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Abstract

Several systematic reviews (SRs) have assessed the effectiveness of cupping for a range of conditions. Our aim was to provide a critical evaluation and summary of these data. Electronic searches were conducted to locate all SRs concerning cupping for any condition. Data were extracted by two authors according to predefined criteria. Five SRs met our inclusion criteria, which related to the following conditions: pain conditions, stroke rehabilitation, hypertension, and herpes zoster. The numbers of studies included in each SR were small. Relatively clear evidence emerged only for one indication, that cupping may be effective for reducing pain. Based on evidence from the currently available SRs, the effectiveness of cupping has been demonstrated only as a treatment for pain, and even for this indication doubts remain.
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... It is stated that stagnation of these fluids resulted in pain and diseases. [1,2] There are two most used types of CT; retained or dry cupping and bleeding or wet cupping. In dry CT, the sucking cups are put in the specific areas in the body and negative pressure is applied. ...
... Dry CT is practiced more commonly in the Far East, while wet CT was preferred in the Middle East and Eastern Europe. [1][2][3][4][5] It was one of the therapeutic methods used by the Egyptians (Pharaohs) as it was recorded in ancient Pharaonic inscriptions known as hieroglyphic inscriptions and the Egyptians recorded CT in the oldest books of medicine known as (Ebers Papyrus) written before about 1550 BC, similarly, it was used by the Arabs before about 5500 BC and was recorded by the Assyrians before about 3500 BC. [5] China also was among the ancient nations that used this technique of treatment, and the Chinese played a big role in the development of this technique of treatment. Early written records in China (28 A.D.) strongly support the use of CT and acupuncture. ...
... In general, the CT has an effective role in treating several diseases such as; fibromyalgia, fibrositis, cervical spondylosis, sciatica, gouty arthritis, skin-related ailments, osteoarthritis, pain, hyperlipidemia, persistent low back pain, chronic non-specific neck pain, nonspecific low back pain, acute and chronic pain management, headache in migraine, cellulitis, gynecological disorders, etc. [1,10] As well as, the CT has a positive effect on reducing total cholesterol blood levels in hypercholesterolemic patients. [11] Observational clinical studies can often be greatly enhanced by the inclusion of biochemical analyses in stored serum samples collected from the volunteers being studied. ...
Article
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Cupping therapy (CT), also known as (Al-Hijamah) is one of the therapeutic techniques that were practiced in many countries of the world in ancient times and it is still used now. The current study was aimed to evaluate some components of the venous blood and comparing the results with that in the blood withdrawn during cupping therapy (CT). The method was carried out by taking blood samples from the scarified area that were made during CT on the skin and venous blood samples. Eighteen mostly healthy male participants were selected randomly between ages 25-61 years. About 5 ml of blood samples were collected from the vein and cupping site for each participant and biochemical parameters that are blood glucose, uric acid, and cholesterol were analyzed. All studied parameters were high in the cupping blood in comparison with the venous blood where it was noted that cholesterol, triglycerides (TG), as well as low-density lipoproteins (LDL), were statistically significant at (p<0.001) while high-density lipoproteins (HDL), blood sugar and uric acid were statistically significant at (p=0.01), and urea was statistically significant at (p=0.05), while creatinine did not give statistical significance at (p>0.05). The current study is consistent with other studies. CT helps in reducing some biological parameters that may be related to some metabolic diseases, so it could maintaining human health.
... It is stated that stagnation of these fluids resulted in pain and diseases. [1,2] There are two most used types of CT; retained or dry cupping and bleeding or wet cupping. In dry CT, the sucking cups are put in the specific areas in the body and negative pressure is applied. ...
