PULSATILE CUPPING FOR OA KNEE JOINTS. Pulsatile dry cupping in patients with osteoarthritis of the knee – a randomized controlled exploratory trial

PULSATILE CUPPING FOR OA KNEE JOINTS.
Pulsatile dry cupping in patients with osteoarthritis of the knee – a randomized controlled exploratory trial

 Michael Teut*, Stefan Kaiser, Miriam Ortiz, Stephanie Roll, Sylvia Binting, Stefan N Willich and Benno Brinkhaus
Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Luisenstr. 57, 10437, Berlin, Germany
Abstract

Introduction

Cupping is used in various traditional medicine forms to relieve pain in musculoskeletal diseases. The aim of this study was to investigate the effectiveness of cupping in relieving the symptoms of knee osteoarthritis (OA).

Methods

In a two-group, randomized controlled exploratory pilot study patients with a clinically and radiological confirmed knee OA (Kellgren-Lawrence Grading Scale: 2-4) and a pain intensity>40mm on a 100mm visual analogue scale (VAS) were included. 40 Patients were randomized to either 8 sessions of pulsatile dry cupping within 4weeks or no intervention (control). Paracetamol was allowed on demand for both groups. Outcomes were the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, the pain intensity on a VAS (0mm=no pain to 100mm=maximum intensity) and Quality of Life (SF-36) 4 and 12weeks after randomization. Use of Paracetamol was documented within the 4-week treatment period. Analyses were performed by analysis of covariance adjusting for the baseline value for each outcome.

Results

21 patients were allocated to the cupping group (5 male; mean age 68±SD 7.2) and 19 to the control group (8 male; 69±6.8). After 4weeks the WOMAC global score improved significantly more in the cupping group with a mean of 27.7 (95% confidence interval 22.1; 33.3) compared to 42.2 (36.3; 48.1) in the control group (p=0.001). After 12weeks the WOMAC global score were still significantly different in favor for cupping (31.0 (24.9; 37.2) vs. 40.8 (34.4; 47.3) p=0.032), however the WOMAC subscores for pain and stiffness were not significant anymore. Significantly better outcomes in the cupping group were also observed for pain intensity on VAS and for the SF-36 Physical Component Scale compared to the control group after 4 and 12weeks. No significant difference was observed for the SF-36 Mental Component Scale and the total number of consumed Paracetamol tablets between both groups (mean 9.1, SD ± 20.0 vs. 11.5 ± 15.9).

Conclusion

In this exploratory study dry cupping with a pulsatile cupping device relieved symptoms of knee OA compared to no intervention. Further studies comparing cupping with active treatments are needed

Clinical Research Evidence of Cupping Therapy in China: A Systematic Literature Review

Huijuan Cao, Mei Han , Xun Li , Shangjuan Dong , Yongmei Shang , Qian Wang , Shu Xu  and Jianping Liu 

BMC Complementary and Alternative Medicine 2010, 10:70doi:10.1186/1472-6882-10-70

Published:	16 November 2010

Abstract

Background

Though cupping therapy has been used in China for thousands of years, there has been no systematic summary of clinical research on it. This review is to evaluate the therapeutic effect of cupping therapy using evidence-based approach based on all available clinical studies.

Methods

We included all clinical studies on cupping therapy for all kinds of diseases. We searched six electronic databases, all searches ended in December 2008. We extracted data on the type of cupping and type of diseases treated.

Results

550 clinical studies were identified published between 1959 and 2008, including 73 randomized controlled trials (RCTs), 22 clinical controlled trials, 373 case series, and 82 case reports. Number of RCTs obviously increased during past decades, but the quality of the RCTs was generally poor according to the risk of bias of the Cochrane standard for important outcome within each trials.
The diseases in which cupping was commonly employed included pain conditions, herpes zoster, cough or asthma, etc. Wet cupping was used in majority studies, followed by retained cupping, moving cupping, medicinal cupping, etc. 38 studies used combination of two types of cupping therapies. No serious adverse effects were reported in the studies.

