The Efficacy of Dry Cupping Compared to Placebo Cupping for People With Musculoskeletal Complaints: A Systematic Review With Meta-Analysis

OBJECTIVE: To compare the effects of dry cupping and placebo cupping in adults with musculoskeletal pain, in the short- (1-week), medium- (4-weeks) and long-term (6-months). DESIGN: Intervention systematic review with meta-analysis LITERATURE SEARCH: Medline, EMBASE, CENTRAL, AMED, CINAHL, PEDro and Web of Science were searched until June 2025. STUDY SELECTION CRITERIA: Design: Randomised clinical trials; Participants: People with musculoskeletal complaints; intervention: dry cupping; control: placebo cupping; primary outcome: pain intensity. DATA SYNTHESIS: Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Pain scales were converted to a 0 to 100 scale, with a meaningful difference threshold of 15 points. Random effects meta-analyses were conducted. We judged the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS: 3330 records were screened; 5 trials (n = 281) were included. There was very-low-certainty evidence that dry cupping was trivially harmful to meaningful beneficial when compared to placebo cupping in the short-term (MD: −9.9, 95%CI: −30.5 to 10.7, 4 trials, n = 243) and long-term (MD: −2.2, 95%CI: −11.8 to 7.4, 1 trial, n = 52). There was very-low-certainty evidence that dry cupping was effective compared to placebo cupping in the medium-term; the effect may be clinically meaningful (MD: −17.2, 95%CI: −33.0 to −1.4, 1 trial). Four trials were at high overall risk of bias. CONCLUSION: The effects of dry cupping on pain was very uncertain at all timepoints. Treatment alternatives with higher certainty evidence of effectiveness should be trialled before cupping.