title: Evaluation of Wet Cupping Therapy: Systematic Review of Randomized Clinical Trials.
abstract: BACKGROUND
  Wet cupping is a widely used traditional therapy in many countries, which justifies a continuous scientific evaluation of its efficacy and safety.
  
  
  OBJECTIVE
  To perform a systematic review to critically evaluate and update the available evidence of wet cupping in traditional and complementary medicine.
  
  
  METHODS
  Ten electronic databases were searched from their inceptions to February 2016. Included studies were randomized clinical trials (RCTs) that evaluated wet cupping against any type of control interventions in patients with any clinical condition, as well as healthy individuals. Cochrane risk of bias tool was used to appraise the included RCTs.
  
  
  RESULTS
  Fourteen RCTs met the eligibility criteria. The included studies evaluated the following clinical conditions: nonspecific low back pain (NSLBP), hypertension, brachialgia, carpal tunnel syndrome (CTS), chronic neck pain, metabolic syndrome, migraine headaches, oxygen saturation in smokers with chronic obstructive pulmonary disease (COPD), and oral and genital ulcers due to Behçet disease. Two RCTs evaluated physiologic and biochemical parameters of healthy individuals. Overall, 9 RCTs favored wet cupping over various control interventions in NSLBP (n = 2), hypertension (n = 1), brachialgia (n = 1), CTS (n = 1), chronic neck pain (n = 2), oxygen saturation in smokers with COPD (n = 1), and oral and genital ulcers due to Behçet disease (n = 1). Five RCTs showed no statistically significant between-group differences: NSLBP (n = 1), metabolic syndrome (n = 1), migraine headaches (n = 1), and physiologic and biochemical parameters of healthy individuals (n = 2). Included RCTs had a variable risk of bias across all domains and suffered methodologic limitations.
  
  
  CONCLUSIONS
  There is a promising evidence in favor of the use of wet cupping for musculoskeletal pain, specifically NSLBP, neck pain, CTS, and brachialgia. Better-quality trials are needed to generate solid evidence and firmly inform policy makers.
authors.affiliation: 1 National Center for Complementary and Alternative Medicine , Ministry of Health, Riyadh, Saudi Arabia .
authors.forename: Abdullah M N
authors.initials: AM
authors.lastname: Al Bedah
authors.affiliation: 1 National Center for Complementary and Alternative Medicine , Ministry of Health, Riyadh, Saudi Arabia .
authors.forename: Mohamed K M
authors.initials: MK
authors.lastname: Khalil
authors.affiliation: 2 Lee Kong Chian School of Medicine, Imperial College, and Nanyang Technological University , Singapore, Singapore .
authors.forename: Paul
authors.initials: P
authors.lastname: Posadzki
authors.affiliation: 1 National Center for Complementary and Alternative Medicine , Ministry of Health, Riyadh, Saudi Arabia .
authors.forename: Imen
authors.initials: I
authors.lastname: Sohaibani
authors.affiliation: 1 National Center for Complementary and Alternative Medicine , Ministry of Health, Riyadh, Saudi Arabia .
authors.forename: Tamer Shaaban
authors.initials: TS
authors.lastname: Aboushanab
authors.affiliation: 1 National Center for Complementary and Alternative Medicine , Ministry of Health, Riyadh, Saudi Arabia .
authors.forename: Meshari
authors.initials: M
authors.lastname: AlQaed
authors.affiliation: 1 National Center for Complementary and Alternative Medicine , Ministry of Health, Riyadh, Saudi Arabia .
authors.forename: Gazzaffi I M
authors.initials: GI
authors.lastname: Ali
mesh_terms: D000328:Adult; D001815:Bloodletting; D006801:Humans; D008297:Male; D008519:Medicine, Traditional; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic
keywords: clinical trial; cupping; evaluation; systematic review; wet cupping