The effectiveness of cupping therapy on chronic fatigue syndrome: A single-blind randomized controlled trial, 2020, Xiu-dong et al

Ouch.

 

So, regardless of pressure, the treatment resulted in improvements on subjective measures. So, the conclusion is that the process of cupping results in an improvement in health outcomes reported in a questionnaire. For that conclusion, the trial was not blinded - participants knew that they were receiving cupping treatment. Unblinded +subjective outcome.... Predictable result.

Other points:

• Investigator bias - the study was done by the Tianjin University of Traditional Chinese Medicine in the outpatient department of Acupuncture and Moxibustion of Baokang Hospital affiliated with university - a lot of careers and infrastructure invested in finding cupping is a useful treatment

• "Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), is a complicated disorder characterized by extreme fatigue that cannot be explained by any underlying medical condition." This wording is repeated a number of times, sometimes with the phrase no 'organic medical condition'. Perhaps it's a mistake, but the inference is that there isn't actually any disease. So perhaps a placebo is fine.

• "Traditional Chinese medicine (TCM) including acupuncture and massage are also recommended in the clinical manual developed by the International Association of Chronic Fatigue Syndrome (IACFS)". Not sure if that is correct, as in recommended as likely to improve symptoms. But, if so, then IACFS need to review their recommendations.

• Selection bias

Exclusion criteria included:

It's the same issue as with the Lightning Process and other woo treatments - only the people who really believe in the treatment are given the treatment.​

• Criteria - looks like Fukuda - PEM is not necessary.

• No control - we don't know how many of the same population might have improved over the 10 weeks. If the participants were most suffering from post-viral fatigue or fatigue from a non-ME/CFS illness and were only 3 or so months into their illness and given the young ages of participants (18 to 34), then the underlying improvement rate might have been significant.

• Dropouts - there were 36 to 38 allocated to each treatment, and between 6 and 8 dropouts per group. 'Inconvenient time' was the most common reason, also some non-compliance.

• Follow-up - I've charted the reported fatigue before, during and after the treatment:

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So, it's pretty clear that the participants' evaluation of fatigue was not improved in a sustainable way. The followup didn't involve all of the participants; it can be expected that the ones who made themselves available for follow-up might have tended to include those who improved. Given that there was probably an underlying trend to improvement over time in patients with no treatment (given the vagueness of ME/CFS diagnosis and the relative youth of the participants), perhaps we can't rule out a mean worsening if all the people treated had been followed up.

Sadly, there is no discussion of the follow-up results in the paper. My interpretation would be that the cupping resulted in brief improvement in reported fatigue but no real improvement. Proponents of cupping might say that ongoing treatment is needed for a treatment effect. If that is so, the question is 'why did the participants not move heaven and earth to continue to get cupping treatment if the improvement was so marked?'.

It's frustrating to see all the detailed analysis and claims of efficacy made in the paper. There's so much effort and money being wasted by people with ME/CFS on treatments that don't help. Trials have to be better than this.

 

Thanks for all that effort, @Hutan. So the conclusion is much the same as for CBT/GET then - transient improvement on subjective measures. What a surprise! Not.