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

[Dolphin]

Free full text:
https://www.sciencedirect.com/science/article/pii/S1744388119308746

Complementary Therapies in Clinical Practice
Available online 20 June 2020, 101210


The effectiveness of cupping therapy on chronic fatigue syndrome: A single-blind randomized controlled trial
MengXiu-dong1GuoHao-ran1ZhangQing-ying1LiXinChenYongLiMu-yangZhuoXue-maoWangMei-juanShanKaiGongYi-nanLiNing-cenChenboChenZe-linGuoYi
https://doi.org/10.1016/j.ctcp.2020.101210

Highlights


•
In this study, cupping in clinical trials using instruments for rated pressure for the first time.

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We found cupping therapy can improve fatigue, emotion and sleep on chronic fatigue syndrome patients.

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The effective of cupping therapy is related to the session of cupping, though no relationship has been found with pressure.

Abstract
Background
and purpose: We investigated the effectiveness of cupping therapy with three different pressures in patients with chronic fatigue syndrome (CFS).

Materials and methods
The participants were randomly assigned to three groups, as follows: cupping pressure of −0.02 mpa (n = 38), −0.03 mpa (n = 38), or −0.05 mpa (n = 36). Each group received cupping treatment that consisted of 10 sessions over 5 weeks (2 sessions per week). The primary outcomes were Fatigue Scale (FS-14) score and Fatigue Assessment Instrument (FAI) score after 5 and 10 sessions. The secondary outcomes were the Self-Rating Anxiety Scale (SAS) score, the Self-Rating Depression Scale (SDS) score, and the Pittsburgh Sleep Quality Index (PSQI) score.

Results
There were 91 participants who completed the trial. After five sessions of treatment, the primary outcome of FS-14 score decreased by 3.20 (2.19, 4.21) in the −0.02 mpa group, by 2.39 (1.51, 3.27) in the −0.03 mpa group, and by 3.40 (2.28, 4.52) in the −0.05 mpa group (P = 0.667). After 10 sessions of treatment, the outcome of FS-14 score decreased by 5.00 (3.79, 6.21) in the −0.02 mpa group, by 4.06 (3.07, 5.05) in the −0.03 mpa group, and by 4.77 (3.52, 5.94) in the −0.05 mpa group (P = 0.929). And, the results were statistically different between 5 sessions and 10 sessions of treatment (P < 0.01). However, there were no statistical differences in FAI, SAS, SDS, and PSQI scores between the three groups after 5 sessions and 10 sessions of treatment.

Conclusions
In conclusion, cupping therapy has significantly relieved fatigue symptoms and improved emotion and sleep condition of CFS patients, and 10 sessions of treatment had superior results compared with 5 sessions in each group. Moreover, in 5 sessions of treatment, cupping with high pressure showed better improvement in fatigue syndromes and sleep condition according to effective rates.

Trial registration
Chinese clinical trial registry (ChiCTR1800017590); Ethical approval number: ChiECRCT-20180085.

Keywords
Chronic fatigue syndrome
Cupping therapy
Regularity of effect

 

[Arnie Pye]

Nothing would induce me to try this treatment for any reason whatsoever.

 

[Trish]

Ouch.

 

[rvallee]

Evidence-based medicine is a clown car wreck. I'm finding harder and harder every day to think it does not deserve to be cancelled entirely and the entire evidence base produced by this process reevaluated entirely, assumed to be misleading.

Enough. Be serious or be gone.

 

[NelliePledge]

 

[alex3619]

Nothing would induce me to try this treatment for any reason whatsoever.

This is an extreme version, and does not have to look like this. I tried all the TCM in the 80s, to no avail, though Chinese herbs did decrease my pain levels a bit. However a slight improvement in symptoms is no reason to use a therapy that has its own potential risks.

"Evidence based" is deeply misunderstood by most doctors. I wonder how many can actually cite the evidence for a treatment that convinced them a given treatment works? Some can. Many cannot I suspect. Most seem to go straight back to argument from authority, which is in opposition to evidence based, and cite something like a Cochrane review said so. The evidence is not cited.

 

[DokaGirl]

91 desperate people, willing to try pretty much anything. ME, the disease itself, and the terrible stigma around it, causes this desperation to try almost anything.

These look like burns. Infection? Good heavens!

 

[Arnie Pye]

This is an extreme version, and does not have to look like this.

The problem with weird treatments like cupping is that people in Western medicine have no experience of using it and I'm guessing the requirements (in terms of training) for offering this as a treatment are probably non-existent or very low, unlike being a doctor. The person whose back is showing in the picture had cupping done daily. I wouldn't have known this but it is obviously too often. I'm not sure if the person's problems were caused by burning or infection or complete breakdown of the skin or some other issue.

I know that cupping doesn't have to look like the picture I posted but to my eyes the pictures of it "being done right" were hideous as well.

 

[Hutan]

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.

Usually, CFS patients have many concomitant symptoms such as bad mood and poor sleep.

• "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

The participants were recruited through the WeChat application (Tencent co., LTD, China) and posters. The recruitment location was the outpatient department of Acupuncture and Moxibustion of Baokang Hospital affiliated with the Tianjin University of TCM in Tianjin. Recruitment posters were placed in the outpatient departments of the hospital, and online recruitment was facilitated via web links. Interested patients were pre-screened by post-graduate students for inclusion.

Exclusion criteria included:

those patients who are unable to evaluate the efficacy of, understand the significance of, or tolerate the treatment measures of the study.

A total of 295 patients were screened for eligibility, and 183 were excluded for not meeting the inclusion criteria (n = 132), refusing to participate after being informed about the trial (n = 28), taking other drugs (n = 6), unwilling to accept cupping treatment (n = 8), not suitable for cupping (n = 6), or receiving acupuncture treatment (n = 3). Altogether 112 patients were randomized and allocated to groups

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:

​

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.

 

[Trish]

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.

 

[lunarainbows]

Why do we still get studies like this?
Or do other illnesses also suffer from these kinds of studies (I don’t know, I haven’t looked)?

 

[Graham]

Sorry to disagree folks, but I find cupping a very effective way of helping my ME. Cupping a large mug of steaming, freshly filtered coffee in my hands in the morning certainly improves my mood, and a hot mug of Earl Grey at lunchtime does wonders for my system. As for a cup of warm milk at night to ease the sleep – what could be better? Agreed this isn't a blinded test (although my cataracts are making me appreciate such things more), but we are talking of a 100% agreement in subjective assessment, based on preselected subjects already in favour of the treatments.

Would you like a couple of graphs, without labels or scales, to convince you of its scientific accuracy?

I hasten to point out that the author of this analysis has no financial interest in anything whatsoever.