevalence in school age girls than in school age boys is likely due to psychological factors, female hormone fluctuation, and menstruation. Compared with young and middle aged subjects, a further increased LBP prevalence in females than in males was noted after menopause age.
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Background: The adoption of incorrect postures or carrying overweight backpacks may contribute to the development of musculoskeletal disorders in school children. Objective: This study evaluated the weight of backpacks and the postural habits adopted in schools by Portuguese adolescents, and their association with scoliosis and low back pain (LBP). Method: The sample comprised 966 Portuguese students, aged between 10 and 16 years. The instruments included a questionnaire to characterize the presence of LBP and the postural habits adopted by students, the weighing of backpacks and a scoliometer to evaluate scoliosis. Results: No association was observed between assuming incorrect postures and carrying overweight backpacks, in students with scoliosis. Students who adopted incorrect sitting postures had 1.77 times the risk (95% CI: 1.32-2.36; p < 0.001) of developing LBP; those positioned incorrectly whilst watching TV and playing games had 1.44 times the risk (95% CI: 1.08-1.90; p = 0.012) of developing LBP; and those standing incorrectly had 2.39 the risk (95% CI: 1.52-3.78; p < 0.001) of developing LBP. Conclusions: The results revealed that students who sat with the spine positioned wrongly, as well as those who were standing incorrectly, were more likely to present with LBP.
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Background: As a traditional treatment method, cupping therapy is widely used in Asian countries. This overview of systematic reviews (SRs) investigated the effectiveness and safety of cupping therapy through an evidence-based approach. Methods: SRs that assessed the effectiveness of cupping therapy for any type of disease were searched through 6 electronic databases. Target diseases, cupping methods, numbers and types of included studies, quality of included trials, main results (including meta-analysis results), and authors' conclusions of SRs were extracted. The Assessment of Multiple Systematic Reviews measurement was used to evaluate methodologic quality of the SRs. Results Eight SRs met the inclusion criteria and effectiveness and safety of cupping therapy for 11 diseases were assessed. All included SRs were of good methodologic quality. However, quality of trials included in the SRs was generally poor. Meta-analysis was performed in 4 studies. Results: showed cupping therapy (alone or combined with other interventions) was better than medications (or other interventions alone) for herpes zoster, acne, facial paralysis, low back pain, or cervical spondylosis. One review reported adverse events, including hematoma, increased pain and tingling following cupping treatment. Conclusions: Cupping therapy may be beneficial for pain-related conditions, acne, and facial paralysis. However, a firm conclusion could not be drawn due to the insufficient number of included reviews and the low quality of the original studies.
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Background: Low Back Pain (LBP) is the commonest musculoskeletal disorder and an important occupational hazard among healthcare workers (HCWs) that peaks among Operating Room (OR) staff. This cross-sectional study aimed to assess the prevalence, characteristics, and risk factors of low back pain among operating room (OR) staff in a tertiary healthcare center in Makkah, Saudi Arabia. Methods: A 39-item self-administered questionnaire was distributed to all available OR staff. Data about personal, sociodemographic, general risk factors OR specific risky activities, and LBP characteristics were obtained. Descriptive, crosstabs, and univariate and multivariate logistic regression tests were employed. Results: Out of the 143 distributed questionnaires, 84 % were received. LBP prevalence was 74.2 %. No statistically significant associations were detected between LBP and any of the general risk factors (p >0.05). However, most of the OR risky activities were significantly associated with the occurrence of LBP (p <0.05) e.g. lifting objects above the waist, rotating torso while bearing weight, transferring patients onto bed or chair, pulling a patient up the bed, and repositioning a patient in bed. These significant associations were preserved after adjustment for gender, perceived stress at work, educational level, and receiving education about LBP. Rest and analgesics were reported to be the most common relievers. Conclusions: LBP is a common health issue among KAMC OR staff. OR risky activities were found to contribute to this problem. We suggest designing educational interventional programs to teach OR staff the best way to prevent this problem.
Background: The Quality of Reporting of Meta-analyses (QUOROM) conference was convened to address standards for improving the quality of reporting of meta-analyses of clinical randomised controlled trials (RCTs). Methods: The QUOROM group consisted of 30 clinical epidemiologists, clinicians, statisticians, editors, and researchers. In conference, the group was asked to identify items they thought should be included in a checklist of standards. Whenever possible, checklist items were guided by research evidence suggesting that failure to adhere to the item proposed could lead to biased results. A modified Delphi technique was used in assessing candidate items. Findings: The conference resulted in the QUOROM statement, a checklist, and a flow diagram. The checklist describes our preferred way to present the abstract, introduction, methods, results, and discussion sections of a report of a meta-analysis. It is organised into 21 headings and subheadings regarding searches, selection, validity assessment, data abstraction, study characteristics, and quantitative data synthesis, and in the results with "trial flow", study characteristics, and quantitative data synthesis; research documentation was identified for eight of the 18 items. The flow diagram provides information about both the numbers of RCTs identified, included, and excluded and the reasons for exclusion of trials. Interpretation: We hope this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement.
