*4.4.2 Hot cupping or Moxa cupping*

*Hot cupping or Moxa cupping* is cupping combined with heat and a herb called Moxa [28]. Moxa is made up of dried Mugwort leaves. During the cupping process, the therapist will initially warm a needle with Moxa and applies a cup over it. A thin aluminum layer is used as a barrier before putting the hot Moxa to prevent skin burns [22].

#### *4.4.3 Herbal cupping*

*Herbal cupping* is also known as medicinal cupping. In this type, the therapist will boil a herbal solution for about 30 minutes and then bamboo cups will be soaked in the solution for five minutes before applying the cups to the skin [29]. To avoid skin burns, the cups will be left for one minute to cool down before applying them to the treated area [22].

*Magnetic cupping* is done by using magnetic cupping sets which have magnets inside. It is commonly used to treat joint-related diseases affecting big joints such as

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*The Role of Cupping Therapy in Pain Management: A Literature Review*

knees and elbows. It is presumed that the electromagnetic stimulation enhances the

*Laser cupping* is a new cupping device which is used in combination with cupping therapy. An acupuncture laser probe is inserted inside the cups in order to stimulate specific acupuncture points as an additive effect to the cupping. The advantage of this method is that it provides the 'double effect' of both cupping

*Electric stimulation cupping* uses transcutaneous electrical nerve stimulation (TENS) with cupping. It has also a dual effect like laser cupping therapy as both electric and cupping stimulate the treated area. It is mainly used for the stimulation

*Water cupping* is done with cups containing warm water. The therapist will fill a third of a cup with warm water and then a burning cotton wool will be inserted into

*Aquatic cupping* is a combination of cupping therapy with aquatic therapy where

the cupping is performed underwater since it is presumed that muscles can be stretched more underwater [32]. It is commonly used for rehabilitation, and muscu-

Low back pain (LBP) is a common clinical problem which has an estimated one-year prevalence of 38% in the general population [33]. The current management options include bed rest during the acute phase, analgesia, physiotherapy, traction, alternative treatments, and health education on prevention of future episodes [34]. Cupping therapy has been used for a long time for both acute and chronic low back pain. Studies have shown significant reduction in pain intensity scores and improvement in functional outcome tools with cupping compared to other modalities of treatment like usual care or medications [34, 35]. Wang *et al* conducted a meta-analysis of six randomized controlled trials (RCTs). The total number of participants was 458 (230 received cupping *versus* 228 who received usual care). Five RCTs included patients with non-specific low back pain and a single RCT included post-partum women with low back pain. Different types of cupping were used in these trials (3 dry cupping, 2 wet cupping, 1 moving cupping). Pain was measured by different tools (1 visual analogue scale (VAS), 2 VAS + Oswestry pain disability index (ODI), 2 the McGill pain index (MPPI) + ODI, 1 VAS + MPPI). The meta-analysis concluded that cupping therapy was more effective compared to other modalities on reducing the VAS scores, and ODI scores. However, this positive effect was not captured on the MPPI.

*DOI: http://dx.doi.org/10.5772/intechopen.93851*

therapeutic effectiveness of cupping [30].

therapy and laser acupuncture [31].

of specific points and in cases of muscular pain [30].

the cup prior to placing the cup over the skin [11].

**5. Common clinical indications for cupping therapy**

*4.4.5 Electric stimulation cupping*

*4.4.4 Laser cupping*

*4.4.6 Water cupping*

*4.4.7 Aquatic cupping*

loskeletal problems [32].

**5.1 Low back pain**

knees and elbows. It is presumed that the electromagnetic stimulation enhances the therapeutic effectiveness of cupping [30].
