Interventions used in control group against cupping therapy for chronic nonspecific low back pain: A systematic review and network meta-analysis

Introduction: The evidence for the effect of cupping therapy on chronic nonspecific low back pain (CLBP) remains controversial, and existing researches didn’t consider outcomes influenced by factor of selection of interventions in control group. This review and network meta-analysis is to compare th...

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Main Authors: Junyan Li, Yuanyuan Jia, Tingting Sun, Zhenmin Bai, Xiaosheng Dong, Xiao Hou
Format: Article
Language:English
Published: Elsevier 2025-06-01
Series:Complementary Therapies in Medicine
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Online Access:http://www.sciencedirect.com/science/article/pii/S0965229925000421
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author Junyan Li
Yuanyuan Jia
Tingting Sun
Zhenmin Bai
Xiaosheng Dong
Xiao Hou
author_facet Junyan Li
Yuanyuan Jia
Tingting Sun
Zhenmin Bai
Xiaosheng Dong
Xiao Hou
author_sort Junyan Li
collection DOAJ
description Introduction: The evidence for the effect of cupping therapy on chronic nonspecific low back pain (CLBP) remains controversial, and existing researches didn’t consider outcomes influenced by factor of selection of interventions in control group. This review and network meta-analysis is to compare the effects of diverse interventions in cupping therapy control groups for CLBP, with the objective of identifying the suitable control intervention against cupping therapy for CLBP. Methods: Studies were identified by a comprehensive search of databases, such as PubMed, Embase, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI), up to June, 2024. A total of 10 randomized control trials (RCT) were included in this network meta-analysis (NMA). Results: The results showed that compared with cupping therapy, minimum negative pressure cupping therapy (MNPCT) (SMD = − 0.01; 95 %CI: − 0.92 to 0.89), air circulating cupping therapy (ACCT) (SMD = − 0.05; 95 %CI: − 0.63 to 0.54) and diclofenac (SMD = − 0.13; 95 %CI: − 1.13 to − 0.87) was no significantly different from improvement of pain intensity. But there was significant difference between cupping therapy and D-ibuprofen (SMD = − 1.11; 95 %CI: − 2.08 to − 0.13), paracetamol (SMD = − 1.12; 95 %CI: − 1.80 to − 0.43) or usual care (SMD = − 1.18; 95 %CI: − 2.56 to − 1.06). The order of intervention effect by SUCRA diagram was as follows: cupping therapy (77.7 %) > MNPCT (75.2 %) > ACCT (73.8 %) > diclofenac (68.8 %) > D-ibuprofen (26.3 %) > paracetamol (24.5 %) > usual care (3.8 %). The quality of evidence for network estimates was moderate to very low due to the risk of bias and imprecision. Conclusions: The results of this study suggest that usual care was the least effective in alleviating the pain intensity of CLBP, which might serve as the most appropriate intervention in the control group in cupping-related RCTs. MNPCT and ACCT have similar effects with cupping therapy for CLBP. Future research may be based on some objective clinical outcomes and control interventions with physiological inertia to isolate the true effect of cupping therapy or SCT from psychological biases. Trial registration: The protocol was registered on the international prospective register of systematic reviews (http://www.crd.york.ac.uk/PROSPERO), registration number: CRD42024527513.