Conclusions

According to the above results, quality and quantity of RCTs on cupping therapy appears to be improved during the past 50 years in China, and majority of studies show potential benefit on pain conditions, herpes zoster and other diseases.
However, further rigorous designed trials in relevant conditions are warranted to support their use in practice.
Source: BMC Complementary and Alternative Medicine 2010, 10:70 (open access)

Lessons from a Cellist

By Marion Bergan Irwin, M. Ac

A 50 year old man in otherwise excellent health presented with level 8 out of 10 pain in this left arm. He complained that the left bicep muscle felt like it was in a vice grip and that there was numbness and pain shooting down the arm to the fingers. The pain had started one year ago on an overseas flight after having slept in an awkward position on the plane. He awoke with pain in the left arm that was so excruciating that he was unable to attend his business functions.

Upon his return to the States he saw a Neurologist who performed an MRI and neurological testing that indicated he had a C5-6 “Nerve burner” or “Stinger”, a compression of the upper portion of the left brachial plexus. He was given Valium and Celebrex that helped temporarily. After five months he started to work out at the gym but found that sit-ups were causing the left arm pain to return with greater intensity this time. He was also experiencing difficulty sleeping, as the pain would wake him several times during the night. In addition to being a lawyer for a national non-profit organization, he was a cellist for a major metropolitan orchestra. The pain and numbness affecting his left arm and hand were severely limiting his ability to play. He had to cancel concerts, and limit his teaching schedule with his cello students.

He returned to the Doctor and received cortisone injections with no positive result. Physical Therapy was tried along with Mobic to relieve any inflammation causing pain, as well as Lyrica at night to help him sleep. He found no relief with the Physical Therapy and limited relief from the medications. He was looking for alternative treatment when a neighbor suggested he try acupuncture.

My examination of the patient’s left neck, shoulders and back revealed extreme tightness in these areas.  I performed acupuncture with electric stimulation along with the Japanese style moxibustion called Okyu, which is the burning of sesame seed size threads of moxa wool on a thin layer Shuinko applied directly to the skin. These therapies promote circulation of the energy, which when stagnant cause pain. On the second office visit the patient reported that he felt a little “different”. The pain was less intense and he felt a bit light headed. The squeeze on the bicep was not as tight, and the numbness down his arm was less severe but still significantly there.

I sensed the patient’s desperation and was concerned my usual approach would not achieve results rapidly enough. As I considered alternatives, I recalled a recent conversation I had with a Medical Resident who was trained as an Osteopathic Doctor and was entering a Physiatry subspecialty training program. As part of her Residency, she was working with a physician who had done some training in Oriental Medicine. He maintained a 7,000 patient case load and had used cupping successfully with most all of them. He resolved their complaints in just a few sessions and they only returned when they had a new complaint. This was challenging her training which involved drugs and complicated procedures. This was so simple, it caused her to question everything. Since we were friends she called me to discuss what she was seeing. I naturally asked a lot of questions about what he was doing, how he did it, and his results. Up to this point in my career as an acupuncturist, I had not used cupping therapy very often. Having had some time to mull this conversation over, and considering the urgency with which this medication dependent Cellist wanted relief, I decided to give wet cupping a try.

I prepared the patient for what I was about to do, and selected the areas to lance, then applied nine suction cups to the upper and middle portion of the upper trapezius, and the medial portion of the lower trapezius. The skin beneath the cups turned red and then purple under some of the cups with the blood being dark, indicating significant stagnation. Cups were applied for about 30 minutes. The next week the patient reported he was feeling better. There was not a lot of pain, the thumb was still numb, the shocks going down his arm less severe, squeezing around the biceps still there but not as severe, and that he no longer needed narcotics because his pain was 60% less than when he presented at his initial office visit. I applied cups again without lancing and he reported at the next office visit a further reduction of the shocks shooting down his arm, and the tightness in his bicep. The trapezius muscle had loosened significantly with the exception of an area around Gall Bladder 21 and Triple Warmer 15. At this point I resumed using needles and electric stimulation as my primary modality of treatment.

