title: The effectiveness of wet-cupping for nonspecific low back pain in Iran: a randomized controlled trial.
abstract: OBJECTIVE
  To determine the efficacy of wet-cupping for treating persistent nonspecific low back pain.
  
  
  BACKGROUND
  Wet-cupping therapy is one of the oldest known medical techniques. It is still used in several contemporary societies. Very minimal empirical study has been conducted on its efficacy.
  
  
  METHODS
  Randomized controlled trial with two parallel groups. Patients in the experimental group were offered the option of referral to the wet-cupping service; all accepted that option. The control group received usual care.
  
  
  METHODS
  Medical clinic in Kermanshah, Iran.
  
  
  METHODS
  In total, 98 patients aged 17-68 years with nonspecific low back pain; 48 were randomly assigned to experimental group and 50 to the control group.
  
  
  METHODS
  Patients in the experimental group were prescribed a series of three staged wet-cupping treatments, placed at 3 days intervals (i.e., 0, 3, and 6 days). Patients in the control group received usual care from their general practitioner.
  
  
  METHODS
  Three outcomes assessed at baseline and again 3 months following intervention: the McGill Present Pain Index, Oswestry Pain Disability Index, and the Medication Quantification Scale.
  
  
  RESULTS
  Wet-cupping care was associated with clinically significant improvement at 3-month follow-up. The experimental group who received wet-cupping care had significantly lower levels of pain intensity ([95% confidence interval (CI) 1.72-2.60] mean difference=2.17, p<0.01), pain-related disability (95% CI=11.18-18.82, means difference=14.99, p<0.01), and medication use (95% CI=3.60-9.50, mean difference=6.55, p<0.01) than the control group. The differences in all three measures were maintained after controlling for age, gender, and duration of lower back pain in regression models (p<0.01).
  
  
  CONCLUSIONS
  Traditional wet-cupping care delivered in a primary care setting was safe and acceptable to patients with nonspecific low back pain. Wet-cupping care was significantly more effective in reducing bodily pain than usual care at 3-month follow-up.
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Management, Pain research center, Kermanshah University of Medical Sciences, Iran.
authors.forename: Khosro
authors.initials: K
authors.lastname: Farhadi
authors.forename: David C
authors.initials: DC
authors.lastname: Schwebel
authors.forename: Morteza
authors.initials: M
authors.lastname: Saeb
authors.forename: Mansour
authors.initials: M
authors.lastname: Choubsaz
authors.forename: Reza
authors.initials: R
authors.lastname: Mohammadi
authors.forename: Alireza
authors.initials: A
authors.lastname: Ahmadi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001815:Bloodletting; D005260:Female; D006801:Humans; D007492:Iran; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D020393:Manipulation, Spinal; D008875:Middle Aged; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D012015:Reference Standards; D012146:Rest; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents