Effects of Traditional Cupping Therapy in Patients With Carpal Tunnel Syndrome: A Randomized Controlled Trial

1. Effects of Traditional Cupping Therapy in Patients With CarpalTunnel Syndrome: A Randomized Controlled Trial Andreas Michalsen, Silke Bock, Rainer Ludtke, Thomas Rampp, Marcus Baecker Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany The Journal of pain, 2009

2. Carpal tunnel syndrome (CTS) is a common disorderwith an estimated prevalence of 2.7%Classic symptoms:of CTS include numbness, tingling, burning, and pain inat least 2 of the digits supplied by the median nerve(thumb, index finger, and middle finger)CTS results: from entrapment of the median nerve inthe carpal tunnel of the wrist, pathologically the consequence of non inflammatory fibrosis of the sub synovial connective tissue surrounding the flexor tendons

3. CTS is also related to: systemic factors such as metabolic and endocrine disorders, obesity, and amyloid degenerationBut:most cases of CTS have no readily identifiable cause (idiopathic CTS)Standard treatment of CTS in the past:wrist splints, oral anti-inflammatory agents, avoidanceof occupational duties, locally injected corticosteroids,and surgery

4. Standard treatments for CTS are not fully satisfactory. So, other conservative methods, including those from traditional and complementary medicine, need to be evaluated.Study:The short-term effectiveness of wet cupping of referred zones of the shoulder and compared with a control treatment in patients with symptomatic CTS.

5. Methods:This study was designed as a randomized, controlledopen trialStudy Procedures: Each participant was randomly assigned to either the wet cupping or the local thermal therapy group, and the respective treatment started. All measurements were repeated on day 7 after the allocated treatment.

6. Study Participants:Patients of both sexes were between18 and 70 years old and suffered from manifest CTS as confirmed by neurological examination and electroneurographyPatients were excluded if:they were receiving anticoagulants or had hemophilia, anemia, polyneuropathy, or a coexisting serious illness, patients who were participating in another study, or had undergone previous surgery for CTS, or had had local injections within the previous 3 months, were taking NSAIDs or analgesics with altered mean weekly dosage and type of administration during the preceding 3 months.

7. Randomization:Patients were randomly allocated to the 2 treatmentsInterventions:Cupping2 main types of cupping: dry and wet cuppingdry cupping involves skin stimulation by suctionwet cupping includes some skin scarification and cupping glassesControl Treatmentapplying heat by means of a heating pad once for 15min

10. Outcome Measures:The primary outcome measure was the change in total CTS symptom severity from day 0 to 7 (global pain, tingling, and numbness) Results: Cupping therapy was more beneficial than heat, according to the primary outcome measure, change in the total symptom score after day 7

11. The average symptom score was reduced: in the cupping group 61.5 ± 20.5 to 24.6 ±22.7 mm (day 7) in the control group 67.1 ±20.2 to 51.7 ± 23.9 mm (day 7)

14. statistical adjustment of the treatment effects for baseline outcome expectation did not affect the overall results. Thus, there was no indication that outcome was largely affected by the patients’ expectations.

15. Safety: no serious adverse events in either study group. adverse effect was a hematoma at the site of cupping glass. Scarified wounds healed without complication. None of the patients rated the cupping procedure as painful All patients in both groups perceived their study treatment as very tolerable.

16. Discussion:Wet cupping group experienced a significant decrease in pain and other symptoms. A single treatmentimproved functional ability and quality of life, and reduced associated neck pain for at least 1 week

17. considered mechanisms to explainthe observed effects:First, the cupping may have been effective due toits direct effect on the patients’ cervicothoracic lesionsWet cupping applies negative local vacuum pressure tosubcutaneous muscle and tissue, causes local bloodletting, and has lymph-flow modulating effectsIt may have altered tissue perfusion and metabolism inthe cervical and brachial plexus regions, and may havesubsequently affected median nerve function

18. Second, nociceptive activation contributes to chronicpain, and wet cupping may alleviate pain by meansof antinociceptive effects and by counter irritation At present, it is unclear to what extent cupping induces such mechanisms Third, cupping therapy may simply have a powerful placebo effect. The nonspecific and placebo effects of cupping therapy may result from the fact that it is an uncommon procedure

19. Limitation: This study is limited because it is an open trialA sham cupping procedure should be developed forfuture trialsThis study is also limited by its brief duration and Further studies are needed to assess the long-term value of cupping in the management of CTS Finally, the study is also limited by the sample size of the study population

20. In conclusion: A single course of wet cupping of the shoulder triangle overlying the trapezius muscle: appears to be effective in relieving symptoms and pain for at least 1 week in patients with manifest CTS The efficacy of this treatment and its related mechanisms should be further studied in blinded, randomized trials of longer duration using other treatments as controls.