Open Access

Efficacy and safety of bloodletting puncture and cupping in postherpetic neuralgia: A systematic review and meta‑analysis

  • Authors:
    • Wenyun Kui
    • Lei Xie
    • Yanan Li
    • Zhen Gu
    • Shuang Liu
    • Chunchun Xue
    • Kaiqiang Wang
  • View Affiliations

  • Published online on: December 28, 2023     https://doi.org/10.3892/br.2023.1718
  • Article Number: 30
  • Copyright: © Kui et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )


Abstract

The present study aimed to evaluate the efficacy and safety of bloodletting puncture and cupping (BLP‑C) in postherpetic neuralgia (PHN) and to provide guidance for clinical treatment. Randomized controlled trials (RCTs) of BLP‑C therapy in PHN were systematically searched in eight databases from inception to September 2022. Literature screening, data extraction and quality assessment were performed by two independent researchers. Dichotomous and continuous variables were pooled using the risk ratio (RR) and weighted mean difference (WMD), respectively. A total of 13 studies involving 1,129 patients with PHN (571 in the experimental group and 558 in the control group) were included in the present meta‑analysis. Overall efficacy (RR=1.21, 95% CI: 1.15 to 1.28, P<0.00001), VAS score (WMD=‑1.10, 95% CI: ‑1.31 to ‑0.90, P<0.00001) and PSQI score (WMD=‑2.42, 95% CI: ‑2.87 to ‑1.96, P<0.0001) were significantly different between the BLP‑C group and Western medicine group. Furthermore, subgroup analysis demonstrated that BLP‑C alone or combined with other traditional Chinese medicines was more effective than Western medicine in PHN. A total of four RCTs mentioned adverse reactions, most of which were in the Western medicine group and were relieved after treatment discontinuation. In conclusion, BLP‑C is superior to Western medicine in relieving pain and improving the sleep quality of patients with PHN with a lower incidence of adverse effects.

Introduction

Postherpetic neuralgia (PHN) is a common type of neuropathic pain that persists for >3 months after a rash heals from acute herpes zoster (HZ) (1,2). PHN typically manifests as spontaneous pain, hyperalgesia and allodynia that last for several months or even a lifetime and seriously affects the physical and mental health of patients (3). PHN is the most common complication of HZ that mainly affects patients >50 years of age (4), and its incidence increases with age.

PHN is difficult to treat and pharmacological therapy is currently the primary treatment for PHN (5). Pregabalin, gabapentin and tricyclic antidepressants are first-line therapeutic drugs recommended for PHN (6). Since long-term medication is needed, adverse effects such as dizziness, drowsiness, dry mouth and edema are often observed in patients with PHN. Opioids, including tramadol, morphine and oxycodone, should generally be considered for PHN with severe pain after consultation with a specialist, and should only be prescribed with appropriate goals followed by close monitoring (2). However, these Western medical practices have only achieved mild successes in pain alleviation. Numerous patients with PHN still respond poorly to pharmacological treatments such as gabapentinoids (7). Therefore, an effective and safe therapy for PHN is urgently needed.

Studies have found that bloodletting puncture and cupping (BLP-C) may effectively reduce pain in patients with PHN with fewer or no adverse effects on physical health. BLP-C is a Traditional Chinese Medicine (TCM) treatment modality based on the meridian theory, which has an important role in the field of complementary and alternative medicine. BLP stimulates the acupoints on the patient's body to promote blood circulation, remove blood stasis and dredge the meridians, thereby relieving pain. Cupping uses the heat of combustion to achieve suction (negative pressure) inside a glass cup, which is then applied to specific parts of the body. This suction induces congestion or hemostasis at selected acupoints (8), resulting in therapeutic effects such as promoting skin blood flow (9), increasing the pain threshold, improving local anaerobic metabolism (10), attenuating inflammation and regulating cellular immune responses (11). In clinical practice, BLP-C has been found to be moderately effective in the management of PHN. However, there is currently no comprehensive systematic review and meta-analysis that quantitatively assessed the efficacy of BLP-C in the treatment of PHN. Therefore, the present meta-analysis aimed to assess the efficacy and safety of BLP-C in PHN patients by performing a data synthesis from randomized-controlled trials (RCTs) and to provide a reliable reference for clinical decision-making.

Materials and methods

Registration

The protocol of this review has been registered in PROSPERO (https://www.crd.york.ac.uk/PROSPERO/) on October 24th, 2022 (no. CRD42022367056).

Search strategies

Relevant RCTs were searched in the China National Knowledge Infrastructure (CNKI; https://www.cnki.net), Wanfang (www.wanfangpaper.net), CQVIP (http://www.cqvip.com), SinoMed (http://www.sinomed.ac.cn), Cochrane Library (https://www.cochranelibrary.com/?contentLanguage=eng), PubMed (https://pubmed.ncbi.nlm.nih.gov), Web of Science (https://www.webofscience.com/wos) and Embase (https://www.embase.com) databases from inception to September 2022 without any language restrictions. The title, abstract and full text of the studies were reviewed and screened independently by two investigators (WK and YL) to determine eligibility for inclusion in the meta-analysis. Any disagreement was resolved by a third investigator (CX).