Objectives: The objectives of this study were to estimate prevalence of low back pain, to investigate associations between low back pain and a set of emerging workplace risk factors, and to identify worker groups with an increased vulnerability for low back pain in the United States. Methods: The data used for this cross-sectional study came from the 2010 National Health Interview Survey, which was designed to collect data on health conditions and related risk factors from the US civilian population. The variance estimation method was used to compute weighted data for prevalence of low back pain. Multivariable logistic regression analyses stratified by sex and age were performed to determine the odds ratios (ORs) and the 95% confidence interval (CI) for low back pain. The examined work-related psychosocial risk factors included work-family imbalance, exposure to a hostile work environment, and job insecurity. Work hours, occupation, and other work organizational factors (nonstandard work arrangements and alternative shifts) were also examined. Results: The prevalence of self-reported low back pain in the previous 3 months among workers in the United States was 25.7% in 2010. Female or older workers were at increased risk of experiencing low back pain. We found significant associations between low back pain and a set of psychosocial factors, including work-family imbalance (OR 1.27, CI 1.15-1.41), exposure to hostile work (OR 1.39, CI 1.25-1.55), and job insecurity (OR 1.44, CI 1.24-1.67), while controlling for demographic characteristics and other health-related factors. Older workers who had nonstandard work arrangements were more likely to report low back pain. Women who worked 41 to 45 hours per week and younger workers who worked >60 hours per week had an increased risk for low back pain. Workers from several occupation groups, including male health care practitioners, female and younger health care support workers, and female farming, fishing, and forestry workers, had an increased risk of low back pain. Conclusions: This study linked low back pain to work-family imbalance, exposure to a hostile work environment, job insecurity, long work hours, and certain occupation groups. These factors should be considered by employers, policymakers, and health care practitioners who are concerned about the impact of low back pain in workers.
Objective: To describe epidemiologic characteristics and associations with increased healthcare utilization in US adults with chronic low back pain (cLBP). Methods: NHANES back pain survey 2009-2010, administered to adults aged 20-69 (N = 5103). cLBP was defined as pain in the area between the lower posterior margin of the ribcage and the horizontal gluteal fold, with a history of pain lasting almost every day for at least 3 months. Demographic and behavioral characteristics were compared between those with cLBP and without. Factors, associated with ≥10 healthcare visits/year were evaluated in the cLBP subgroup (N=700). Results: cLBP associations with adjusted odds ratios (aORs) ≥2 included age 50-69, education less than high school, annual household income <$20 000, income from disability, depression, sleep disturbances, and medical comorbidities. Subjects with cLBP were more likely to be covered by government-sponsored insurance plans: aOR 3.23 ([95% CI] 2.19-4.75) for Medicaid, aOR 2.25 (1.57-3.22) for Medicare (p < 0.0001), and visited healthcare providers more frequently: aOR 3.35 (2.40-4.67) for ≥10 healthcare visits in the past year (p < 0.0001). In the cLBP subgroup aORs ≥2 were found for associations between ≥10 visits per year and unemployment, income from disability, depression, and sleep disturbances. Conclusion: US adults with cLBP are socio-economically disadvantaged, make frequent healthcare visits and are often covered by government-sponsored health insurance. The clustering of behavioral, psychosocial, and medical issues should be considered in the care of Americans with cLBP. This article is protected by copyright. All rights reserved.
Objective: To assess the treatment effect of moving cupping therapy on nonspecific low back pain(NLBP). Method: Randomly divided 70 outpatients of NLBP into two groups among which one group as study group of 37 cases was treated with moving cupping therapy and another 33 cases control group was given dexibuprofen (one kind of nonsteroidal anti-inflammatory drugs, NSAIDs). For study group, a period of moving cupping therapy included 6-times moving cupping therapy in all (one time with two days) interval; For control group, dexibuprofen was prescribed 0.15g per oral and 3 times per day, and 12 days were as a course of treatment. Before and after a course of treatment using visual analog scale(VAS) and 36-Item Short Form(SF-36) assessed the degree of low back pain, the capability of daily activity, and the total state of heath. Result: 0n the whole, in two groups the changes of VAS index and SF-36 scores were both significantly improved(P<0.01), which indicated both moving cupping therapy and dexibuprofen alleviated nonspecific low back pain, and improve their total state of heath. However, in comparison with control group, the changes of VAS in study group index and SF-36 scores were more significant (P< 0.01), it demonstrated that the effect of moving cupping therapy on NLBP was better than that of dexibuprofen. Furthermore, the effective rate of study group was 91.9% that was much higher than 75.8% of control group, which also revealed that moving cupping therapy was more effective than dexibuprofen. Conclusion: Being a sort of economical and effective method, moving cupping therapy can alleviate or even cure NLBP, therefore it might be recommended to treat and prevent NLBP.