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Research · Therapies

Cupping

Cupping eased chronic pain a large amount against no treatment in pooled trials, but did not differ from sham cupping in meta-analyses or in trials of back pain, knee osteoarthritis and fibromyalgia. One small trial found lower LDL cholesterol after wet cupping. Detox claims rest on theory. Burns, scarring and anemia after repeated wet cupping appear in case reports.

Checked 2026-11-13
Status
A traditional practice used in China, the Middle East and elsewhere, with suction created in glass, ceramic, bamboo or plastic cups. In wet cupping the skin is pierced and blood flows into the cup [1]. The sources located name no separate US license or FDA position for cupping.
Also called
cupping therapy, dry cupping, wet cupping, hijama, hijamah, bloodletting cupping, fire cupping, baguan, ba guan, moving cupping, myofascial decompression, cups
Used for
back pain, neck pain, chronic pain, fibromyalgia, knee osteoarthritis, muscle recovery, athletic recovery, flexibility, high blood pressure, cholesterol, inflammation, detox, removing toxins, blood cleansing, immunity, circulation

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help2

Reported risks3

What it is used for, and what was found

Shown to help2

Strong

Chronic pain, compared with no treatment or usual care

Shown to ease chronic pain by a large amount against no treatment in the short term, and neck pain and fibromyalgia pain against no intervention or usual care.

Compared with no treatment [2]; no intervention [7]; usual care [6]

The numbers and sources
Effect
Against no treatment, cupping had a large short-term effect on pain (SMD -1.03, 95% CI -1.41 to -0.65) and a medium effect on disability (SMD -0.66) [2]. For neck pain, pain fell more than with no intervention (mean difference -2.42, 95% CI -3.98 to -0.86) and function improved [7]. In fibromyalgia, pain at day 18 was 12.4 points lower than with usual care (95% CI -18.9 to -5.9) [6].
Population
1,172 people in 18 trials [2]. 18 trials of people with neck pain [7]. 141 patients with fibromyalgia [6].
Sources
[2], [7], [6]
Caveats
Without a sham, participants know they were treated. The same reviews and trials found no difference from sham cupping [2][6]. The neck pain reviewers rated the evidence low in quality [7].
LimitedStudied in men

LDL cholesterol, wet cupping

One small trial found LDL cholesterol fell after wet cupping in 47 healthy young men, with no significant change in total cholesterol, HDL or triglycerides.

Compared with no treatment [12]

The numbers and sources
Effect
Over 3 weeks after one wet cupping session, LDL cholesterol and the LDL to HDL ratio fell in the treated group against untreated controls (p < 0.0001). Triglycerides did not change, and total cholesterol (7% lower) and HDL (3% higher) did not differ significantly [12].
Population
47 healthy men aged 18 to 25 [12].
Sources
[12]
Caveats
One small trial in young men without high cholesterol, with no sham. Wet cupping removes blood, and the authors compare it with phlebotomy [12].

Mixed results3

Moderate

Chronic pain, compared with other active treatments

Mixed results: one meta-analysis found no pain difference from other active treatments, while reviews of neck and low back pain trials found cupping ahead.

Compared with other active treatments [2][7]; medication [8]; usual care [8]

The numbers and sources
Effect
Against other active treatments, chronic pain did not differ significantly (SMD -0.24, 95% CI -0.57 to 0.09), while disability was lower (SMD -0.52) [2]. In neck pain trials, pain fell more than with active controls (p = 0.0009) [7]. In low back pain trials, pain fell more than with medication (d 1.8, 8 trials) and usual care (d 1.07, 5 trials) at 2 to 8 weeks, with no difference at 1 month or 3 to 6 months [8].
Population
18 trials [2]. 18 neck pain trials [7]. 921 participants in 11 low back pain trials [8].
Sources
[2], [7], [8]
Caveats
Heterogeneity was high across the low back pain subgroups [8].
Limited

Recovery and flexibility in athletes

Limited evidence: small trials against mostly untreated controls reported less pain and more range of motion, and a sham-controlled study found no change in hamstring flexibility.

