JOURNAL REVIEW Cupping Therapy as Alternative Treatment for Patients with Low Back Pain: Literature Review Author : M. Fikky Hafidz Kalamulloh 1. Introduction Cupping therapy is an ancient technique of healing. Cupping therapy was a popular historical treatment in Arabic and Islamic countries. It was recommended by Arabic and Islamic physicians. In addition, cupping is still used also in industrialized countries and its costs is covered by national health insurance e.g. in South Korea an China (Kim, 2013). Cupping is performed by applying cups to selected skin points and creating a subatmospheric pressure, either by heat or by suction. There are many types of cuping including dry cupping, wet cupping, cupping with retention, moving cupping, shaking cupping, quick cupping and balance cupping. Cupping is based on a sucking traction of the skin and hypoderm: a cupping glass is applied to a predefined skin area and a negative pressure (compared to atmospheric pressure) is generated mechanically (pumping) or thermally (cooling heated air) withdrawing the trapped air from under the cup (Metha, 2015). There is growing evidence that cupping might be effective in improving various pain conditions such as low back pain paraesthetica carpal tunnel syndrome, chronic neck pain and osteoarthritis of the knee. (Teut et.al, 2018; Launche R et.al, 2012; Kim JL et.al, 2011; Michalsen et.al, 2009). Nowdays, more and more study concering cupping therapy for LBP or neck pain which English have been plubishe. In 2014, a systematic review of traditional medicine in east asian countries weakly recommended cupping therapy for both sub-acute and chronic LBP (Akbarzadeh 2014). In 2015 here was systematic reviews drew a conclusion that cupping therapy is promising for pain (AlBedah, 2015). In 2015 a review about all aspests of cupping teraphy for neck pain and LBP indicated that cupping could be effications in pain and disability for chronic neck pain or chronic LBP in the immediete term (Yuan QT, et.al, 2015). The aim of the literature review was to investigate the effecticeness of cupping for chronic LPB patients. 2. Method The metods used in the research that I got was: study type randomized controlled trials, participants were diagnosed as non spesific subacute or chronic LBP. Intervention in experimental group was a kind of cupping therapy, which could be dry cupping and wet cupping. Intervention in control group was medication or usual care. The interested outcomes included one of the VAS (visual analogue scale) scores, ODI (Oswesty pain disability index) scores and MPPI (McGill present pain index) scores. Study Diagnosi Interventio Sampl Outcome Follo s n e s w up VAS, 2 MPPI weeks MPPI, 2,4 ODI weeks Akbarzade PLBP h et al. 2014 AlBedah 2015 NLBP Dry cupping; 50 qd; for 4 days Wet 40 cupping, 3 times per weeks for 2 weeks 3. Results The study from Akbarzadh et.al (2014) showed that a significant difference was observed between the two groups regarding the mean intensity of low back pain 24 hours and 2 weeks after the intervention (P<0.01). The study findings showed that dry cupping therapy at accupoint BL23 had a desirable effect on reduction of pain in the patients. The study from AlBedah (2015) showed that within the wet cupping group, the NRS, ODQ, and PPI showed a statistically significant decrease at the primary end point (day 14) compared with the baseline data (day0). Two weeks after the end of wet cupping, NRS and ODQ scores were significantly lower compared with the primary end point at the end of the intervention (day 14). Wet cupping is potentially effective in reducing pain and improving disability associated with Persistent nonspecific low back pain (PNSLBP) at least for 2 weeks after the end of the wet cupping period. Cupping therapy is a promisingly effective and safe therapy method for subacute or chronic low back pain. Cupping therapy can significantly decrease the VAS scores and ODI scores compared to the control management (usual care/medication). 4. Discussion Cupping therapy reduces local congestion through relative suction applied in the cups by heat or a sucker. This method has been employed for more than a thousand years. Although it is believed that cupping therapy originates from traditional Chinese medicine, this method is known as a beneficial treatment method all around the world. There are many types of cuping including dry cupping, wet cupping, cupping with retention, moving cupping, shaking cupping, quick cupping and balance cupping. All of these types of cupping were frequently used inChina, while dry cupping and wet cupping were widely used in Asian and Middle Eastern countries (Yoo, 2004). Dry cupping is using negative pressure conditions og the cup to suck the skin into the cup eithout drawing blood.Wet cupping should prick the skin, so that blood of local site should be drawn into the cup. Cupping with retention is that sup is retained for a period of time on the skin after the dry cupping process copleted (Yoo, 2004). The study findings that wet cupping and dry cupping therapy can significantly decrease the VAS scores and ODI scores compared to the control management for patients with LBP. The study from Akbarzadh et.al (2014) was the first clinical trialon cupping therapy in gynecological diseasesin Iran and aimed to investigate the effect of cupping therapy on the intensity of low backpain. The study findings showed that dry cupping therapy at accupoint BL23 had a desirable effect on reduction of pain in the patients. It should be noted that the results of VAS in this study were quite in agreement with those obtained from short-form McGill questionnaire, while these two instruments measure different criteria of pain. The study results showed cupping therapy to be effective in sedation of pain. Thus, it can be used as an effective treatment for reducing the low back pain. In the same line, the findings of another study in Busan, South Korea indicated a significant difference between two groups of nurses regarding the frequency and intensity of shoulder pain and weakness after dry cupping therapy (P<0.05) (Dorina, 2011). The study from AlBedah et.al (2015) findings showed that wet cupping is potentially effective in reducing pain and improving disability associated with Persistent nonspecific low back pain (PNSLBP) at least for 2 weeks after the end of the wet cupping period. The mechanism of action of wet cupping is still not clear, and many theories have been proposed. Wet cupping may act as a nociceptive stimuli, which would trigger diffuse noxious inhibitory control, or by the removal of oxidants, which would decrease oxidative stress (Tagil, 2014). The short and long term effects of wet cupping may be explained by a combination of mechanisms, including the affective component of chronic pain. Overall, no severe complications have been mentioned for cupping therapy to affect its efficiency and safety. Furthermore, since dry cupping was utilized in the current study, the potential risk of blood-borne diseases by contaminated instruments was eliminated. 5. Conclusion Cupping therapy is a promisingly effective and safe therapy method for subacute or chronic low back pain. Cupping therapy can significantly decrease the VAS scores and ODI scores compared to the control management (usual care/medication). References Albedah A, Khalil M, Elolemy A, Hussein AA, Alqaed M. The use of wet cupping for persistent nonspecific low back 5pain: Randomized controlled clinical trial. Journal of Alternative & Complementary Medicine. 2015; 21(8): 504-508. Akbarzadeh M, Ghaemmaghami M, Yazdanpanahi Z, Zare N, Azizi A, Mohagheghzadeh A. The effect dry cupping therapy at acupoint BL23 on the intensity of postpartum low back pain in primiparous women based on two types of questionnaires, 2012; A randomized clinical trial. International Journal of Community Based Nursing & Midwifery. 2014; 2(2): 112-120. Dorina Sohn, Hyunmin Yoon, Hyangmi Jung. The Effects of Dry Cupping Therapy on the Shoulder Pain and Fatigue of Nurses. 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