This case revolutionized my practice. I saw dramatic results with this modality and began to incorporate it into my treatments on a regular basis. People enjoy the feeling and appreciate the freedom it brings to their lives. After 10 years of practice I am still amazed at the new things I am learning.

Effective Natural Treatment for Rheumatoid Arthritis

Rheumatoid arthritis is an inflammatory disease without a known cause, which affects usually more than one joint and may lead to severe deformity and disability. Rheumatoid arthritis is three times more common in females than males, and its prevalence is about 1-2% in United Sates of America. It usually occurs after the age of 40 and before the age of 60. But it may also affect any age.

Rheumatoid arthritis symptoms

Symptoms of rheumatoid arthritis are variable. Joints are symmetrically inflamed and painful. Swelling and stiffness of affected joints are present. Stiffness in the morning which lasts more than half an hour is usually present. General symptoms of fever, malaise, loss of weight and pain are also present. Rheumatoid arthritis may affect other body parts. It may affect the skin, lungs, lymph nodes, spleen, heart, blood and blood vessels. Rheumatoid arthritis is a serious disease. It leads to severe disability and tends to shorten life.

Rheumatoid arthritis treatment

The goals of the treatment are aimed to reduce pain and inflammation, and to prevent deformities. In the beginning of the treatment, explaining the disease is a very important and supportive part of the treatment plan. Rest is indicated in inflammatory periods to decrease inflammation. Exercises are performed to preserve motion of affected joints according to a special program for each patient. Heat therapy has a great role in decreasing pain and inflammation. Natural supplements with A-3 fatty acids may be helpful.

Cupping therapy
Cupping therapy is a type of alternative and complementary medicine. It is one of the corner stones of Chinese medicine. Cupping therapy reduces pain and increases blood circulation. It also eliminates body toxins and inflammatory substances. Cupping therapy is a very effective natural treatment for rheumatoid arthritis. Cupping therapy reduces pain and inflammation of the affected joints. In the Egyptian Journal of Immunology (2005), researchers state that "Blood-letting cupping combined with conventional medicinal therapy has several advantages. It exerts marked improvement on the clinical condition of patients especially visual analogue scale of pain, it significantly reduces the laboratory markers of RA (rheumatoid arthritis) activity and it modulates the immune cellular conditions."(1). In another trial submitted in partial fulfillment for M.D degree in Mansoura University, researchers state that "Cupping therapy is a good treatment for pain in rheumatoid arthritis" and "Cupping therapy is useful in many diseases including arthritis"(2). Finally you need to find a qualified and licensed acupuncturist or cupping therapist to do cupping therapy.

References:

1-Sahbaa M.Ahmed, Soheir S.Maklad, Nour H.Madbouly, and Eman A.Abu-Shady. Immunomodulatory Effects of Blood Letting Cupping Therapy in Patients with Rheumatoid Arthritis. Egyptian journal of Immunology 12(2), 39-51. 2005.(http://www.ncbi.nlm.nih.gov/pubmed/...)

2-Ashraf Hussein Hassan, Farag Mohammed Farag, Mohammed Elmahdy H.Sarhan, Mohammed Yakout Abdel Aziz, and Mohammed Ahmed Abo Elela. Evaluation of cupping therapy in some chronic diseases (Rheumatoid Arthritis, Type 2 DM and chronic HCV infection). Thesis Submitted in partial fulfillment for M.D Degree of Internal Medicine. Faculty of Medicine, Mansoura University page 253. 2006.

3-Rheumatoid Arthritis and Complementary and Alternative Medicine (http://nccam.nih.gov/health/RA/#safe)

4-Rheumatoid Arthritis (MedlinePlus)(http://www.nlm.nih.gov/medlineplus/...)