... Dry CT is practiced more commonly in the Far East, while wet CT was preferred in the Middle East and Eastern Europe. [1][2][3][4][5] It was one of the therapeutic methods used by the Egyptians (Pharaohs) as it was recorded in ancient Pharaonic inscriptions known as hieroglyphic inscriptions and the Egyptians recorded CT in the oldest books of medicine known as (Ebers Papyrus) written before about 1550 BC, similarly, it was used by the Arabs before about 5500 BC and was recorded by the Assyrians before about 3500 BC. [5] China also was among the ancient nations that used this technique of treatment, and the Chinese played a big role in the development of this technique of treatment. Early written records in China (28 A.D.) strongly support the use of CT and acupuncture. ...
... In general, the CT has an effective role in treating several diseases such as; fibromyalgia, fibrositis, cervical spondylosis, sciatica, gouty arthritis, skin-related ailments, osteoarthritis, pain, hyperlipidemia, persistent low back pain, chronic non-specific neck pain, nonspecific low back pain, acute and chronic pain management, headache in migraine, cellulitis, gynecological disorders, etc. [1,10] As well as, the CT has a positive effect on reducing total cholesterol blood levels in hypercholesterolemic patients. [11] Observational clinical studies can often be greatly enhanced by the inclusion of biochemical analyses in stored serum samples collected from the volunteers being studied. ...
Article
Cupping therapy (CT), also known as (Al-Hijamah) is one of the therapeutic techniques that were practiced in many countries of the world in ancient times and it is still used now. The current study was aimed to evaluate some components of the venous blood and comparing the results with that in the blood withdrawn during cupping therapy (CT). The method was carried out by taking blood samples from the scarified area that were made during CT on the skin and venous blood samples. Eighteen mostly healthy male participants were selected randomly between ages 25-61 years. About 5 ml of blood samples were collected from the vein and cupping site for each participant and biochemical parameters that are blood glucose, uric acid, and cholesterol were analyzed. All studied parameters were high in the cupping blood in comparison with the venous blood where it was noted that cholesterol, triglycerides (TG), as well as low-density lipoproteins (LDL), were statistically significant at (p<0.001) while high-density lipoproteins (HDL), blood sugar and uric acid were statistically significant at (p=0.01), and urea was statistically significant at (p=0.05), while creatinine did not give statistical significance at (p>0.05). The current study is consistent with other studies. CT helps in reducing some biological parameters that may be related to some metabolic diseases, so it could maintaining human health.
... Another comprehensive systematic review [8] found dry cupping therapy to be more effective in reducing pain as compared to other treatments such as heat therapy etc. A recent study [19] showed a significant association between dry cupping therapy and pain reduction in PF patients. It is hypothesized that dry cupping therapy may relieve pain by applying localized negative pressure to the plantar surface, heels and calves which allows more blood to circulate and in turn promotes healing and relaxation of the muscles and ligaments in these areas [16,19]. ...
... A recent study [19] showed a significant association between dry cupping therapy and pain reduction in PF patients. It is hypothesized that dry cupping therapy may relieve pain by applying localized negative pressure to the plantar surface, heels and calves which allows more blood to circulate and in turn promotes healing and relaxation of the muscles and ligaments in these areas [16,19]. ...
Background There is limited evidence available on the effects of dry cupping therapy on outcomes of pain, dynamic balance and functional performance in young female recreational runners chronic plantar fasciitis. Purpose To investigate the effectiveness of dry cupping therapy on pain, dynamic balance and functional performance parameters in young female recreational runners with chronic plantar fasciitis. Method Thirty female recreational runners with plantar fasciitis were recruited from outpatient department of SGT hospital. They were randomly divided into two equal groups: Dry cupping therapy (Experimental group n = 15) and Conventional therapy (Control group n = 15). The experimental group received dry cupping therapy along with the conventional treatment whereas the control group received conventional treatment alone for 4 weeks (3 days/week). Outcome variables such as pain (Numeric pain rating scale), dynamic balance (Star excursion balance test) and functional performance (Figure of eight hop test) were evaluated at baseline and after 4 weeks of study period. Appropriate statistical tests were performed to test hypothesis the study hypothesis. Results Findings suggested a significant improvement in parameters of pain, dynamic balance and functional performance (p < 0.05). However, these improvements were found to be significantly greater (p< 0.05) with the addition of dry cupping therapy to the conventional treatment. Conclusion Findings of the present study suggests that dry cupping therapy may be considered as an adjunct treatment method in addition to the conventional treatment in young female runners with chronic plantar fasciitis.