Compared with mostly untreated control groups [9]; sham cupping and no treatment [10]

The numbers and sources
Effect
Across 11 trials in athletes, cupping was reported to lower pain and disability, increase range of motion and reduce creatine kinase against mostly untreated controls [9]. In 25 adults with tight hamstrings, 10 minutes of cupping did not change flexibility compared with sham or control (p = 0.35 and 0.36) [10].
Population
498 amateur and professional athletes in 11 trials [9]. 25 healthy adults in a crossover study [10].
Sources
[9], [10]
Caveats
Most athlete trials were at unclear or high risk of bias, and none reported safety [9].
Limited

High blood pressure, wet cupping

Limited evidence: a few small trials suggested wet cupping lowered blood pressure against blood pressure drugs, and reviewers drew no firm conclusion.

Compared with antihypertensive medication [11]

The numbers and sources
Effect
In 7 randomized trials, a few small studies suggested wet cupping alone lowered blood pressure more than antihypertensive medication. The reviewers wrote that no firm conclusions can be drawn [11].
Population
Adults with hypertension in 7 trials [11].
Sources
[11]
Caveats
Most trials were not of high methodological quality [11].

Not shown to help2

Moderate

Chronic pain, compared with sham cupping

Not shown to ease chronic pain more than sham cupping, in two meta-analyses and three later trials of back pain, knee osteoarthritis and fibromyalgia.

Compared with sham cupping [2][3][4][5][6]

The numbers and sources
Effect
Against sham cupping, pain did not differ significantly (SMD -0.27, 95% CI -0.58 to 0.05) and neither did disability (SMD -0.26) [2]. In 5 trials of dry against placebo cupping, the short-term pain difference was -9.9 points on a 100-point scale (95% CI -30.5 to 10.7), very uncertain at every time point [3]. In 90 people with chronic low back pain, pain differed by 0.0 to 0.6 points on a 0 to 10 scale over 8 weeks [4]. In 62 women with knee osteoarthritis, no outcome differed from sham at any time point [5]. In 141 people with fibromyalgia, pain at day 18 differed from sham by -3.0 points (95% CI -9.9 to 3.9) [6].
Population
1,172 people with chronic pain in 18 trials [2]. 281 adults with musculoskeletal complaints in 5 trials [3]. 90 adults [4]. 62 women aged 50 to 75 [5]. 141 patients, 139 of them women [6].
Sources
[2], [3], [4], [5], [6]
Caveats
Few sham-controlled trials exist and most are small. The second meta-analysis rated certainty very low and four of its trials at high risk of bias [3].
Limited

Inflammation, wet cupping

One trial of 126 people with metabolic syndrome found wet cupping did not change high-sensitivity C-reactive protein over 12 weeks.

Compared with dietary advice alone [13]

The numbers and sources
Effect
Serum hs-CRP did not change between groups (p > 0.05) or over time when wet cupping was added to dietary advice, measured at 6 and 12 weeks [13].
Population
126 patients aged 18 to 65 with metabolic syndrome [13].
Sources
[13]
Caveats
One trial without a sham.

Claimed, not studied in people1

Untested

Detox and removing toxins

Not studied in people. A review lists a proposed blood detoxification theory for wet cupping, which no study located has tested.

No study in people. This rests on how it acts in the body, documented traditional use.

The numbers and sources
Effect
A review of 64 studies on how cupping might act lists six theories, including a blood detoxification theory proposing the release of toxins and removal of wastes and heavy metals. The authors write that further research is needed to support or refute these theories [14]. NCCIH describes cupping as a traditional practice in China and the Middle East [1].
Population
No study population. A narrative review of proposed mechanisms [14].
Sources
[14], [1]
Caveats
A proposed theory is not a measured effect. No study located measured toxins removed from the body by cupping.

