Cupping: Myths and Facts
I really like to write about the things that come into my clinic, and one of the things I've had a lot of questions on is cupping. If you have seen me for pain, you'll know I love to do cupping, though I generally keep the cups moving, rather than static, so the marks are never quite as dark and lasting as what mainstream media might suggest. Maybe you've also found that it can significantly relieve pain and increase movement. I love cupping, so no surprise, this one is going to be a scour of the internet to show you where cupping excels, but also what it's not.
Why is "detox" such a hype, anyways? Our body's are so smart and they have their own mechanisms throughout the lymphatic system, the liver and the kidneys that are always working to maintain our current inner environment. Cupping gets sold as a way to "detox" or remove "toxins" from the body, sometimes people will say that the darker the cupping mark, the more toxins you are releasing, to which I say bogus. When there is a mechanism that we develop that allows us to detox through suction from the skin, sign me up. Until then, I will let my liver and kidneys handle that job.
Here is what a cup will do on your body: it lowers the pressure on the skin (negative pressure- the opposite of a massage essentially), the tissue underneath lifts into it and blood flow to the area increases. The tiniest vessels can leak a little blood into the surrounding tissue (this is called ecchymosis), creating those bruise-like marks. Your body reads that as minor damage and sends in its repair response, including local immune signalling. Besides this, if you've had it, you know it just feels good.
The strongest evidence: Low back pain
A 2024 systematic review and meta-analysis pooling 11 randomised controlled trials found high to moderate quality evidence that cupping significantly improves pain and disability in low back pain management. Comparing cupping to standard care directly, the meta-analysis showed a significant effect on pain improvement compare with medication therapy and usual care, with cupping showing a superior and sustained effect on pain reduction relative to both.
Importantly with these studies, placement of the cups was very (obviously) important. The same review found that cupping produced a statistically significant pain improvement when applied on acupuncture points, but no significant improvement when applied over the lower back area generally. For acupuncturists like me, I really liked this detail.
Chronic pain more broadly
A 2025 systematic review and meta analysis looked at cupping for chronic musculoskeletal pain and found a significant reduction in pain intensity with moderate quality evidence. The same review was honest about its limits, saying that cupping showed no significant improvement for functional disability or mental health... it states clearly that pain relief is affected by the modality, but it's no surprise that this is not a 'cure-all'.
A bit murkier evidence, but still hopeful
A broader 2023 evidence-mapping review landed somewhere in the middle grounds, concluding the availably evidence ranging from very low to moderate quality, suggests that cupping is effective for managing chronic pain, knee osteoarthritis, low back pain, neck pain and, oddly enough, herpes zoster.
My personal take:
Stop using buzzwords like detox please. Cupping isn't detox, and its certainly not magic, but I have seen in my patients and felt myself the benefits from pain relief with a cupping session. The research supports cupping in its role in pain management, especially low back pain, knee OA and some chronic pain conditions, with best results often tied to specific point placement rather than a general application (i.e.: see your local acupuncturist for a session rather than depending on your mum to pop a few of those suction type cups on your back).
I know some folks dismiss cupping therapy as pseudoscience and some oversell it as some kind of a cure all for systemic issues. I will continue to use it with intention for as long as it continues to help improve symptoms for you guys coming into the clinic with pain.
Zhang Z, Pasapula M, Wang Z, Edwards K, Norrish A. The effectiveness of cupping therapy on low back pain: A systematic review and meta-analysis of randomized control trials. 2024.
Effects of cupping therapy on chronic musculoskeletal pain and collateral problems: a systematic review and meta-analysis. 2025.
Evidence Map of Cupping Therapy. 2021.
Update evidence of effectiveness on pain relieving of cupping therapy: a systematic review and Meta-analysis of randomized controlled trials.
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