The practice of cupping has been around for centuries having been practised across a variety of cultures and civilisations. Many ancient texts refer to the practice, including the Ebers Papyrus from Ancient Egypt. The Ancient physician Galen is also said to have been an avid practitioner. In modern times the practice continues. Recently, Team USA athletes at the 2016 Rio Olympic Games, were seen proudly sporting round, red marks indicative of a recent cupping session. Numerous practitioners offer the treatment, but is this ancient practice relevant in the modern era of medicine we now live in?
What is wet cupping?
The practice itself is very similar to dry cupping where a suction cup is applied to the skin to create a vacuum through negative pressure. The practitioner then removes the cup to make incisions into the cupped skin with a needle. Blood is then collected by placing the cup back on the treatment area and it is removed once the flow of blood has stemmed. Practitioners believe this to be stagnant blood that is contributing to illness.
In 2015, concerns were raised around the practice of wet cupping. The practice is often referred to by its Arabic name, Hijama, meaning “suction”. The concerns related to poor hygiene practices, the credibility of the practitioners and the vulnerability of patients.
Does it work?
There are many individuals who claim that Hijama works and indeed there is evidence to support the use of cupping to cure ailments from rheumatoid arthritis to herpetic neuralgia. Trials comparing wet cupping with conventional medical treatments seem to show a significant reduction in pain intensity in the groups treated with cupping. Further to this, when wet cupping is combined with other forms of treatment, better therapeutic outcomes are observed.
Can we believe these results?
When researchers looked more carefully at the way in which these trials were carried out a series of flaws were identified. Firstly, the overall number of studies examining the technique was small. These studies often originate from developing countries where trial regulations are not as regimented as in the West.
In medical trials, there needs to be a large number of participants to eliminate the risk of the results being due to chance. The Hijama trials that were examined had fewer participants than needed to produce good results. This means that the effectiveness of the treatment could not be reliably interpreted.
Blinding involves concealing the treatment to all involved in the trial. An example of this is not telling participants whether they are taking an active drug or a placebo.
Randomisation involves randomly allocating the trial participants to either the placebo or treatment group to ensure that there is a varied demographic in each group. These measures help to minimise differences between treatment groups at the outset of the trial.
With a technique like as cupping, it would be extremely difficult to blind the patients, practitioners and researchers. This makes it difficult to measure how much of the pain reduction cited in the trials is actually due to the technique itself, rather than other factors. These could be, for example, patient expectations and prior knowledge of what the treatment can do.
What does this mean for the future?
Hijama has been shown to have some benefits when used in conjunction with other treatments. However, the trials that have been conducted are of low quality, therefore, their credibility is reduced. The fact that these studies often come from the developing world probably has an impact on this. The way forward would be to combine the complementary techniques that are practised in the East with Western trial methodology. This would help to produce reliable results which could influence current medical practice.
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Any opinions above are the author’s alone and may not represent those of his/her affiliations. Any comment is based on the best available evidence at the time of writing. All data is based on externally validated studies unless expressed otherwise. Novel data is representative of the sample surveyed. An online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice. Article edited for publication by Dr Hannah Arnstein
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Sources and Further Reading
http://www.webmd.com/balance/guide/cupping-therapy#1 (A guide to cupping)
https://www.britannica.com/topic/Ebers-papyrus (The Ebers papyrus citing ancient medical treatments)
http://www.bbc.co.uk/history/historic_figures/galen.shtml (Biography of the Ancient physician Galen)
http://www.bbc.co.uk/news/health-37009240 (Article from 2016 on the practice of cupping at the Olympic Games)
http://www.hijama.co.uk/ (A website promoting hijama)
http://www.bbc.co.uk/news/health-32653971 (BBC article from 2015 looking at regulating the practice of hijama)
http://www.hijama.co.uk/1-12-medical-studies.aspx (A series of studies on hijama)
http://www.nras.org.uk/ (rheumatoid arthritis explanation)
http://www.nhs.uk/conditions/postherpetic-neuralgia/Pages/Introduction.aspx (Explanation of herpetic neuralgia)
http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7166.2010.01060.x/abstract?systemMessage=Wiley+Online+Library+will+be+disrupted+on+23+February+from+10:00-12:00+BST+(05:00-07:00+EDT)+for+essential+maintenance&userIsAuthenticated=false&deniedAccessCustomisedMessage= (Systematic review on of cuppingy trials)
http://www.bmj.com/content/321/7259/504 (BMJ article on the technique of blinding)
http://www.bmj.com/content/317/7168/1301 (BMJ article on the technique of randomisation)