Protocols studied

The fibromyalgia trial gave cupping 5 times at twice-weekly intervals on the upper and lower back [6]. The low back pain trial placed cups on both sides of the spine from L1 to L5 once a week for 8 weeks [4], and the knee trial gave 12 sessions of 15 minutes, twice a week for 6 weeks [5]. Athlete trials used 1 to 20 sessions, daily or weekly, sometimes with acupuncture [9]. The flexibility study applied cups for 10 minutes [10]. The cholesterol trial gave a single wet cupping session and measured lipids weekly for 3 weeks [12]. The inflammation trial applied wet cupping between the shoulder blades [13].

Risks

Reported risks3

ModerateHow often is not known

Marks, soreness and minor effects

Shown to cause more adverse events than no treatment in pooled trials, mostly mild and temporary, with no significant difference from sham cupping.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Adverse events were more frequent with cupping than with no treatment, and did not differ significantly from sham or other active treatments [2]. In neck pain trials, 8 of 18 trials reported adverse events, mostly mild and temporary [7]. In the fibromyalgia trial only minor side effects were seen [6]. Cupping leaves temporary marks on the skin [1].
Population
18 trials [2]. 18 neck pain trials [7]. 141 patients [6].
Sources
[2], [7], [6], [1]
Caveats
The abstracts give no rates, and many trials did not report adverse events [7].
LimitedHow often is not known

Burns, scars, infection and skin damage

Case reports: burns, blisters, lasting skin discoloration, scars and infections after cupping, and rare bleeding inside the skull after cupping on the scalp.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
NCCIH lists persistent skin discoloration, scars, burns and infections, worsening of eczema or psoriasis, and rare bleeding inside the skull after scalp cupping, and notes that shared equipment used without sterilization can spread hepatitis B and C [1]. A review of case reports from 2000 to 2011 found 10 adverse events tied to cupping [15]. Published cases include burns from cupping [16].
Population
Case reports [15][16].
Sources
[1], [15], [16]
Caveats
Case reports give no rate.
LimitedHow often is not known

Anemia after repeated wet cupping

Case reports: severe iron deficiency anemia after repeated wet cupping, needing transfusion, and in one man a heart attack with hemoglobin of 4.1 g/dL.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
A 55-year-old man who had intensified regular wet cupping for back pain presented with a heart attack and hemoglobin of 4.1 g/dL. After transfusion, hemoglobin was 14.8 g/dL within 2 months [17]. In Korea, about 30 sessions of cupping with blood loss over 2 months by an unqualified practitioner led to hospital admission and transfusion for iron deficiency anemia, with lasting skin pigmentation [18].
Population
One man [17]. One patient [18].
Sources
[17], [18], [1]
Caveats
Single cases after unusually frequent cupping. NCCIH also lists anemia from blood loss after repeated wet cupping [1].

Claims tested and not found

  1. That cupping eases chronic low back pain beyond sham. Pain differed from sham by 0.0 to 0.6 points on a 0 to 10 scale over 8 weeks in 90 adults [4].
  2. That cupping eases knee osteoarthritis pain beyond sham. No outcome differed from sham in 62 women [5].
  3. That cupping eases fibromyalgia pain beyond sham. Pain at day 18 did not differ from sham in 141 patients [6].
  4. That cupping increases flexibility. Hamstring range of motion did not change against sham or control in 25 adults [10].
  5. That wet cupping lowers inflammation. High-sensitivity C-reactive protein did not change in 126 people with metabolic syndrome [13].