... [6] Regardless of its common use in many countries, the evidence to support its practice to promote patients' health and improve quality of life is incomplete. [7,8] Different types of cupping appear in literature, including dry cupping, wet cupping, moving cupping, and fire cupping. [2,[9][10][11] All types involve suction created by various means with or without bloodletting. ...
... Studies aimed to establish or correlate the beneficial effects of Hijama therapy in various health conditions were mainly able to associate beneficial effects to different kinds of pain, including neck pain, upper shoulder pain, and low back pain. [8,[12][13][14][15][16][17] In addition, tension and migraine headache, [18] acute/chronic inflammation, infectious diseases, [19] immune system disorders, diabetes, [20] anxiety and depression, [21] sleep quality, [22] heart rate variability, [23] and hypertension have been investigated. [24] Of particular interest was the control of hypertension because contradictory findings have been reported. ...
Article
Bloodletting cupping therapy (Hijama) is a traditional alternative medicine practiced in different cultures. Claims about the therapeutic efficacy of Hijama in hypertension are contradictory. The aim of this project was to determine if Hijama therapy is beneficial in the treatment of patients with hypertension
... For wet cupping, the cup suctions the lacerated skin to draw blood from the dermal microcirculation. Cupping has also been used to improve subcutaneous blood flow to skin and muscles and to stimulate the autonomic nervous system [7,8]. Besides, cupping is also used for draining excess fluids and toxins, loosening adhesions, and lifting connective tissues [8]. ...
... Cupping has also been used to improve subcutaneous blood flow to skin and muscles and to stimulate the autonomic nervous system [7,8]. Besides, cupping is also used for draining excess fluids and toxins, loosening adhesions, and lifting connective tissues [8]. Correspondingly, in the theory of traditional medicine, cupping promotes the circulation of Qi and blood of the treatment area to alleviate pain and tension caused by stagnation, and expels the pathogenic factors, eventually leading to the restoration of physiological harmony and balance. ...
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This study aimed to describe and assess the current evidence in systematic reviews on cupping therapy for various conditions. We searched PubMed, EMBASE, Cochrane Database of Systematic Reviews, China National Knowledge Infrastructure, and six Korean databases for systematic reviews of trials on cupping treatments for any condition published prior to March 2021. We used a bubble plot to graphically display the clinical topics, the number of articles, the number of participants in the total population, confidence, and effectiveness. Thirteen systematic reviews that met the inclusion criteria were included in the evidence map, and 16 bubbles were created. The findings from six reviews showed potential benefits of cupping for conditions such as low back pain, ankylosing spondylitis, knee osteoarthritis, neck pain, herpes zoster, migraine, plaque psoriasis, and chronic urticaria. Cupping has been applied in a variety of clinical areas, and systematic reviews in a few of these areas have demonstrated statistically significant benefits. The evidence map provides a visual overview of cupping research volume and findings. Evidence mapping can facilitate the transfer of knowledge from researchers to policymakers and promote research on musculoskeletal pain (such as low back pain, neck pain, and knee osteoarthritis) and skin disease (plaque psoriasis).
... Cardiovascular disease defines as disease that related to heart and blood vessel. 1 One of condition associated to cardiovascular is imbalances of auto- Cupping therapy, wet and dry are assumed that can release liquid and toxic in human body, diffuse the condition of adhesion, strengthen the connective tissue, accelerate blood circulation to skin and muscle and also stimulate peripheral nervous system. 6 Dry cupping could increase blood flow and stimulate autonomic nervous system. Dry cupping provides potential benefits of simple administration, low costs, and safety. ...
