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The effectiveness of wet-cupping for nonspecific low back pain in Iran: a randomized controlled trial
Farhadi K, Schwebel DC, Saeb M, Choubsaz M, Mohammadi R, Ahmadi A
Complementary Therapies in Medicine 2009 Jan;17(1):9-15
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVES: To determine the efficacy of wet-cupping for treating persistent nonspecific low back pain. BACKGROUND: Wet-cupping therapy is one of the oldest known medical techniques. It is still used in several contemporary societies. Very minimal empirical study has been conducted on its efficacy. DESIGN: Randomized controlled trial with two parallel groups. Patients in the experimental group were offered the option of referral to the wet-cupping service; all accepted that option. The control group received usual care. SETTING: Medical clinic in Kermanshah, Iran. PARTICIPANTS: In total, 98 patients aged 17 to 68 years with nonspecific low back pain; 48 were randomly assigned to experimental group and 50 to the control group. INTERVENTION: Patients in the experimental group were prescribed a series of three staged wet-cupping treatments, placed at 3 days intervals (ie, 0, 3, and 6 days). Patients in the control group received usual care from their general practitioner. MAIN OUTCOME MEASURES: Three outcomes assessed at baseline and again 3 months following intervention: the McGill Present Pain Index, Oswestry Pain Disability Index, and the Medication Quantification Scale. RESULTS: Wet-cupping care was associated with clinically significant improvement at 3-month follow-up. The experimental group who received wet-cupping care had significantly lower levels of pain intensity (95% confidence interval (CI) 1.72 to 2.60, mean difference 2.17, p < 0.01), pain-related disability (95% CI 11.18 to 18.82, mean difference 14.99, p < 0.01), and medication use (95% CI 3.60 to 9.50, mean difference 6.55, p < 0.01) than the control group. The differences in all three measures were maintained after controlling for age, gender, and duration of lower back pain in regression models (p < 0.01). CONCLUSIONS: Traditional wet-cupping care delivered in a primary care setting was safe and acceptable to patients with nonspecific low back pain. Wet-cupping care was significantly more effective in reducing bodily pain than usual care at 3-month follow-up.

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