Cupping Therapy for infertility

 by Dr Tamer Shaban

The definition of infertile couple is the inability to conceive after one year of regular sexual relationship without any use of contraceptive methods. (1) The prevalence among couples is about 10% to 20%. (2) The causes of infertility is divided into male and female causes. Female factors contribute 40% of all factors, and ovaries diseases plus unexplained female causes contribute 45% of all female factors. (1)
Complementary medicine is widely used between Americans and Europeans. There are about 64% of united states schools of medicine and colleges reported offering courses of complementary medicine or include these subjects into their required courses.(3)
Cupping therapy is one of the ancient types of complementary and alternative medicine. Cupping therapy has been used in the treatment of broad range of diseases. (4) Cupping is also effective as needles in stimulating acupuncture points. (5) It can be used instead of needles.
Cupping therapy has many benefits for an infertile female as it induces a feeling of physical and psychological well being (4), regulates female hormones, improves ovaries functions, increases uterine blood flow, increases the thickness of uterine lining and improves implantation. (8)
Various studies found that acupuncture can affect levels of female hormones and can regulate them. (6) In 1999 Ji et al conducted a trial to examine the efficacy of acupuncture against medical treatment on 98 women. The results indicate significant pregnancy rate 69% v 40% in the acupuncture group. (9)
Another trial conducted by Yang et al in 2005 in the field of using acupuncture in the induction of ovulation for hormonal infertility. 240 women involved in this trial and divided into two groups, the treatment group who received acupuncture treatment and control group who received medical treatment. The final results indicated pregnancy rate is significantly greater in acupuncture group (65%) than in medical treatment group (45%). (10)
In 1997 Ma et al conducted trial on 111 women suffered from hypo ovarinism (weak ovarian functions) divided into two groups, the first group received body acupuncture plus cupping therapy, the other group received medical treatment. The result was amazing, it was 76.4% in test group received acupuncture plus cupping than 47.3% in medical treatment group. (11)
References
1- Sandra L. Torrente, Valerian Montgomery Rice. An Overview of Female Infertility. Reproductive Endocrinology and Infertility. Landers Biosciences. Chapter 13 - P 145. 2007.
2-SpringHouse. Female Infertility: Causes and incidence. Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
3. Wetzel MS, Eisenberg DM, and Kaptchuk TJ. Courses involving complementary and alternative medicine at US medical scools. JAMA 280(9), 784-787. 2-9-1998.
4. Kaleem Ullah and Ahmed Younis. An investigation into the effect of Cupping Therapy as a treatment for Anterior Knee Pain and its potential role in Health Promotion. TheInternet Journal of Alternative Medicine. 4(1). 2007
5. Tham LM, Lee HP, and Lu C. Cupping: From a biomechanical perspective. J Biomech 39(12). 2005.
6- Mark Bovey. Female Infertility the evidence for the effectiveness of Acupuncture. Acupuncture Research Resource Centre. British Acupuncture Council. P 6. November 2006.
7- Chang R, Chung PH, Rosenwaks Z. Role of acupuncture in the treatment of female Infertility. Infertility and sterility. 85: P 1347-1351. 2002.
8-Hennawy M . Cupping therapy and Infertility. Available at: http://www.obgyn.net/english/pubs/features/presentations/hennawy15/280,1 Cupping Therapy and Infertility. Accessed December 2004.
9-Ji P, Ma RH, Wang ZX, Liu SH (1999) Acupuncture treatment of infertility due to irregular menstruation and influence of acupuncture on hypo-thalamus-pituitary-ovary axis International Journal of Clinical Acupuncture 10(4):343-7
10-Yang JR, Ma YY, Liu YL, Wang HL, Liu Z (2005). Controlled study on acupuncture for
treatment of endocrine dysfunctional infertility. Zhongguo Zhen Jiu 25:299-300
11-Ma RH et al. [Clinical observation of acupuncture treatment in polycystic ovary syndrome.] Chinese Acupuncture and Moxibustion, 1996, 16(11):602–623 [in Chinese].