Cupping Therapy for Chronic Neck Pain

Chronic neck pain affects more than 200 million people worldwide and is one of the leading causes of long-term disability. Although exercise, manual therapy, and medications remain standard treatments, many patients continue to experience persistent pain or are unable to tolerate long-term use of analgesics. As a result, complementary therapies such as cupping are increasingly being considered as part of multidisciplinary rehabilitation.

This systematic review and meta-analysis examined nine randomized controlled trials involving 401 adults with chronic neck pain. The review evaluated several forms of cupping therapy, including dry cupping, wet cupping, moving cupping, cupping massage, fire cupping, and pneumatic vacuum cupping. Comparators included usual care, exercise, physiotherapy, transcutaneous electrical nerve stimulation (TENS), progressive muscle relaxation, sham cupping, and no treatment.

Main findings

The strongest evidence was for improvements in functional disability. Across seven randomized trials, cupping consistently reduced disability measured by the Neck Disability Index, with little variation between studies. The evidence for this outcome was rated as high certainty, suggesting therapists can be reasonably confident that cupping improves patients’ ability to perform daily activities.

Cupping also reduced pain intensity, with all included studies reporting some degree of pain relief. However, the magnitude of benefit varied substantially between studies because of differences in cupping techniques, treatment frequency, comparator interventions, and study quality. Consequently, the certainty of evidence for pain reduction was rated low, indicating that future high-quality trials may modify current estimates of effectiveness.

Several studies also reported secondary benefits, including:

• improved cervical range of motion,
• increased pressure pain thresholds,
• improvements in aspects of quality of life, particularly mental well-being and vitality,
• reduced pain during movement.

Safety

Cupping therapy demonstrated a favourable safety profile. Reported adverse events were generally mild and transient, consisting mainly of bruising, erythema, or temporary discomfort at the treatment site. No serious adverse events were reported across the included trials.

Clinical implications for therapists

The findings suggest that cupping should not be viewed as a stand-alone treatment or cure for chronic neck pain. Instead, it appears to be most valuable as an adjunct therapy within a comprehensive rehabilitation programme.

By reducing pain and improving movement tolerance, cupping may help patients engage more effectively in active rehabilitation, including:

• therapeutic exercise,
• strengthening programmes,
• movement retraining,
• manual therapy,
• patient education.

This aligns with modern rehabilitation principles that emphasize restoring function rather than relying solely on passive pain relief.

Limitations

Several limitations should be considered when interpreting the evidence:

• Many studies were relatively small.
• Blinding was difficult because participants could usually tell whether cupping had been performed.
• Treatment protocols differed considerably in technique, duration, and frequency.
• Most studies evaluated only short-term outcomes.
• Some evidence of publication bias was detected for pain outcomes.