Efficacy and safety of blood pricking and cupping for treating nonspecific low back pain: a systematic review and Meta-analysis

doi:10.19852/j.cnki.jtcm.20220922.003

Abstract

Abstract:

OBJECTIVE: To systematically evaluate the efficacy and safety of blood pricking and cupping in the treatment of nonspecific low back pain (NLBP).

METHODS: The China National Knowledge Infrastructure Database (CNKI), Wanfang Med Online Database (Wanfang), China Science and Technology Journal Database (VIP), PubMed, Web of Science, EMBase, and Cochrane Library databases were searched from inception to October 31, 2021, for randomized controlled trials (RCTs) of the treatment of NLBP by blood pricking and cupping. The quality of each included study was evaluated according to the Cochrane Systematic Assessor’s Manual evaluation criteria, while the Meta-analysis was performed using RevMan 5.4 software.

RESULTS: A total of 13 thirteen RCTs included a total of 1088 subjects. The visual analogue scale scores indicated that blood pricking and cupping was superior to the other treatments at relieving NLBP pain [mean difference (MD) = –1.43; 95% confidence interval (CI): –2.31 to 0.54; Z = 3.15; P = 0.002). The Oswestry Disability Index score of blood pricking and cupping was superior to that of the control group in terms of improving NLBP dysfunction (MD = –6.25; 95%CI: –8.37 to –4.31); Z = 5.77; P < 0.000 01). 7 RCTs mentioned no adverse reactions, while one study reported mild syncope [7% (n = 3), all in the 17-30 years group] that was gradually relieved after rest.

CONCLUSIONS: Blood pricking and cupping therapy can safely and effectively reduce pain and improve functional impairment in patients with NLBP. However, this study included limited high-grade studies with a small overall sample size; therefore, further high-quality large-sample RCTs are needed to improve clinical evidence.

Key words: low back pain, blood pricking, cupping therapy, Meta-analysis, systematic review, randomized controlled trial

XIE Chaoju, SUN Zhangyin, JI Changchun, YANG Jinsheng. Efficacy and safety of blood pricking and cupping for treating nonspecific low back pain: a systematic review and Meta-analysis[J]. Journal of Traditional Chinese Medicine, 2022, 42(6): 869-876.

Figures/Tables 6

References 30

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Study	Randomization method	Sample size (TG/CG)	Intervention		Treatment	Outcome indicators	Adverse reactions
Study	Randomization method	Sample size (TG/CG)	Treatment group	Control group	Treatment	Outcome indicators	Adverse reactions
Wang Y et al 2020⁹	Random characters	40/40	Blood pricking/cupping	NSAIDs	3 w	①②	Not mentioned
Li ZQ et al 2020¹⁰	Envelope	35/35	Blood pricking/cupping + Long’s method	Long’s method	2 w	①	Not mentioned
Chen JX et al 2020¹¹	Random characters	48/48	Blood pricking/cupping + McKenzie method	McKenzie method	5 times	①②	Not mentioned
Huang GH, 2018¹²	Random number table	30/30	Blood pricking/cupping + acupuncture	Acupuncture	4 times (2 w)	①②	None
Cui LJ et al 2015¹³	Order of consultation	40/40	Blood pricking/cupping	NSAIDs	4 times	①	Not mentioned
Li JY et al 2009²⁰	Random Characters	30/30	Blood pricking/cupping	NSAIDs	3 times	①②	Not mentioned
Pan L et al 2016¹⁴	Random number table	30/30	Blood pricking/cupping	Medicine cupping^a	6 times	①②	None
Liu Y et al 2021¹⁵	Random characters	31/31	Blood pricking/cupping + acupuncture	Acupuncture	5 times	①②	Not mentioned
Farhadi K et al 2009¹⁶	Envelope	48/50	Blood pricking/cupping	Routine care	3 times	②	None
Kim JI et al 2011⁵	Envelope	21/11	Blood pricking/cupping + routine care	Routine care	6 times (2 w)	②③	None
AlBedah A et al 2015¹⁷	Envelope	40/40	Blood pricking/cupping + NSAIDs	NSAIDs	6 times (2 w)	②③	None
Al-Eidi SM et al 2019¹⁸	Envelope	34/36	Blood pricking/cupping	Traditional cupping	2 w	②③	None
Mardani KM et al 2018¹⁹	Computer block	90/90	Blood pricking/cupping	Routine care	4 w	①②	None