Sources

  1. National Center for Complementary and Integrative Health. Cupping. 2018. https://www.nccih.nih.gov/health/cupping
  2. Cramer H, Klose P, Teut M, et al. Cupping for Patients With Chronic Pain: A Systematic Review and Meta-Analysis. The Journal of Pain. 2020. https://doi.org/10.1016/j.jpain.2020.01.002
  3. Jenkins LC, Verhagen AP, Amorim M, et al. The Efficacy of Dry Cupping Compared to Placebo Cupping for People With Musculoskeletal Complaints: A Systematic Review With Meta-Analysis. JOSPT Open. 2026. https://doi.org/10.2519/josptopen.2025.0159
  4. Almeida Silva HJ, Barbosa GM, Scattone Silva R, et al. Dry cupping therapy is not superior to sham cupping to improve clinical outcomes in people with non-specific chronic low back pain: a randomised trial. Journal of Physiotherapy. 2021. https://doi.org/10.1016/j.jphys.2021.02.013
  5. Cavalcanti RR, Almeida Silva HJ, Pontes-Silva A, et al. Dry cupping therapy has no effect on pain, function, or quality of life in women with knee osteoarthritis: Randomized placebo-controlled trial. Brazilian Journal of Physical Therapy. 2026. https://doi.org/10.1016/j.bjpt.2025.101259
  6. Lauche R, Spitzer J, Schwahn B, et al. Efficacy of cupping therapy in patients with the fibromyalgia syndrome: a randomised placebo controlled trial. Scientific Reports. 2016. https://doi.org/10.1038/srep37316
  7. Kim S, Lee SH, Kim MR, et al. Is cupping therapy effective in patients with neck pain? A systematic review and meta-analysis. BMJ Open. 2018. https://doi.org/10.1136/bmjopen-2017-021070
  8. Zhang Z, Pasapula M, Wang Z, et al. The effectiveness of cupping therapy on low back pain: A systematic review and meta-analysis of randomized control trials. Complementary Therapies in Medicine. 2024. https://doi.org/10.1016/j.ctim.2024.103013
  9. Bridgett R, Klose P, Duffield R, et al. Effects of Cupping Therapy in Amateur and Professional Athletes: Systematic Review of Randomized Controlled Trials. The Journal of Alternative and Complementary Medicine. 2018. https://doi.org/10.1089/acm.2017.0191
  10. Schafer M, Tom JC, Girouard T, et al. Cupping Therapy Does Not Influence Healthy Adult's Hamstring Range of Motion Compared to Control or Sham Conditions. International Journal of Exercise Science. 2020. https://doi.org/10.70252/mbqb8167
  11. Lu S, Du S, Fish A, et al. Wet cupping for hypertension: a systematic review and meta-analysis. Clinical and Experimental Hypertension. 2018. https://doi.org/10.1080/10641963.2018.1510939
  12. Niasari M, Kosari F, Ahmadi A. The effect of wet cupping on serum lipid concentrations of clinically healthy young men: a randomized controlled trial. The Journal of Alternative and Complementary Medicine. 2007. https://doi.org/10.1089/acm.2006.4226
  13. Farahmand SK, Gang LZ, Saghebi SA, et al. The effects of wet cupping on serum high-sensitivity C-reactive protein and heat shock protein 27 antibody titers in patients with metabolic syndrome. Complementary Therapies in Medicine. 2014. https://doi.org/10.1016/j.ctim.2014.04.004
  14. Al-Bedah AMN, Elsubai IS, Qureshi NA, et al. The medical perspective of cupping therapy: Effects and mechanisms of action. Journal of Traditional and Complementary Medicine. 2019. https://doi.org/10.1016/j.jtcme.2018.03.003
  15. Xu S, Wang L, Cooper E, et al. Adverse events of acupuncture: a systematic review of case reports. Evidence-Based Complementary and Alternative Medicine. 2013. https://doi.org/10.1155/2013/581203
  16. Kose AA, Karabağli Y, Cetin C. An unusual cause of burns due to cupping: complication of a folk medicine remedy. Burns. 2006. https://doi.org/10.1016/j.burns.2005.05.006
  17. Jang AY, Suh SY. Extreme venous letting and cupping resulting in life-threatening anemia and acute myocardial infarction: A case report. World Journal of Clinical Cases. 2020. https://doi.org/10.12998/wjcc.v8.i24.6432
  18. Kim KH, Kim TH, Hwangbo M, et al. Anaemia and skin pigmentation after excessive cupping therapy by an unqualified therapist in Korea: a case report. Acupuncture in Medicine. 2012. https://doi.org/10.1136/acupmed-2012-010185

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