Article
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Cardiovascular disease defines as a disease related to heart and blood vessel. One of high risk in the disease of cardiovascular is its on people with obesity. Heart Rate Variability (HRV) indicator is an important sign to identify cardiovascular risk and provide early information related to change of heart autonomy controlling. This indicator was influenced by several factors such as cupping therapy. Study found that HRV increased after cupping therapy by wet cupping treatment in healthy people. The aims of this research is to investigate the influence of dry cupping toward increased HRV in male obesity adolescence. The study was experimental with pre-post test design by using consecutive sampling of 30 male adolescence aged 18-24 years old with BMI  25 kg/m 2. They were divided into 2 groups, control and intervention group with cupping therapy. Data result used in SDDN and RMSSD level. Analysis Data were used paired and independent t test. The result showed SDNN and RMMSD level before intervention were 73,95 ms dan 67,11 ms. Whereas SDNN and RMMSD level after intervention were 69,66 ms dan 61,95 ms. In paired (p=0,52 and p=0,38) and independent t test (p=0,30 and p=0,56) showed that there were no significant difference between SDNN and RMSSD in intervention group and control group (p>0,05). The conclusion of this study is dry cupping had no effects toward increased HRV level in male obesity adolescence. Abstrak Penyakit kardiovaskular adalah penyakit yang terkait dengan jantung dan pembuluh darah. Salah satu faktor risiko yang cukup tinggi pada penyakit kardiovaskular adalah obesitas. Indikator Heart Rate Variability (HRV) adalah tanda yang penting untuk mengetahui risiko penyakit kardiovaskular yang menyediakan informasi awal tentang perubahan pada kontrol otonom jantung. Indikator ini dipengaruhi oleh beberapa faktor salah satunya adalah perlakuan bekam. Tujuan penelitian ini adalah untuk mengetahui pengaruh perlakuan bekam kering terhadap peningkatan HRV pada remaja laki-laki obesitas. Metode penelitian yang digunakan berupa eksperimental dengan rancangan pre-post test design. Subyek penelitian adalah 30 mahasiswa berusia 18-24 tahun, yang dibagi menjadi 2 kelompok yaitu kelompok kontrol dan kelompok intervensi. Kelompok kontrol adalah remaja laki-laki tidak obesitas sedangkan kelompok intervensi adalah remaja laki-laki obesitas dengan perlakuan bekam. Sampel dipilih melalui teknik consecutive sampling. Hasil menunjukkan tidak adanya pengaruh secara signifikan bekam kering terhadap nilai SDNN dan RMSSD pada kelompok intervensi (p>0,05). Uji statistik independent t test menunjukkan tidak adanya perbedaan secara signifikan SDNN dan RMSSD pada kelompok kontrol dan intervensi, sehingga bekam kering tidak memberikan pengaruh terhadap peningkatan HRV pada remaja laki-laki obesitas. Jenis penelitian yang digunakan adalah eksperimen dengan desain pre-post test design. Subyek penelitian sebanyak 30 orang dengan kriteria inklusi laki-laki usia 18-24 tahun dengan IMT  25 kg/m 2. Subyek dipilih melalui teknik consecutive sampling. Subyek dibagi menjadi 2 kelompok yaitu kelompok kontrol dan kelompok intervensi dengan perlakuan bekam. Data yang dihasilkan adalah nilai SDNN dan ARTIKEL PENELITIAN Mutiara Medika Vol. 16 No. 2: 71-75, Juli 2016 72 Syahruramdhani, dkk., The Influence of Dry Cupping RMSSD. Analisis data yang digunakan adalah paired dan independent t test. Hasil penelitian menunjukkan nilai SDNN dan RMSSD sebelum intervensi adalah 73,95 ms dan 67,11 ms. Sedangkan nilai SDNN dan RMSSD setelah intervensi adalah 69,66 ms dan 61,95 ms. Uji statistik paired (p=0,52 dan p=0,38) dan independent t test (p=0,) menunjukkan tidak adanya perbedaan secara signifikan SDNN dan RMSSD pada kelompok kontrol dan intervensi. Kesimpulan dari penelitian ini bahwa bekam kering tidak memberikan pengaruh terhadap peningkatan HRV pada remaja laki-laki obesitas.
