title: Cupping - is it reproducible? Experiments about factors determining the vacuum.
abstract: OBJECTIVE
  Cupping is a traditional method for treating pain which is investigated nowadays in clinical studies. Because the methods for producing the vacuum vary considerably we tested their reproducibility.
  
  
  METHODS
  In a first set of experiments (study 1) four methods for producing the vacuum (lighter flame 2 cm (LF1), lighter flame 4 cm (LF2), alcohol flame (AF) and mechanical suction with a balloon (BA)) have been compared in 50 trials each. The cupping glass was prepared with an outlet and stop-cock, the vacuum was measured with a pressure-gauge after the cup was set to a soft rubber pad. In a second series of experiments (study 2) we investigated the stability of pressures in 20 consecutive trials in two experienced cupping practitioners and ten beginners using method AF.
  
  
  RESULTS
  In study 1 all four methods yielded consistent pressures. Large differences in magnitude were, however, observed between methods (mean pressures -200±30 hPa with LF1, -310±30 hPa with LF2, -560±30 hPa with AF, and -270±16 hPa with BA). With method BA the standard deviation was reduced by a factor 2 compared to the flame methods. In study 2 beginners had considerably more difficulty obtaining a stable pressure yield than advanced cupping practitioners, showing a distinct learning curve before reaching expertise levels after about 10-20 trials.
  
  
  CONCLUSIONS
  Cupping is reproducible if the exact method is described in detail. Mechanical suction with a balloon has the best reproducibility. Beginners need at least 10-20 trials to produce stable pressures.
authors.affiliation: Center for Complementqry Medicine, Department of Environmental Health Sciences, University Hospital Freiburg, Breisacher Str. 115b, D-79106 Freiburg, Germany. roman.huber@uniklinik-freiburg.de
authors.forename: R
authors.initials: R
authors.lastname: Huber
authors.forename: M
authors.initials: M
authors.lastname: Emerich
authors.forename: M
authors.initials: M
authors.lastname: Braeunig
mesh_terms: D006801:Humans; D008519:Medicine, Traditional / Q000379:methods / Q000592:standards; D059408:Pain Management; D011312:Pressure; D015203:Reproducibility of Results; D016896:Treatment Outcome; D014618:Vacuum