Efficacy and safety of blood pricking and cupping for treating nonspecific low back pain: a systematic review and Meta-analysis

OBJECTIVE: To systematically evaluate the efficacy and safety of blood pricking and cupping in the treatment of nonspecific low back pain(NLBP).METHODS:The China National Knowledge Infrastructure Database(CNKI), Wanfang Med Online Database(Wanfang), China Science and Technology Journal Database(VIP), Pub Med, Web of Science,EMBase, and Cochrane Library databases were searched from inception to October 31, 2021, for randomized controlled trials(RCTs) of the treatment of NLBP by blood pricking and cupping. The quality of each included study was evaluated according to the Cochrane Systematic Assessor’s Manual evaluation criteria, while the Meta-analysis was performed using RevMan 5.4software.RESULTS: A total of 13 thirteen RCTs included a total of 1088 subjects. The visual analogue scale scores indicated that blood pricking and cupping was superior to the other treatments at relieving NLBP pain [mean difference(MD) =-1.43;95% confidence interval(CI):-2.31 to 0.54;Z = 3.15;P = 0.002). The Oswestry Disability Index score of blood pricking and cupping was superior to that of the control group in terms of improving NLBP dysfunction(MD =-6.25;95%CI:-8.37 to-4.31);Z = 5.77;P < 0.000 01). 7 RCTs mentioned no adverse reactions, while one study reported mild syncope [7%(n = 3), all in the 17-30 years group] that was gradually relieved after rest. CONCLUSIONS: Blood pricking and cupping therapy can safely and effectively reduce pain and improve functional impairment in patients with NLBP. However, this study included limited high-grade studies with a small overall sample size;therefore, further high-quality large-sample RCTs are needed to improve clinical evidence.