... Prof. Lee assessed five systematic reviews and came to a conclusion that reduction of pain may be the only therapeutic effect of cupping. 5 However, this indication is not well proven as well. Given the variation in the findings of previous studies, it is necessary to critically evaluate and summarize the existing clinical evidence for obtaining a clearer picture of the mechanism and therapeutic effect of cupping therapy. ...
Article
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Objective The aim of this review was to identify the possible mechanisms behind cupping therapy by employing an evidence-based approach, and to explore its possible regional and systemic effects in the human body. Methods We searched six electronic databases and four online trial registries for articles published up to January 1, 2020. Clinical studies on the mechanisms of retained cupping, flashing cupping, moving cupping, and vacuum cupping were considered for this review. The methodological qualities of controlled studies were assessed using the National Institute for Clinical Excellence methodology checklist, the Newcastle-Ottawa Scale, and the Cochrane risk of bias tool. Characteristic statistical description and qualitative summary of results were used for data analysis. Results Thirty-eight studies (37 full texts and one abstract) were included in this study. Due to the clinical heterogeneity among the studies, we could not conduct a meta-analysis. The results showed that the key factors that contribute to the efficacy of cupping therapy are negative pressure and temperature. Cupping therapy mainly causes local and systemic changes in hemodynamics, immune regulation, metabolism, and pain relief. Conclusion We identified negative pressure as the key element behind cupping therapy. Cupping therapy may cause redistribution of oxygen at the cupping site and in neighboring tissues, thereby inducing a therapeutic effect by increasing regional blood flow. It may also induce metabolic change, immunomodulation, and neuromodulation. However, additional rigorous clinical research needs to be conducted to further clarify the mechanism behind cupping therapy.
... A total of 144 systematic reviews were retrieved; there were 5 overviews of SRs without analysis [35][36][37][38][39]. e evidence map for TCM is based on the 139 published systematic reviews, including the Chinese herbal medicine studies (n � 92) and nondrug therapy studies (n � 47). ...
Article
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We systematically retrieved and summarised clinical studies on traditional Chinese medicine (TCM) for the prevention and treatment of essential hypertension (EH) using the evidence map. We aimed to explore the evidence distribution, identify gaps in evidence, and inform on future research priorities. Clinical studies, systematic reviews, guidelines, and pathway studies related to TCM for the prevention and treatment of EH, published between January 2000 and December 2019, were included from databases CNKI, WanFang Data, VIP, PubMed, Embase, and Web of Science. The distribution of evidence was analysed using text descriptions, tables, and graphs. A total of 9,403 articles were included, including 5,920 randomised controlled studies (RCTs), 16 guidelines, expert consensus and path studies, and 139 systematic reviews (SRs). The articles publishing trend increased over time. This study showed that the intervention time of TCM was concentrated at 4-8 weeks, mainly through Chinese herbal medicine (CHM) for the prevention and treatment of elderly hypertension and the complications. A Measurement Tool to Assess Systematic Reviews (AMSTAR) scores of the included reviews ranged from 2 to 10. Most of the SRs had a potentially positive effect (n = 120), mainly in 5-8 score. Primary studies and SRs show potential benefits of TCM in lowering blood pressure, lowering the TCM syndrome and symptom differentiation scores (TCM-SSD scores), improving the total effective rate, and reducing the adverse events. The adjunctive effect of TCM on improving the total effective rate, lowering the blood pressure, lowering the TCM-SSD scores, and lowering the adverse effects was only supported by low-quality evidence in this research. The evidence map was used to show the overall research on TCM for the treatment of EH; however, due to the existing problems of the primary studies, the current research conclusion needs further research with higher quality and standardisation.
