Wet Cupping for Neck Pain – A Preliminary Review

Background: Neck pain is a widespread global issue, impacting approximately 200 million people and contributing significantly to disability and economic burden. Conventional treatments, including pharmacological agents and surgery, present limitations such as side effects, dependency, and potential complications. Wet cupping, an ancient therapeutic practice, involves inducing superficial bleeding and the application of negative pressure. Given its historical prominence and persistent use, this study aimed to analyse its effectiveness and methodological approaches for managing neck pain. Methods: A search for Randomized Controlled Trials (RCTs) on wet cupping for neck pain was conducted across PubMed, EuropePMC, and SciELO up to June 2025.

Results: Out of 23 initial records, 21 unique studies remained after de-duplication. After screening, 17 were excluded, leaving 4 full texts for eligibility assessment. Ultimately, one RCT involving 44 participants met the inclusion criteria and was included in the analysis. This open, randomized, controlled, parallel-group clinical trial compared a three-staged wet cupping treatment over two weeks against 12 sessions of Transcutaneous Electrical Nerve Stimulation (TENS) for pain management in cervical spondylosis patients. Both groups showed improvement in pain (VAS scores) and disability (NDI scores) within their respective groups. However, the wet cupping group demonstrated statistically significant superior benefits over TENS in reducing both pain (VAS: p=0.01) and, more notably, disability (NDI: p=0.01). While both improved most aspects of cervical range of motion (CROM) within groups, there was no significant difference between therapies in overall CROM improvement. Other studies also support cupping's benefits for pain and quality of life, with proposed mechanisms including localized anaerobic metabolism/reperfusion, mu opioid receptor expression, and increased HSP70 and ß-endorphin expression. Cupping generally exhibits few adverse effects. Conclusion: The existing evidence suggests that wet cupping holds potential as a valuable, less invasive complementary option for managing neck pain, demonstrating superior effects on pain and disability compared to TENS. However, further robust, standardized, and long-term randomized controlled trials are imperative to validate its efficacy across diverse patient populations and facilitate its broader integration into mainstream clinical practice.