My back has shrunk – The influence of cupping therapy on body image

My Ph.D. research investigated the effect of cupping therapy in the treatment of chronic non-specific neck pain [1-3]. Besides pain and well-being we followed the approach by Moseley, 2008 [4] who found that patients with chronic low back pain showed body image distortions. His patients were unable to designate their whole bodily contours and there was a tendency for displacement of the spine towards painful area.

We were really fascinated by the results and we wondered if this would apply for chronic neck pain as well. So we adapted the design of the body image drawings for the neck area and the study patients who suffered from chronic neck pain were asked to draw the neck area as they felt it.

The drawings themselves indicated that body image was disturbed in neck pain patients too. Parts of the contours were missing, others were very prominent and in most drawings we found a discrepancy between the bodies drawn and normal body physique, for examples shoulders were elevated and at the same height as the ears. We tried to identify these patterns within the drawing but we failed with that. We realized that patients with similar complaints had drawn their neck completely different.

So we tried a new approach, we used qualitative interviews and the study patients themselves interpreted their own drawings. We further asked them about their body image, their coping and daily life and their experiences with cupping therapy. [5]

As a result patients reported that pain was the predominant sensation, it hindered them from sensing the non-painful parts of the neck area. The neck area also felt altered, e.g. swollen or magnified, one also described “having shoulders like an anvil”. Patients’ coping strategies were mostly passive, they tried to endure or distract from the pain. If that did not work they would try to get fixed by their physician instead.

Interestingly cupping therapy did have an effect on body perception; patients reported not only less pain, but also a more differentiated pain and body perception and a feeling of less weight and tension which also expressed in the drawings with a smaller neck and shoulders with rounder edges. What surprised us even more was that the drawings itself and the interview had some impact on body perception when patients drew their attention to the “blind spots”. Coping strategies on the other hand did not change, which is probably the most common finding with passive therapies.

Altogether this study [5] showed that pain and body image distortions are also present in patients with chronic neck pain and that cupping might actually reduce pain and influence the body image. In order to change coping strategies more active treatments are needed.

About Romy Lauche

grey My back has shrunk – The influence of cupping therapy on body imageRomy has studied psychology with a focus on neurophysiology and research methods at the University of Jena, Germany. She has recently finished her Ph.D. thesis about the influence of cupping therapy on chronic neck pain. Romy is now working as a researcher at the Department for Complementary and Integrative Medicine in Essen, Germany. Her main interests are complementary and integrative medicine in general (traditional medicine, manipulative therapies) and Mind/Body techniques in particular (mindfulness, meditation, qigong, yoga) in the treatment of chronic conditions. During her Ph.D. study Romy has also become certified mindfulness instructor and acquired knowledge in fMRI research.

References

[1] Lauche R, Cramer H, Choi KE, Rampp T, Saha FJ, Dobos GJ, & Musial F (2011). The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain–a randomised controlled pilot study. BMC complementary and alternative medicine, 11 PMID: 21843336

[2] Lauche R, Cramer H, Hohmann C, Choi KE, Rampp T, Saha FJ, Musial F, Langhorst J, & Dobos G (2012). The effect of traditional cupping on pain and mechanical thresholds in patients with chronic nonspecific neck pain: a randomised controlled pilot study. Evidence-based complementary and alternative medicine : eCAM, 2012 PMID: 22203873

[3] Cramer H, Lauche R, Hohmann C, Choi KE, Rampp T, Musial F, Langhorst J, & Dobos G (2011). Randomized controlled trial of pulsating cupping (pneumatic pulsation therapy) for chronic neck pain. Forschende Komplementarmedizin (2006), 18 (6), 327-34 PMID: 22189364

[4] Moseley GL (2008). I can’t find it! Distorted body image and tactile dysfunction in patients with chronic back pain. Pain, 140 (1), 239-43 PMID: 18786763

[5] Lauche R, Cramer H, Haller H, Langhorst J, Musial F, Dobos GJ, Berger B. (in press) “My back has shrunk” – The influence of traditional cupping on body image in patients with chronic neck pain. Forsch Komplementmed. PMID:

 

 

 

 

Comments

  1. So Romy – how do you think what you did had its effect on body image?

    Romy Reply:

    Dear Lorimer

    that is a tough question because I think that many factors might have influenced the body image.