... Although the mechanisms behind the effectiveness of cupping therapy have been proposed by many authors, there is still no single theory to explain its effects entirely [4]. Even though it is used widely in the management of myofascial pain and in sports medicine [5,6], there are still debates about the effectiveness in the current literature [7,8]. One of the most commonly criticized issues is that cupping therapy is performed using traditional methods, and the dose of cupping, included number of cups, negative pressure value, and duration and frequency of cupping cannot be quantified. ...
Article
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Purpose This study aimed to develop a quantitative dry cupping system that can monitor negative pressure attenuation and soft tissue pull-up during cupping to quantify soft tissue compliance. Methods Baseball players with myofascial pain syndrome were recruited to validate the benefits of cupping therapy. Nine of 40 baseball players on the same team were diagnosed with trapezius myofascial pain syndrome; another nine players from the same team were recruited as controls. All participants received cupping with a negative pressure of 400 mmHg for 15 minutes each time, twice a week, for 4 weeks. Subjective perception was investigated using upper extremity function questionnaires, and soft tissue compliance was quantified objectively by the system. Results During the 15-minute cupping procedure, pressure attenuation in the normal group was significantly greater than that in the myofascial group ( p = 0.017). The soft tissue compliance in the normal group was significantly higher than that in the myofascial group ( p = 0.050). Moreover, a 4-week cupping intervention resulted in an obvious increase in soft tissue lift in the myofascial pain group ( p = 0.027), although there was no statistical difference in the improvement of soft tissue compliance. Shoulder ( p = 0.023) and upper extremity function ( p = 0.008) were significantly improved in both groups, but there was no significant difference between the two groups. Conclusion This quantitative cupping monitoring system could immediately assess tissue compliance and facilitate the improvement of soft tissues after cupping therapy. Hence, it can be used in athletes to improve their functional recovery and maintain soft tissues health during the off-season period.
Article
Background Chronic migraine is a disabling condition that negatively affects many aspects of migraineurs’ lives. Patients who use pharmacological agents experience various side effects. Some studies have reported clinical improvement following wet cupping therapy in migraine patients. This study examined the effectiveness of wet cupping therapy on headache severity and its complications in patients with migraine. Methods In this study, a total of 29 patients previously diagnosed with migraine were treated with wet cupping therapy and followed up for headache severity. The severity of pain was measured before therapy, 1 h after therapy, and one month after therapy. The wet cupping therapy was performed by an experienced nurse who was not part of the research team. Results The mean age of the patients was 36.17 (Sta. Deviation: 10.74 years; range: 22–68 years), and on average, patients had experienced migraine for 11.14 years. The severity of headache pain was decreased significantly from 6.66 (very intense pain) before cupping therapy to 2.48 (discomforting pain) 1 h after cupping therapy and 0.72 (very mild pain) one month after cupping therapy (p<0.001). The observed complications were skin pigmentation (6.9%), skin scarring (24.1%), and itching in the cupping region (31.0%). Conclusions The present study suggests a significant improvement in the severity of headache in migraine patients 1 h and one month after wet cupping therapy.
