Cupping therapy versus acupuncture for pain-related conditions: a systematic review of randomized controlled trials and
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Chinese Medicine Open Access
REVIEW
Cupping therapy versus acupuncture for pain‑related conditions: a systematic review of randomized controlled trials and trial sequential analysis Ya‑Jing Zhang1†, Hui‑Juan Cao1†, Xin‑Lin Li1, Xiao‑Ying Yang1, Bao‑Yong Lai1, Guo‑Yang Yang3 and Jian‑Ping Liu1,2*
Abstract Background: Both cupping therapy and acupuncture have been used in China for a long time, and their target indi‑ cations are pain-related conditions. There is no systematic review comparing the effectiveness of these two therapies. Objectives: To compare the beneficial effectiveness and safety between cupping therapy and acupuncture for painrelated conditions to provide evidence for clinical practice. Methods: Protocol of this review was registered in PROSPERO (CRD42016050986). We conducted literature search from six electronic databases until 31st March 2017. We included randomized trials comparing cupping therapy with acupuncture on pain-related conditions. Methodological quality of the included studies was evaluated by risk of bias tool. Mean difference, risk ratio, risk difference and their 95% confidence interval were used to report the estimate effect of the pooled results through meta-analysis or the results from each individual study. Trial sequential analysis (TSA) was applied to adjust random errors and calculate the sample size. Results: Twenty-three randomized trials with 2845 participants were included covering 12 pain-related conditions. All included studies were of poor methodological quality. Three meta-analyses were conducted, which showed similar clinical beneficial effects of cupping therapy and acupuncture for the rate of symptom improvement in cervi‑ cal spondylosis (RR 1.13, 95% CI 1.01 to 1.26; n = 646), lateral femoral cutaneous neuritis (RR 1.10, 95% CI 1.00 to 1.22; n = 102) and scapulohumeral periarthritis (RR 1.31, 95% CI 1.15 to 1.51; n = 208). Results from other outcomes (such as visual analogue and numerical rating scale) in each study also showed no statistical significant difference between these two therapies for all included pain-related conditions. The results of TSA for cervical spondylosis demonstrated that the current available data have not reached a powerful conclusion. No serious adverse events related to cupping therapy or acupuncture was found in included studies. Conclusion: Cupping therapy and acupuncture are potentially safe, and they have similar effectiveness in reliev‑ ing pain. However, further rigorous studies investigating relevant pain-related conditions are warranted to establish comparative effectiveness analysis between these two therapies. Cost-effectiveness studies should be considered in the future studies to establish evidence for decision-making in clinical practice. Keywords: Acupuncture, Cupping therapy, Randomized controlled trial, Systematic review, Trial sequential analysis
*Correspondence: [email protected]; [email protected] † Ya-Jing Zhang and Hui-Juan Cao contributed equally to this work 1 Centre for Evidence‑Based Chinese Medici
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