What Does Research Actually Say About Cupping Therapy?

"Is there any real science behind cupping, or is it all tradition?" It is one of the most common questions we hear, and it deserves a straight answer. The short version: researchers have studied cupping quite a lot, but most of the studies are small and not well designed, so the evidence is mixed and far from settled.

Below we walk through what the larger reviews have found, why researchers are careful about their conclusions, and what nobody knows yet. We are a hijama and cupping clinic, so we have a point of view. That is exactly why we want to be honest with you about the research.

How researchers look at cupping

A single study can easily be a fluke. That is why the most useful research is the systematic review, where a team gathers every trial they can find on a question, checks how well each one was done, and sometimes pools the results (a meta-analysis).

Two main kinds of cupping show up in these reviews. Dry cupping uses suction on the skin only. Wet cupping, which includes hijama, adds small, shallow cuts so that a little blood is drawn into the cup. The US National Center for Complementary and Integrative Health (NCCIH), a US government agency that studies complementary approaches, describes both and treats cupping as a complementary practice, not a replacement for regular medical care (Source 1).

What the larger reviews have found

A broad 2012 review. Researchers looked at 135 randomized trials published between 1992 and 2010, covering 56 different conditions. The most studied were shingles (herpes zoster), facial paralysis, cough and breathing problems, acne, and neck and back problems. They concluded that cupping showed "potential" for shingles and some other conditions, but they also found that the studies were "generally of low methodological quality" and called for better-designed trials (Source 2).

A 2011 review focused on pain. A second team set stricter rules and accepted only 7 trials. Some results looked favourable, but the authors said most trials were of poor quality and the evidence was too limited for firm conclusions (Source 3).

A 2016 review of wet cupping. A review that looked only at wet cupping included 14 randomized trials on conditions such as low back pain, neck pain, carpal tunnel syndrome, high blood pressure and migraine. Nine trials favoured wet cupping and five found no meaningful difference between groups. The authors described the evidence for some musculoskeletal pain conditions as "promising", but noted that the trials had methodological limitations and a variable risk of bias, and asked for better-quality studies (Source 4).

A 2023 "review of reviews" on pain. This study pulled together 14 earlier meta-analyses on conditions including neck pain, low back pain and knee osteoarthritis, and graded how much confidence we can place in the findings. Its key sentence: "no high-quality evidence was found" for cupping on pain outcomes. The evidence ranged from very low to moderate certainty, and most of the reviews it examined were themselves of low or critically low quality (Source 5).

Newer areas of interest. Researchers have also started looking beyond pain. A 2023 meta-analysis on metabolic syndrome found only 5 trials with 489 people. The authors reported some changes in measures like waist size and body weight, but found no significant change in blood pressure, blood sugar and several other markers. They noted risk of bias and asked for higher-quality, longer-term trials (Source 6). Five small trials are an early look, not an answer.

Why the evidence is still uncertain

Reading these reviews side by side, the same problems keep coming up:

Small trials. Many studies had few participants, so chance can easily sway the results.
Blinding is hard. In a drug trial, nobody knows who got the real pill. With cupping, people can tell when cups are on their back. The 2012 review found that only 4 of 135 trials even mentioned blinding (Source 2), and in the 2011 pain review no trial blinded both patients and assessors (Source 3).
"Add-on" designs. Many trials compared cupping plus usual care against usual care alone. The 2011 authors pointed out that this design cannot separate cupping itself from the general effects of extra attention and expectation (Source 3).
High risk of bias. In the 2012 review, none of the 135 trials was rated as low risk of bias (Source 2).
Mixed results. Different reviews of similar questions do not always agree, and results vary a lot from one trial to the next (Source 5).

NCCIH sums it up plainly: there has been some research on cupping, "but most of it is of low quality", and there is not enough high-quality research to draw conclusions about most conditions (Source 1).

What is not known

Some honest gaps remain:

How much of any effect is specific to cupping, and how much comes from relaxation, touch, time with a practitioner, or expectation. Without well-designed sham-controlled trials, this is hard to answer (Source 3).
Long-term effects. Most trials followed people for a short time.
Which method, how often, and for whom. Trials use very different techniques, cup placements and schedules, which makes comparisons difficult.
Safety in detail. The 2012 review found no serious adverse effects reported in its trials (Source 2), but trials are not always good at tracking side effects. NCCIH lists possible problems such as lasting skin discolouration, scars, burns and infections, and notes that repeated wet cupping has rarely been linked to anemia from blood loss (Source 1). Clean, single-use equipment matters.

How we think about this at M.K Holistic Clinic

We see cupping and hijama as a traditional, complementary practice. We do not promise outcomes, and we encourage you to keep your doctor in the loop.

A few things we do with every client:

Intake form. Everyone fills one out before a session, so we understand your health history.
Blood work. Recent blood work is not mandatory, but it is important for some conditions, such as anemia.
Before hijama. No food for 3 hours before your session. Water is fine.
After hijama. For 24 hours, no exercise and no animal products.

We are open daily from 9 a.m. to 5 p.m. at 2009 Lawrence Ave W in Etobicoke, and a 50% deposit holds your appointment.

Please talk with your doctor about any health concern before trying cupping or any other complementary practice. When you are ready, you can book at mkholisticclinic.schedulista.com or call 416-710-2033. We are happy to answer your questions.

Sources

Cupping — National Center for Complementary and Integrative Health (NCCIH), 2018
An Updated Review of the Efficacy of Cupping Therapy — Cao H, Li X, Liu J; PLOS ONE, 2012
Cupping for Treating Pain: A Systematic Review — Kim JI, Lee MS, Lee DH, Boddy K, Ernst E; Evidence-Based Complementary and Alternative Medicine, 2011
Evaluation of Wet Cupping Therapy: Systematic Review of Randomized Clinical Trials — Al Bedah AMN et al.; Journal of Alternative and Complementary Medicine, 2016
Efficacy of cupping therapy on pain outcomes: an evidence-mapping study — Wang L, Cai Z, Li X, Zhu A; Frontiers in Neurology, 2023
The efficacy and safety of cupping as complementary and alternative therapy for metabolic syndrome: A systematic review and meta-analysis — Wu LK et al.; Medicine (Baltimore), 2023