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spelling doaj-art-10b3ebe18b684011b6f6d7d6ea55bf952025-08-20T02:09:56ZengElsevierComplementary Therapies in Medicine0965-22992025-06-019010316710.1016/j.ctim.2025.103167Interventions used in control group against cupping therapy for chronic nonspecific low back pain: A systematic review and network meta-analysisJunyan Li0Yuanyuan Jia1Tingting Sun2Zhenmin Bai3Xiaosheng Dong4Xiao Hou5Key Laboratory of Sports and Physical Health Ministry of Education, Beijing Sport University, Beijing, China; School of Sport Science, Beijing Sport University, Beijing, ChinaKey Laboratory of Sports and Physical Health Ministry of Education, Beijing Sport University, Beijing, China; School of Sport Science, Beijing Sport University, Beijing, ChinaKey Laboratory of Sports and Physical Health Ministry of Education, Beijing Sport University, Beijing, ChinaSchool of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, ChinaDepartment of Social Medicine and Health Management, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; National Health Commission of China Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China; Center for Health Management and Policy Research, Shandong University (Shandong Provincial Key New Think Tank), Jinan, China; Institute of Health and Elderly Care, Shandong University, Jinan, China; Correspondence to: Shandong University, No. 44, Wenhua West Road, Lixia District, Jinan, China.Dapartment of Physical Education, Peking University; Correspondence to: Peking University, No. 5, Yiheyuan Road, Haidian District, Beijing, China.Introduction: The evidence for the effect of cupping therapy on chronic nonspecific low back pain (CLBP) remains controversial, and existing researches didn’t consider outcomes influenced by factor of selection of interventions in control group. This review and network meta-analysis is to compare the effects of diverse interventions in cupping therapy control groups for CLBP, with the objective of identifying the suitable control intervention against cupping therapy for CLBP. Methods: Studies were identified by a comprehensive search of databases, such as PubMed, Embase, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI), up to June, 2024. A total of 10 randomized control trials (RCT) were included in this network meta-analysis (NMA). Results: The results showed that compared with cupping therapy, minimum negative pressure cupping therapy (MNPCT) (SMD = − 0.01; 95 %CI: − 0.92 to 0.89), air circulating cupping therapy (ACCT) (SMD = − 0.05; 95 %CI: − 0.63 to 0.54) and diclofenac (SMD = − 0.13; 95 %CI: − 1.13 to − 0.87) was no significantly different from improvement of pain intensity. But there was significant difference between cupping therapy and D-ibuprofen (SMD = − 1.11; 95 %CI: − 2.08 to − 0.13), paracetamol (SMD = − 1.12; 95 %CI: − 1.80 to − 0.43) or usual care (SMD = − 1.18; 95 %CI: − 2.56 to − 1.06). The order of intervention effect by SUCRA diagram was as follows: cupping therapy (77.7 %) > MNPCT (75.2 %) > ACCT (73.8 %) > diclofenac (68.8 %) > D-ibuprofen (26.3 %) > paracetamol (24.5 %) > usual care (3.8 %). The quality of evidence for network estimates was moderate to very low due to the risk of bias and imprecision. Conclusions: The results of this study suggest that usual care was the least effective in alleviating the pain intensity of CLBP, which might serve as the most appropriate intervention in the control group in cupping-related RCTs. MNPCT and ACCT have similar effects with cupping therapy for CLBP. Future research may be based on some objective clinical outcomes and control interventions with physiological inertia to isolate the true effect of cupping therapy or SCT from psychological biases. Trial registration: The protocol was registered on the international prospective register of systematic reviews (http://www.crd.york.ac.uk/PROSPERO), registration number: CRD42024527513.http://www.sciencedirect.com/science/article/pii/S0965229925000421Chronic nonspecific low back painCupping therapyComplementary and alternative medicineNetwork meta-analysis
spellingShingle Junyan Li
Yuanyuan Jia
Tingting Sun
Zhenmin Bai
Xiaosheng Dong
Xiao Hou
Interventions used in control group against cupping therapy for chronic nonspecific low back pain: A systematic review and network meta-analysis
Complementary Therapies in Medicine
Chronic nonspecific low back pain
Cupping therapy
Complementary and alternative medicine
Network meta-analysis
title Interventions used in control group against cupping therapy for chronic nonspecific low back pain: A systematic review and network meta-analysis
title_full Interventions used in control group against cupping therapy for chronic nonspecific low back pain: A systematic review and network meta-analysis
title_fullStr Interventions used in control group against cupping therapy for chronic nonspecific low back pain: A systematic review and network meta-analysis
title_full_unstemmed Interventions used in control group against cupping therapy for chronic nonspecific low back pain: A systematic review and network meta-analysis
title_short Interventions used in control group against cupping therapy for chronic nonspecific low back pain: A systematic review and network meta-analysis
title_sort interventions used in control group against cupping therapy for chronic nonspecific low back pain a systematic review and network meta analysis
topic Chronic nonspecific low back pain
Cupping therapy
Complementary and alternative medicine
Network meta-analysis
url http://www.sciencedirect.com/science/article/pii/S0965229925000421
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