Study	Randomization method	Sample size (TG/CG)	Intervention		Treatment	Outcome indicators	Adverse reactions
Study	Randomization method	Sample size (TG/CG)	Treatment group	Control group	Treatment	Outcome indicators	Adverse reactions
Wang Y et al 2020⁹	Random characters	40/40	Blood pricking/cupping	NSAIDs	3 w	①②	Not mentioned
Li ZQ et al 2020¹⁰	Envelope	35/35	Blood pricking/cupping + Long’s method	Long’s method	2 w	①	Not mentioned
Chen JX et al 2020¹¹	Random characters	48/48	Blood pricking/cupping + McKenzie method	McKenzie method	5 times	①②	Not mentioned
Huang GH, 2018¹²	Random number table	30/30	Blood pricking/cupping + acupuncture	Acupuncture	4 times (2 w)	①②	None
Cui LJ et al 2015¹³	Order of consultation	40/40	Blood pricking/cupping	NSAIDs	4 times	①	Not mentioned
Li JY et al 2009²⁰	Random Characters	30/30	Blood pricking/cupping	NSAIDs	3 times	①②	Not mentioned
Pan L et al 2016¹⁴	Random number table	30/30	Blood pricking/cupping	Medicine cupping^a	6 times	①②	None
Liu Y et al 2021¹⁵	Random characters	31/31	Blood pricking/cupping + acupuncture	Acupuncture	5 times	①②	Not mentioned
Farhadi K et al 2009¹⁶	Envelope	48/50	Blood pricking/cupping	Routine care	3 times	②	None
Kim JI et al 2011⁵	Envelope	21/11	Blood pricking/cupping + routine care	Routine care	6 times (2 w)	②③	None
AlBedah A et al 2015¹⁷	Envelope	40/40	Blood pricking/cupping + NSAIDs	NSAIDs	6 times (2 w)	②③	None
Al-Eidi SM et al 2019¹⁸	Envelope	34/36	Blood pricking/cupping	Traditional cupping	2 w	②③	None
Mardani KM et al 2018¹⁹	Computer block	90/90	Blood pricking/cupping	Routine care	4 w	①②	None

Outcome indicator	Studies using (n)	Heterogeneity tests		Effects model	Meta-analysis results
Outcome indicator	Studies using (n)	P value	I² value (% )	Effects model	MD (95% CI)	P value
Visual analogue scale	9	<0.000 01	95	Random	-1.43 (-2.31 to -0.54)	0.002
Average age by group, years
30-39	2	0.24	28	Random	-1.32 (-1.93 to -0.72)	< 0.0001
40-49	6	<0.000 01	96	Random	-1.08 (-2.28 to 0.12)	0.08
50-60	1	-	-	Random	-3.26 (-3.9 to -2.59)	< 0.000 01
Oswestry Disability Index	11	<0.000 01	84	Random	-6.25 (-8.37 to -4.31)	< 0.000 01
Average disease duration, months
1-3	2	0.47	0	Random	-4.77 (-9.55 to -4.28)	< 0.0001
≥3	8	<0.000 01	87	Random	-6.43 (-8.59 to -4.28)	< 0.000 01
Control group
Manual therapy	1	-	-	Random	-9.13 (-10.10 to -8.16)	< 0.000 01
Needlepoint	2	0.28	16	Random	-5.66 (-7.46 to -3.85)	< 0.000 01
NSAIDs	3	0.001	86	Random	-8.57 (-13.28 to -3.86)	0.0004
Routine care	3	0.05	66	Random	-7.40 (-17.35 to 2.55)	0.14
Medicine cupping	1	-	-	Random	1.00 (-3.66 to 5.66)	0.67
Traditional cupping	1	-	-	Random	-1.34 (-7.40 to 4.72)	0.66

Outcome indicator	Studies using (n)	Heterogeneity tests		Effects model	Meta-analysis results
Outcome indicator	Studies using (n)	P value	I² value (% )	Effects model	MD (95% CI)	P value
Visual analogue scale	9	<0.000 01	95	Random	-1.43 (-2.31 to -0.54)	0.002
Average age by group, years
30-39	2	0.24	28	Random	-1.32 (-1.93 to -0.72)	< 0.0001
40-49	6	<0.000 01	96	Random	-1.08 (-2.28 to 0.12)	0.08
50-60	1	-	-	Random	-3.26 (-3.9 to -2.59)	< 0.000 01
Oswestry Disability Index	11	<0.000 01	84	Random	-6.25 (-8.37 to -4.31)	< 0.000 01
Average disease duration, months
1-3	2	0.47	0	Random	-4.77 (-9.55 to -4.28)	< 0.0001
≥3	8	<0.000 01	87	Random	-6.43 (-8.59 to -4.28)	< 0.000 01
Control group
Manual therapy	1	-	-	Random	-9.13 (-10.10 to -8.16)	< 0.000 01
Needlepoint	2	0.28	16	Random	-5.66 (-7.46 to -3.85)	< 0.000 01
NSAIDs	3	0.001	86	Random	-8.57 (-13.28 to -3.86)	0.0004
Routine care	3	0.05	66	Random	-7.40 (-17.35 to 2.55)	0.14
Medicine cupping	1	-	-	Random	1.00 (-3.66 to 5.66)	0.67
Traditional cupping	1	-	-	Random	-1.34 (-7.40 to 4.72)	0.66

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