    Most likely the changes in body image appear to be results of the reduction of pain and muscle tension. Cupping therapy significantly reduced neck pain and almost every patient described less muscle tension which might increase microcirculation. Less pain leads to decreased nociceptive sensory input and improved microcirculation might improve function of mechanoreceptors in general. Therefore it might be explained by simply changed sensory input of the neck area.

    But it is not only reduced pain itself that changed body image. One patient (the one that said “my back has shrunk”) really drew her body smaller than before. This is fascinating and I wonder if it is related to the actual relieve of the swellings in the neck tissue. This patient did have a so called plethora or overabundance. These terms refer to a voluminous gelosis of the subskin, which indicates local blood congestion, swelling and adhesions of the connective tissue in the neck region. It was very impressive to see this swelling reduced after cupping therapy.

    Also learning processes and improved body awareness through repeated drawing tasks might have changed body perception, at least thats what a patient mentioned.

    The mechanical stimulation of the neck area during cupping is probably less important because the drawings were made 3 days after the treatment.

    There are still many open questions which I hope further research might answer.

  2. Nice work Romy – thank you for sharing.
    I wonder is ther anything specific about cupping that would distinguish it from many other forms of sensory stimulation / treatment?
    As is so frequently referred to on the BiM forum the role of multi-sensory integration and stimulus competition seems to be an important contributor at play here?
    David

    Romy Reply:

    Dear David

    thanks a lot for your suggestions.

    There actually is something specific about cupping. It is not the same kind of sensory stimulation like a massage etc.
    [This cupping treatment we used was traditional cupping with incisions made at the areas before applying the glasses. The glasses are stationary for approx. 10 minutes and apart from applying the glasses there is no more stimulation of the neck. Furthermore the treatment effect is not an immediate effect therefore it might no be so much a matter of stimulus competition.]

    In my opinion traditional cupping treatment might act not only through unspecific ways but also through
    1. direct influences on the muscles and connective tissue. The negative pressure pulls in the skin and the effects of this pulling force can be observed even in deeper layers of the skin and connective tissues.
    2. improved sensory function (relieve of local blood congestion, swelling and adhesions of the connective tissue in the neck region).
    3.triggering of the immune system.

    Best regards
    Romy

  3. David Kennedy says:

    While this is an interesting project, some scientific concerns should be raised as this blog seeks to “disseminate good clinical science research.” Fundamental questions arise from the use of cupping to treat pain. The first is what is the physiological effect of using cupping? The author avoids traditional Chinese medical theory for explaining how cupping could affect pain. Instead, the authors suggest cupping may provide mechanical stimulation of the neck area, which would then have some effect on pain perception, body image, and self reported muscle tension. Additionally, there was an assumption that cupping could increase microcirculation, which may affect mechano/nociceptors (also an assumption), which may alter pain and body perception. With regard to improved microcirculation, these are simply assumptions and not measurements. There is no way to know from the information presented what the physiological effects of cupping are on local circulation. Furthermore, the author discounts mechanical stimulation as having an effect on body image since the outcome occurred three days after treatment. It is unclear from the information provided whether the other outcomes were assessed in the same time frame.