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Wet cupping is a traditional Chinese medicine therapy commonly used in treating herpes zoster in China, and clinical studies have shown that wet cupping may have beneficial effect on herpes zoster compared with Western medication. We included randomized controlled trials (RCTs) on wet cupping for herpes zoster. We searched PubMed, the Cochrane Library (Issue 3, 2008), China Network Knowledge Infrastructure (CNKI), Chinese Scientific Journals Fulltext Database VIP, and Wan Fang Database. All searches ended in February 2009. Two authors extracted data and assessed the trials' quality independently. RevMan 5.0.18 software (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark) was used for data analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI). Eight RCTs involving 651 patients were included, and the methodological quality of trials was generally fair in terms of randomization, blinding, and intention-to-treat analysis. Meta-analyses showed wet cupping was superior to medication in the number of cured patients (RR 2.49, 95% CI 1.91 to 3.24, P < .00001), the number of patients with improved symptoms (RR 1.15, 95% CI 1.05 to 1.26, P = .003), and reducing the incidence rate of postherpetic neuralgia (RR 0.06, 95% CI 0.02 to 0.25, P = .0001). Wet cupping plus medication was significantly better than medication alone on number of cured patients (RR 1.93, 95% CI 1.23 to 3.04, P = .005) but demonstrated no difference in symptom improvement (RR 1.00, 95% CI 0.92 to 1.08, P = .98). There were no serious adverse effects related to wet cupping therapy in the included trials. Wet cupping appears to be effective in the treatment of herpes zoster. However, further large, rigorously designed
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The CONSORT statement is used worldwide to improve the reporting of randomised controlled trials. Kenneth Schulz and colleagues describe the latest version, CONSORT 2010, which updates the reporting guideline based on new methodological evidence and accumulating experience. To encourage dissemination of the CONSORT 2010 Statement, this article is freely accessible on bmj.com and will also be published in the Lancet, Obstetrics and Gynecology, PLoS Medicine, Annals of Internal Medicine, Open Medicine, Journal of Clinical Epidemiology, BMC Medicine, and Trials.
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The objective of this study was to assess the evidence for or against the effectiveness of cupping as a treatment option for pain. Fourteen databases were searched. Randomized clinical trials (RCTs) testing cupping in patients with pain of any origin were considered. Trials using cupping with or without drawing blood were included, while trials comparing cupping with other treatments of unproven efficacy were excluded. Trials with cupping as concomitant treatment together with other treatments of unproven efficacy were excluded. Trials were also excluded if pain was not a central symptom of the condition. The selection of studies, data extraction and validation were performed independently by three reviewers. Seven RCTs met all the inclusion criteria. Two RCTs suggested significant pain reduction for cupping in low back pain compared with usual care (P < .01) and analgesia (P < .001). Another two RCTs also showed positive effects of cupping in cancer pain (P < .05) and trigeminal neuralgia (P < .01) compared with anticancer drugs and analgesics, respectively. Two RCTs reported favorable effects of cupping on pain in brachialgia compared with usual care (P = .03) or heat pad (P < .001). The other RCT failed to show superior effects of cupping on pain in herpes zoster compared with anti-viral medication (P = .065). Currently there are few RCTs testing the effectiveness of cupping in the management of pain. Most of the existing trials are of poor quality. Therefore, more rigorous studies are required before the effectiveness of cupping for the treatment of pain can be determined.
Article
To determine whether clinical trials originating in certain countries always have positive results. Abstracts of trials from Medline (January 1966-June 1995). Two separate studies were conducted. The first included trials in which the clinical outcome of a group of subjects receiving acupuncture was compared to that of a group receiving placebo, no treatment, or a nonacupuncture intervention. In the second study, randomized or controlled trials of interventions other than acupuncture that were published in China, Japan, Russia/USSR, or Taiwan were compared to those published in England. Blinded reviewers determined inclusion and outcome and separately classified each trial by country of origin. In the study of acupuncture trials, 252 of 1085 abstracts met the inclusion criteria. Research conducted in certain countries was uniformly favorable to acupuncture; all trials originating in China, Japan, Hong Kong, and Taiwan were positive, as were 10 out of 11 of those published in Russia/USSR. In studies that examined interventions other than acupuncture, 405 of 1100 abstracts met the inclusion criteria. Of trials published in England, 75% gave the test treatment as superior to control. The results for China, Japan, Russia/USSR, and Taiwan were 99%, 89%, 97%, and 95%, respectively. No trial published in China or Russia/USSR found a test treatment to be ineffective. Some countries publish unusually high proportions of positive results. Publication bias is a possible explanation. Researchers undertaking systematic reviews should consider carefully how to manage data from these countries.
