**4.2 Power of suction**

This category of cupping is classified according to the negative pressure level created inside the cups. The pressure levels used are light, medium, strong or pulsatile pressure [22].

#### *4.2.1 Light cupping pressure*

*Light cupping pressure* is defined as a pressure level between 100 and less than 300 millibar (mb). The therapist generates weak suctions in the cup using one to two full manual pump suctions [2, 25]. It is mainly used for children, elderly patients, and for sensitive body parts like the face. Light cupping pressure can be used in conjunction with massage, dry, and flash cupping techniques. Its main

**221**

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

advantage that it leaves most patients with no cupping marks. However, because of

*Images representing the four technical types of cupping; (a) dry cupping, (b) flash cupping, (c) wet cupping,* 

*Medium cupping pressure* is used for common purpose cupping [25]. The pressure

*Strong cupping pressure* involves using a pressure level of above 500 mb [2]. It is usually generated by 5 or more full manual pump suctions. It is not recommended for children and elderly people. It can cause inflammation, dermatitis, skin burns,

*Pulsatile cupping* is when variable pulses of pressure are used. It is created by a mechanical device. One pulse is generated every 2 seconds. Therapists might use flexible silicone and plastic cups. The generated pressure level is usually between 100 and 200 mb. Its use has been limited to symptomatic pain relief in patients with

The classification here is based on the method used to create the negative pressure

level used is between 300 and less than 500 mb. It is created by 3–4 full manual pump suctions. Unlike light cupping, medium cupping can leave cupping marks over the body parts. It is not recommended for use over sensitive body areas such as

the light pressure, the cup tends to fall during the therapy session [22].

*4.2.2 Medium cupping pressure*

*4.2.3 Strong cupping pressure*

the face [22].

**Figure 1.**

*(d) massage cuppin.*

and pain [22].

*4.2.4 Pulsatile cupping*

knee osteoarthritis [26].

**4.3 Methods of suction**

inside the cups. These are as follows:

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

*The Role of Cupping Therapy in Pain Management: A Literature Review DOI: http://dx.doi.org/10.5772/intechopen.93851*

#### **Figure 1.**

*Pain Management - Practices, Novel Therapies and Bioactives*

pressure leads to protrusion of the skin [22].

This category of cupping is classified according to the cupping technique which is used. It includes four types; dry cupping, flash cupping, wet cupping and massage

*Dry cupping* is also known as static cupping or retained cupping [24]. In dry cupping, negative pressure is generated inside the cups by different ways of suction like fire, manual pump or electrical suction. The cups are usually kept on the skin for up to 15 minutes [22]. When a manual pump is used, the pressure inside the cup is controlled by the number of suctions. As the number increases, the negative pressure inside the cup will increase [2]. Similarly, when fire is used, prolongation of fire exposure will increase the negative pressure inside the cup. This negative

*Flash cupping* is also known as empty cupping [24]. It involves performing quick suctions of medium to light pressure over the targeted area. The cup is applied for a very short time of less than 30 seconds to stimulate the area. It can be done by using only one cup or four medium-sized cups. This method can be used in situations where dry cupping is not recommended. For example, in young people and females [22].

*Wet cupping* is also known as full cupping, bloodletting cupping, and bleeding cupping. It is commonly used in traditional medicine [24]. It involves scraping of the skin by a surgical instrument before applying the cups to suck the blood. The main side-effects of this method include higher risk of infection, vasovagal attacks,

*Massage cupping* is also known as moving cupping, dynamic cupping, and gliding cupping [2]. It is performed by applying oil over the skin and moving the cups over the treated area by using weak suction. Different types of oils are used such as olive oil, peppermint oil, and lavender oil. This type of cupping can be used for both young and elderly people [22]. **Figure 1** contains images of the four technical types.

This category of cupping is classified according to the negative pressure level created inside the cups. The pressure levels used are light, medium, strong or

*Light cupping pressure* is defined as a pressure level between 100 and less than 300 millibar (mb). The therapist generates weak suctions in the cup using one to two full manual pump suctions [2, 25]. It is mainly used for children, elderly patients, and for sensitive body parts like the face. Light cupping pressure can be used in conjunction with massage, dry, and flash cupping techniques. Its main

**4.1 Technical types**

cupping [22].

*4.1.1 Dry cupping*

*4.1.2 Flash cupping*

*4.1.3 Wet cupping*

and scars development [22].

*4.1.4 Massage cupping*

**4.2 Power of suction**

pulsatile pressure [22].

*4.2.1 Light cupping pressure*

**220**

*Images representing the four technical types of cupping; (a) dry cupping, (b) flash cupping, (c) wet cupping, (d) massage cuppin.*

advantage that it leaves most patients with no cupping marks. However, because of the light pressure, the cup tends to fall during the therapy session [22].

#### *4.2.2 Medium cupping pressure*

*Medium cupping pressure* is used for common purpose cupping [25]. The pressure level used is between 300 and less than 500 mb. It is created by 3–4 full manual pump suctions. Unlike light cupping, medium cupping can leave cupping marks over the body parts. It is not recommended for use over sensitive body areas such as the face [22].

#### *4.2.3 Strong cupping pressure*

*Strong cupping pressure* involves using a pressure level of above 500 mb [2]. It is usually generated by 5 or more full manual pump suctions. It is not recommended for children and elderly people. It can cause inflammation, dermatitis, skin burns, and pain [22].

#### *4.2.4 Pulsatile cupping*

*Pulsatile cupping* is when variable pulses of pressure are used. It is created by a mechanical device. One pulse is generated every 2 seconds. Therapists might use flexible silicone and plastic cups. The generated pressure level is usually between 100 and 200 mb. Its use has been limited to symptomatic pain relief in patients with knee osteoarthritis [26].

#### **4.3 Methods of suction**

The classification here is based on the method used to create the negative pressure inside the cups. These are as follows:
