Hijama (cupping) for pain and recovery: what the evidence shows

By the Voltra team · Updated 30 September 2026

Wet and dry cupping

The US National Center for Complementary and Integrative Health (NCCIH) says: "Cupping is a practice used in traditional medicine in several parts of the world, including China and the Middle East." [1] A glass, ceramic, bamboo or plastic cup creates suction on the skin; in wet cupping the skin is pierced so blood flows into the cup, and dry cupping doesn't pierce the skin [1]. Saudi Arabia's National Center for Complementary and Alternative Medicine (NCCAM) defines wet cupping, hijama, as suction with special cups followed by limited, shallow cuts that draw a small amount of blood, and dry cupping as suction without cuts or drawing blood [2].

For many readers hijama also has religious significance. This guide doesn't make or dispute religious claims; it looks only at what clinical trials have measured.

Pain: neck, back and knee

NCCIH's summary: "Cupping may help reduce pain, but the evidence for this isn't very strong." [1] The main reviews:

The pattern repeats: cupping looks good against no treatment, and the gap shrinks or disappears against sham cupping. In a 2020 review of chronic pain, pain fell a lot compared with no treatment but not significantly compared with sham cupping, and side effects were more common with cupping than with no treatment [3]. Three placebo-controlled trials found dry cupping no better than sham: in 90 people with chronic low back pain [9], in 62 women with knee osteoarthritis [10], and in 141 people with fibromyalgia, where cupping beat usual care but not sham [11]. The 2026 review of dry versus placebo cupping advised trying treatments with better evidence first [8].

Saudi Arabia's NCCAM puts it this way: some studies suggest a possible benefit of hijama for some kinds of pain, but that doesn't mean it suits every condition [12].

Why the trials are hard to trust

You can feel cupping, so a convincing placebo is hard to make. Researchers in Korea built a sham cup with a small hole that lets the suction leak away; volunteers found both similar, but tended to rate real cupping as the stronger sensation [13]. Many trials compared cupping with no treatment, which can't separate cupping's effect from expectation. In the fibromyalgia trial, even the sham cups gave some suction when they were first put on, so the authors wrote that "the sham may be considered a minimal cupping" [11]. A 2025 analysis of low back pain trials found that cupping with minimal suction eased pain about as well as full cupping [14]. NCCIH: "There's been some research on cupping, but most of it is of low quality." [1]

Athletes and recovery

For athletes, the trials are few and weak. A 2018 review found 11 trials with 498 athletes from China, the US, Greece, Iran and the UAE. Cupping was reported to help pain, disability, range of motion and a muscle-damage marker (creatine kinase), mostly compared with no treatment; most trials had an unclear or high risk of bias, none reported on safety, and the authors concluded that no recommendation for or against cupping in athletes can be made [15].

A 2025 trial in 81 recreational runners in Brazil found 5 minutes of cupping on the thighs after a run no better than a sham treatment for muscle pain, fatigue, perceived recovery or jump height over the next 72 hours [16].

Other claims

Beyond pain, NCCIH says there isn't enough high-quality research to reach conclusions [1]. A 2011 overview of systematic reviews found relatively clear evidence only for pain, and even there doubts remained [17]. A 2021 evidence map of 13 reviews, most of moderate to critically low quality, found signs that cupping may not work for conditions including high blood pressure, obesity, acne and stroke rehabilitation [18]. In a trial of 126 people with metabolic syndrome in Iran, adding wet cupping to diet advice didn't improve cholesterol or body measurements more than diet advice alone [19].

NCCAM says cupping can't currently be considered a proven alternative treatment for psoriasis [20]. And on the belief that hijama removes bad blood (al-dam al-fasid), NCCAM says there's no such thing in the body, and that hijama should be done only under the approved rules, by a licensed practitioner [12].

Side effects and risks

NCCIH: "Cupping can cause side effects such as persistent skin discoloration, scars, burns, and infections, and may worsen eczema or psoriasis." [1] And: "Rare cases of severe side effects have been reported, such as bleeding inside the skull (after cupping on the scalp) and anemia from blood loss (after repeated wet cupping)." [1]

• Burns. A hospital burn centre in China treated 14 people burned during cupping; wet cupping was more common among them than dry [21].
• Serious infections and bleeding. In Turkey, a 35-year-old man developed an abscess and bone infection at the sacroiliac joint where he'd had wet cupping, and needed 6 months of antibiotics [22]. A review of neurological complications found 14 patients in the published reports, the commonest problem being bleeding around the brain (subdural haemorrhage); most had no underlying disease, and all but 3 recovered [23].
• Anaemia. Among 206 men with iron-deficiency anaemia in Korea, blood-letting cupping was the probable cause in 11 (5.3%) [24]. A 55-year-old man who had stepped up regular wet cupping for back pain arrived at hospital with a haemoglobin of 4.1 g/dL and a heart attack [25]. Our iron guide covers iron-deficiency anaemia.
• Hepatitis and other blood-borne infections. NCCIH warns that "using the same equipment on more than one person, without sterilization between patients, can spread bloodborne diseases such as hepatitis B and C." [1] A 2015 meta-analysis listed hijama among significant risk factors for hepatitis C [26], and a study in Egypt found cupping among practices linked to higher hepatitis C risk [27]; a study in Malaysia found no link [28].
• Hygiene in practice. In a 2026 survey of 120 hijama practitioners at five centres in Qatar, about half weren't following safety guidelines; hand hygiene, sterilising equipment, using disposable lancets and keeping records were often neglected [29].

Who shouldn't have hijama

Saudi Arabia's hijama rules bar it for [30] [31]:

• children under 12
• people with cancer, or on chemotherapy or radiotherapy
• people with acute or chronic kidney failure on dialysis, or with liver failure
• people with bleeding disorders such as haemophilia and von Willebrand disease
• people with a pacemaker, or varicose veins in the legs
• anyone taking blood thinners such as warfarin or heparin

The same rules ask for extra care with severe hunger or fullness, pregnancy, diabetes with peripheral nerve damage (neuropathy), patches on the skin, boils or severe skin inflammation, and aspirin or herbal remedies with a similar effect [30]. Before a session, a doctor should take the person's medical history, and vital signs, haemoglobin and bleeding and clotting times should be measured, with written consent [30].

Rules in Saudi Arabia, the UAE and Kuwait

Saudi Arabia. NCCAM's rules say hijama isn't allowed anywhere outside licensed institutions [30]; when licensing began in 2015, the Ministry of Health said the aim was to curb hijama at homes and barber shops [31]. Practitioners must be registered with the Saudi Commission for Health Specialties and with NCCAM, complete approved training, pass written, oral and practical exams, and hold a health certificate showing they're free of HIV, hepatitis B and C and tuberculosis [30] [31]. Clinics must use sterile, single-use supplies [30]; NCCAM's later practice guide requires single-use cupping sets registered with the Saudi Food and Drug Authority, and adherence to the national infection-control guide [32]. Opening a hijama clinic without a licence can bring closure and a fine of at least 50,000 riyals [30].

UAE. The unified qualification requirements used by the federal ministry and the Abu Dhabi, Dubai and Sharjah health authorities set out the training a hijama therapist needs, including courses that cover infection prevention and control, biology and blood diseases and 20 hijama cases during training, and state: "Hijama clinical practice shall be conducted in a Health Facility" [33]. We couldn't access the Abu Dhabi Department of Health's own practice standards.

Kuwait. The Ministry of Health's 2025 rules for salons and beauty centres ban hijama in them without a special licence [34]. We found no Kuwaiti standard specific to hijama clinics.

In Voltra

Voltra doesn't log hijama or other treatments. Home shows a Recovery reading from 0 to 100. From Apple Health data, it compares your heart rate variability and resting heart rate with your own 30-day baseline.

Frequently asked

Sources

1. National Center for Complementary and Integrative Health (NIH) (2018). Cupping (last updated November 2018). Public domain.
2. المركز الوطني للطب البديل والتكميلي، وزارة الصحة السعودية (٢٠٢٦). الممارسات المعتمدة. In Arabic. Definitions of wet and dry cupping.
3. Cramer H, Klose P, Teut M, et al. (2020). Cupping for patients with chronic pain: a systematic review and meta-analysis. J Pain 21(9–10):943–956. Abstract.
4. Kim S, Lee SH, Kim MR, et al. (2018). Is cupping therapy effective in patients with neck pain? A systematic review and meta-analysis. BMJ Open 8(11):e021070. Abstract and full text.
5. Torad AA, Taha MM, Elbosaty RF, et al. (2026). Effect of cupping therapy on chronic neck pain: a systematic review and meta-analysis of randomized controlled trials. J Back Musculoskelet Rehabil (online 9 May 2026). Abstract. Authors in Saudi Arabia and Egypt.
6. Zhang Z, Pasapula M, Wang Z, Edwards K, Norrish A (2024). The effectiveness of cupping therapy on low back pain: a systematic review and meta-analysis of randomized control trials. Complement Ther Med 80:103013. Abstract.
7. Li JQ, Guo W, Sun ZG, et al. (2017). Cupping therapy for treating knee osteoarthritis: the evidence from systematic review and meta-analysis. Complement Ther Clin Pract 28:152–160. Abstract.
8. Jenkins LC, Verhagen AP, Amorim M, et al. (2026). The efficacy of dry cupping compared to placebo cupping for people with musculoskeletal complaints: a systematic review with meta-analysis. JOSPT Open 4(1):23–35. Abstract.
9. Almeida Silva HJ, Barbosa GM, Scattone Silva R, et al. (2021). Dry cupping therapy is not superior to sham cupping to improve clinical outcomes in people with non-specific chronic low back pain: a randomised trial. J Physiother 67(2):132–139. Abstract. 90 people, Brazil.
10. Cavalcanti RR, Almeida Silva HJ, Pontes-Silva A, et al. (2026). Dry cupping therapy has no effect on pain, function, or quality of life in women with knee osteoarthritis: randomized placebo-controlled trial. Braz J Phys Ther 30(1):101259. Abstract. 62 women, Brazil.
11. Lauche R, Spitzer J, Schwahn B, et al. (2016). Efficacy of cupping therapy in patients with the fibromyalgia syndrome: a randomised placebo controlled trial. Sci Rep 6:37316. Abstract and full text. 141 people, Germany.
12. المركز الوطني للطب البديل والتكميلي، وزارة الصحة السعودية (٢٠٢٦). مفاهيم خاطئة عن الطب البديل والتكميلي وممارساته (١٢ أغسطس ٢٠٢٦). In Arabic.
13. Lee MS, Kim JI, Kong JC, Lee DH, Shin BC (2010). Developing and validating a sham cupping device. Acupunct Med 28(4):200–204. Abstract. 34 healthy volunteers, Korea.
14. Li J, Jia Y, Sun T, Bai Z, Dong X, Hou X (2025). Interventions used in control group against cupping therapy for chronic nonspecific low back pain: a systematic review and network meta-analysis. Complement Ther Med 90:103167. Abstract. 10 trials.
15. Bridgett R, Klose P, Duffield R, Mydock S, Lauche R (2018). Effects of cupping therapy in amateur and professional athletes: systematic review of randomized controlled trials. J Altern Complement Med 24(3):208–219. Abstract.
16. Coutinho LOB, Alves BS, Caetano RO, et al. (2025). Cupping therapy does not improve quadriceps muscle pain and fatigue intensity, perceived recovery, and vertical jump height after running: a randomized clinical trial. J Bodyw Mov Ther 42:441–445. Abstract. 81 runners, Brazil.
17. Lee MS, Kim JI, Ernst E (2011). Is cupping an effective treatment? An overview of systematic reviews. J Acupunct Meridian Stud 4(1):1–4. Abstract.
18. Choi TY, Ang L, Ku B, Jun JH, Lee MS (2021). Evidence map of cupping therapy. J Clin Med 10(8):1750. Abstract and full text.
19. Farahmand SK, Gang LZ, Saghebi SA, et al. (2012). The effects of wet cupping on coronary risk factors in patients with metabolic syndrome: a randomized controlled trial. Am J Chin Med 40(2):269–277. Abstract. 126 people, Iran.
20. المركز الوطني للطب البديل والتكميلي، وزارة الصحة السعودية (٢٠٢٦). الحجامة والوخز بالإبر لعلاج الصدفية.. ماذا تقول الأدلة؟ (٦ سبتمبر ٢٠٢٦). In Arabic.
21. Jing-Chun Z, Jia-Ao Y, Chun-Jing X, Kai S, Lai-Jin L (2014). Burns induced by cupping therapy in a burn center in northeast China. Wounds 26(7):214–220. Abstract. 14 patients, China.
22. Kandemir B, Bulut R, Keskin PB, Kurt EK, Erayman İ (2026). Sacroiliac joint abscess and osteomyelitis associated with wet cupping therapy: a case report. BMC Complement Med Ther 26:275. Abstract and full text. Single case, Turkey.
23. Daneshfard B, Sadeghi S, Cordato D (2025). Neurological complications of cupping therapy: a comprehensive review. Complement Med Res 32(2):151–159. Abstract. 14 patients in 12 reports.
24. Yun GW, Yang YJ, Song IC, et al. (2011). A prospective evaluation of adult men with iron-deficiency anemia in Korea. Intern Med 50(13):1371–1375. Abstract. 206 men, Korea.
25. Jang AY, Suh SY (2020). Extreme venous letting and cupping resulting in life-threatening anemia and acute myocardial infarction: a case report. World J Clin Cases 8(24):6432–6436. Abstract and full text. Single case, Korea.
26. El-Ghitany EM, Abdel Wahab MM, Abd El-Wahab EW, Hassouna S, Farghaly AG (2015). A comprehensive hepatitis C virus risk factors meta-analysis (1989–2013): do they differ in Egypt? Liver Int 35(2):489–501. Abstract. 357 studies.
27. Heiza M, Elmola K, Salama B (2021). Unsafe practices associated with HCV infection among adults: a case control study. Int J Prev Med 12:60. Abstract. 150 cases and 300 controls, Egypt.
28. Mohd Suan MA, Said SM, Lim PY, Azman AZF, Abu Hassan MR (2019). Risk factors for hepatitis C infection among adult patients in Kedah state, Malaysia: a case-control study. PLoS One 14(10):e0224459. Abstract. 255 pairs, Malaysia.
29. Ali MHA, Khalek EMA, Hassan AK, Kotb SAM (2026). Practices of Al-Hijama practitioners at cupping community centers in Qatar. Iran J Nurs Midwifery Res 31(4):663–669. Abstract and full text. 120 practitioners, self-reported.
30. المركز الوطني للطب البديل والتكميلي، وزارة الصحة السعودية (١٤٣٦هـ/٢٠١٥). ضوابط تنظيم ممارسة الحجامة للممارسين والمؤسسات (الطبعة الأولى). In Arabic. First edition, 2015, posted on NCCAM's site; articles 2, 3, 8, 10, 11 and 16 and annex 2.
31. Ministry of Health, Saudi Arabia (2015). MOH Approves Licenses for Cupping (news, 17 February 2015). Announcement of the licensing plan and banned groups.
32. المركز الوطني للطب البديل والتكميلي، وزارة الصحة السعودية (١٤٤١هـ). دليل مزاولة الطب البديل والتكميلي، الإصدار الأول. In Arabic. Stamped 8 March 2020; pages 8 and 17.
33. Ministry of Health and Prevention, Department of Health – Abu Dhabi, Dubai Health Authority, Sharjah Health Authority (2025). Unified Healthcare Professional Qualification Requirements (PQR), April 2025. Hijama Therapist, printed page 126.
34. وزارة الصحة، دولة الكويت: اللجنة المشتركة للرقابة على الصالونات والمعاهد الصحية (٢٠٢٥). دليل الاشتراطات الصحية للمعاهد الصحية والصالونات ومراكز التجميل والعناية الشخصية. In Arabic. Printed page 14.

Sources checked on 30 September 2026.

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