Article
The objective of this review is to assess the clinical evidence for or against cupping as a treatment for hypertension. We searched the literature using 15 databases from their inception to 30 June 2009, without language restrictions. We included all clinical trials (CTs) of cupping to treat hypertension in human patients. Risk of bias was assessed using the Cochrane criteria. Two CTs met all inclusion criteria. One RCT (randomized CT) assessed the effectiveness of dry cupping on changes in cerebral vascular function compared with drug therapy. Their results suggested significant effect in favor of cupping on vascular compliance and degree of vascular filling. One uncontrolled observational study (UOS) tested wet cupping for acute hypertension and found that a one-time treatment reduced blood pressure. In conclusion, the evidence is not significantly convincing to suggest cupping is effective for treating hypertension. Further research is required to investigate whether it generates any specific effects for that condition.
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The CONSORT statement is used worldwide to improve the reporting of randomised controlled trials. Kenneth Schulz and colleagues describe the latest version, CONSORT 2010, which updates the reporting guideline based on new methodological evidence and accumulating experience. To encourage dissemination of the CONSORT 2010 Statement, this article is freely accessible on bmj.com and will also be published in the Lancet, Obstetrics and Gynecology, PLoS Medicine, Annals of Internal Medicine, Open Medicine, Journal of Clinical Epidemiology, BMC Medicine, and Trials.
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Cupping is often used for stroke rehabilitation in Asian countries. Currently, no systematic review of this topic is available. The aim of this systematic review is to summarize and critically evaluate the evidence for and against the effectiveness of cupping for stroke rehabilitation. Thirteen databases were searched from their inception through March of 2010 without language restrictions. Prospective clinical trials were included if cupping was tested as the sole treatment or as an adjunct to other conventional treatments for stroke rehabilitation. We found 43 potentially relevant articles, of which 5 studies including 3 randomized clinical trials (RCTs) and 2 uncontrolled observational studies (UOSs) met our inclusion criteria. Cupping was compared with acupuncture, electro-acupuncture and warm needling. Some superior effects of cupping were found in two of the RCTs when compared to acupuncture in hemiplegic shoulder pain and high upper-limb myodynamia after stroke. The other RCT failed to show favorable effects of cupping when compared to acupuncture and warm needling in patients with hemiplegic hand edema. The two UOSs reported favorable effects of cupping on aphasia and intractable hiccup after stroke. There are not enough trials to provide evidence for the effectiveness of cupping for stroke rehabilitation because most of the included trials compared the effects with unproven evidence and were not informative. Future RCTs seem warranted but must overcome the methodological shortcomings of the existing evidence.
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The objective of this study was to assess the validity of an index of the scientific quality of research overviews, the Overview Quality Assessment Questionnaire (OQAQ). Thirty-six published review articles were assessed by 9 judges using the OQAQ. Authors reports of what they had done were compared to OQAQ ratings. The sensibility of the OQAQ was assessed using a 13 item questionnaire. Seven a priori hypotheses were used to assess construct validity. The review articles were drawn from three sampling frames: articles highly rated by criteria external to the study, meta-analyses, and a broad spectrum of medical journals. Three categories of judges were used to assess the articles: research assistants, clinicians with research training and experts in research methodology, with 3 judges in each category. The sensibility of the index was assessed by 15 randomly selected faculty members of the Department of Clinical Epidemiology and Biostatistics at McMaster. Authors' reports of their methods related closely to ratings from corresponding OQAQ items: for each criterion, the mean score was significantly higher for articles for which the authors responses indicated that they had used more rigorous methods. For 10 of the 13 questions used to assess sensibility the mean rating was 5 or greater, indicating general satisfaction with the instrument. The primary shortcoming noted was the need for judgement in applying the index. Six of the 7 hypotheses used to test construct validity held true. The OQAQ is a valid measure of the quality of research overviews.