Effect of cupping therapy on chronic neck pain: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Chronic neck pain is a prevalent source of disability worldwide, and existing reviews report limited certainty due to heterogeneous methodologies and outdated trials. Objective: To update and strengthen the evidence on the effectiveness and safety of cupping therapy for chronic neck pain by incorporating recent high-quality randomized controlled trials (RCTs). Methods: In accordance with PRISMA 2020 and PROSPERO registration (CRD42025633104), major databases were searched through January 2025 for RCTs comparing various cupping modalities to control interventions in adults with chronic neck pain (≥3 months). Primary outcomes were pain intensity (Visual Analogue Scale, VAS/ Numeric Rating Scale, NRS) and functional disability (NDI); secondary outcomes included quality of life, range of motion, and adverse events. Results: Nine RCTs involving 401 participants met inclusion criteria. Meta-analysis revealed that cupping significantly reduced pain intensity (Cohen's d = 1.17; 95% CI 0.26–2.09; p = 0.002) and produced consistent functional improvements (Cohen's d = 0.77; 95% CI 0.63–0.91; p < 0.001; I2 = 0%). Secondary outcomes favored cupping, with enhanced quality of life and range of motion. No serious adverse events were reported. Conclusion: Cupping therapy provides consistent, clinically meaningful improvements in functional disability and significant pain relief for adults with chronic neck pain, within an overall evidence base that is stronger for function than for pain and is tempered by methodological limitations in several included trials. This updated synthesis elevates the evidence base, supporting cupping as a function-enhancing adjunct in multidisciplinary management and guiding its integration into clinical practice.