    Besides the fact that the three-day delay in post-treatment reporting allows the influence of numerous uncontrolled variables to influence the outcome, I am most concerned by the lack of controls. The current study does not have a control group at all. Thus, it is unknown whether cupping or no cupping would have changed pain, reported muscle tension, or body image. Again, any number of variables could account for the results. Perhaps having patients with neck pain, draw their necks, contemplate and interpret their drawings was sufficient to cause the change. Without a control, and specifically a sham control for cupping, there is no way to know if cupping caused the changes reported. The references that lead to this study suggest that cupping can reduce neck pain 1, 2. However, the controls in these studies did not receive treatment, thus the cupping intervention may simply be placebo. Indeed, most trials examining the effects of cupping are of poor quality and do not allow any conclusions to be drawn 3.

    Modern pain science, particularly that for chronic pain is quite complex. To sort out the pathophysiological, psychological, and social variables that contribute to the perception of ongoing pain states requires rigorous science. The complimentary and alternative medicine approaches may have something to offer in the management of these patients, but these interventions need to adhere to the same scientific standards set for all medical interventions. Indeed, if cupping can be shown to reduce chronic pain or alter body image with consistent, transparent evidence garnered from high quality, blinded, randomized control trials; then the evidence would speak for itself.

    References:
    1. Lauche R, Cramer H, Choi KE, Rampp T, Saha FJ, Dobos GJ, & Musial F (2011). The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain–a randomised controlled pilot study. BMC complementary and alternative medicine, 11 PMID: 21843336

    2. Lauche R, Cramer H, Hohmann C, Choi KE, Rampp T, Saha FJ, Musial F, Langhorst J, & Dobos G (2012). The effect of traditional cupping on pain and mechanical thresholds in patients with chronic nonspecific neck pain: a randomised controlled pilot study. Evidence-based complementary and alternative medicine : eCAM, 2012 PMID: 22203873

    3. Kim JI, Lee MS, Lee DH, Boddy K, Ernst E. Cupping for Treating Pain: A Systematic Review. Evid Based Complement Alternat Med. 2009 May 7. [Epub ahead of print] PubMed PMID: 19423657; PubMed Central PMCID: PMC3136528.

  4. Lorimer says:

    David’s – nice observations. David K – I completely agree that pain is quite complex! And I agree that we need to make sure our interpretations match our methods. This is tricky for anything aside from drugs – try blinding a patient or ‘cupper’ (is that what people who do cupping are called?) to the cupping! I think we can conclude that the outcomes changed between time one and time two. We currently have no idea why, but Romy has some theories, that should now be tested using rigorous experiments. David K, or anyone else for that matter – any alternative theories worth testing?

  5. “However, the controls in these studies did not receive treatment, thus the cupping intervention may simply be placebo.”

    Indeed. I find this study to be very fascinating however we not ignore placebo, expectations, or simply the concept that the more impressive a treatment is, the bigger the effects are. I would be curious to see if the changes were truly due to cupping? Would something like joint mobilizations or simply touching and acknowledging the patients painful area result in the same effect? What do you think?

  6. Dear Joseph,
    In my opinion the effects might be a direct result of the reduced pain and muscle tension in the neck area, which are most probably caused by cupping.
    I also think many other therapies might have similar effects. A recent yoga study of our team found similar but more extensive changes in the body image after 9 weeks of Iyengar yoga.

    There are so many open questions, that it really gives me a thrill continuing research in that area.

    Cramer H, Lauche R, Haller H, Langhorst J, Dobos G, Berger B. “I’m more in balance.” A qualitative study of yoga for patients with chronic neck pain. Journal of Alternative and Complementary Medicine, 2012: in press.

  7. shaik tariq says:

    At the out set i congratulate you for the work done on cupping. i do accept the effect is due to the suction induced (which improves local circulation- hyperemia itself is indication of improved circulation) and relieving of congestion through sucking out blood. this in turn draws new blood towards the site which helps in reducing muscle tension and healing the condition. As far as scientific reasons are concerned its a infinite continuous process, a prior theory is replaced by new theory and cycle continues. any how can we view your research publication?

    Romy Reply:

    The article is now available at http://content.karger.com/ProdukteDB/produkte.asp?Aktion=Ausgabe&Ausgabe=257029&ProduktNr=224242