The Efficacy of Dry Cupping Compared to Placebo Cupping for People With Musculoskeletal Complaints: A Systematic Review With Meta-Analysis.

OBJECTIVE: To compare the effects of dry cupping and placebo cupping in adults with musculoskeletal pain, in the short (1 week), medium (4 weeks), and long (6 months) term. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: Medline, EMBASE, CENTRAL, AMED, CINAHL, Physiotherapy Evidence Database, and Web of Science were searched until June 2025. STUDY SELECTION CRITERIA: The study design consisted of randomized clinical trials. Participants included people with musculoskeletal complaints. The intervention was dry cupping, and control was placebo cupping. The primary outcome was pain intensity. DATA SYNTHESIS: Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Pain scales were converted to a 0-100 scale, with a meaningful difference threshold of 15 points. Random-effects meta-analyses were conducted. We judged the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation framework. RESULTS: A total of 3,330 records were screened; five trials (n = 281) were included. There was very-low-certainty evidence that dry cupping was trivially harmful to meaningfully beneficial when compared to placebo cupping in the short term (mean difference [MD] = -9.9, 95% confidence interval [CI; -30.5, 10.7], four trials, n = 243) and long term (MD = -2.2, 95% CI [-11.8, 7.4], one trial, n = 52). There was very-low-certainty evidence that dry cupping was effective compared to placebo cupping in the medium term; the effect may be clinically meaningful (MD = -17.2, 95% CI [-33.0, -1.4], one trial). Four trials were at high overall risk of bias. CONCLUSION: The effects of dry cupping on pain were very uncertain at all timepoints. Treatment alternatives with higher-certainty evidence of effectiveness should be trialed before cupping. OPEN SCIENCE FRAMEWORK REGISTRATION: The study's registration is available at https://osf.io/3fa9m/. JOSPT Open 2026;4(1):23-35. Epub 3 October 2025. doi:10.2519/josptopen.2025.0159.