The relevant studies were searched using subject and entry terms. Chinese databases were searched using Chinese (Mandarin) search terms ‘Ci Luo Ba Guan’ (BLP-C) and ‘Dai Zhuang Pao Zhen Hou Yi Shen Jing Tong/Dai Zhuang Pao Zhen Hou Yi Liu Shen Jing Tong’ (PHN). English databases were searched by the English search terms ‘acupuncture’, ‘blood-letting’, ‘pricking’, ‘cupping’, ‘postherpetic neuralgia’ and ‘PHN’. The search strategy for PubMed is outlined in Table SI.

Eligibility criteria

The inclusion criteria for the present study were as follows: i) Participants: Patients medically diagnosed with PHN, regardless of ethnicity, nationality or course of the disease; ii) interventions and controls: Intervention in the treatment group included BLP-C therapy or BLP-C combined with other TCM therapies. Intervention in the control group was conventional Western medicine therapy; iii) outcomes: Overall efficacy [efficacy=(cured + markedly improved + improved)/total number of cases in each group x100%], visual analogue scale (VAS) score (12) and Pittsburgh sleep quality index (PSQI) (13); iv) study type: RCT. The exclusion criteria for this study were as follows: i) Participants: Patients diagnosed with a special type of HZ, such as HZ ophthalmicus, HZ sacralis or incomplete HZ; ii) study type: Studies that did not describe outcome measures in detail or had an inaccessible full text.

Literature screening and data extraction

Literature screening and data extraction were performed independently by two investigators (WK and YL). Any disagreement was resolved by a third investigator (XC). Data were extracted according to a pre-designed Excel 2019 data extraction form, including basic literature information, study type, basic subject information, interventions for the treatment group and control group, intervention time, outcome measures, safety evaluation and other observational measures.

Quality assessment

The quality of the articles was assessed independently by two investigators (WK and YL) using the Cochrane risk of bias (RoB) tool (methods.cochrane.org). The RoB tool assesses risk of bias in 7 domains, namely sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome evaluation, incomplete outcome data, selective reporting and other biases. The possible answers for each domain are Yes (+); Not clear (?) and No (-). Yes (+) indicates a low risk of bias for the respective domain; Not clear (?) indicates an unclear or uncertain risk of bias for the respective domain; No (-) indicates a high risk of bias for the respective domain.

Data synthesis and statistical analysis

The collected data were processed and analyzed by RevMan 5.4 (Cochrane Collaboration) and StataSE15 (StataCorp LP). Dichotomous and continuous variables were pooled using the risk ratio (RR) and weighted mean difference (WMD), respectively. Heterogeneity was evaluated using the I2 statistic and was considered absent when P>0.1 and I2≤50%. The meta-analysis was conducted using a fixed-effects or random-effects model and the presence of bias among studies for different interventions was judged using a funnel plot. A fixed-effects model was used when the studies were assumed to be homogeneous, while a random-effects model was used when there was heterogeneity among the studies.

Results

Literature search

A total of 671 records were initially identified through database searching, of which 381 were duplicates. After a preliminary review of titles and abstracts, 177 records were excluded for not meeting the inclusion criteria. Of the remaining 113 records, 67 were excluded due to the lack of outcomes of interest, 13 were excluded due to no available data and 20 were excluded due to abstract-only access. Finally, a total of 13 RCTs involving 1,129 patients with PHN were included (14-26). The process of study search and selection is illustrated in Fig. 1.

Characteristics of included studies

A total of 13 RCTs were included in the present review (14-26), all of which were conducted in China and published in Chinese. Basic information on the included RCTs is provided in Table I.

Table I

Basic characteristics of included studies.

Table I

Basic characteristics of included studies.

Author, yearNumber of cases (Exp/Ctr)Age, years (Exp/Ctr)Duration of disease, months (Exp/Ctr)Intervention (Exp/Ctr)Course of treatment, daysOperating pointOutcome indicators(Refs.)
Gao, 201930/30 71.78±7.53/73.16±7.34 20.04±1.68/13.56±15.00 PC+A+TCM/Carbamazepine14Ashi Xue①②④⑦(14)
Liu, 201940/40 50.25±10.17/50.18±10.38/PC/Pregabalin30Ashi Xue①②③(15)
Lu, 201930/30 66.50±2.69/69.90±2.52 9.38±2.87/10.16±2.38 PC+A/Pregabalin10Ashi Xue①②③④(16)
Ma, 201468/68 56.4±0.00/51.3±0.00/PC+A+TCM/VitB130Ashi Xue①②③⑤(17)
Tang, 201930/30 59.5±10.30/61.67±8.20/ PC+A/Pregabalin14Ashi Xue①②③⑥(18)
Tian, 201332/3261.00/61.004.00/4.00PC/Pregabalin16Ashi Xue③⑧(19)
Wang, 201649/40 58.26±2.16/57.26±2.21 4.02±0.43/4.00±0.44 PC+TCM/Ibuprofen84Ashi Xue①②③⑤(20)
Wang, 201939/39 58.30±3.20/59.10±2.80 4.20±1.30/4.00±1.40 PC+A/Pregabalin10Ashi Xue①②③④(21)
Wang, 202035/3558.60/57.80 2.09±0.34/2.06±0.32PC/Gabapentin16Ashi Xue①②③⑦⑧(22)
Wen, 201525/25 45.00±20.00/45.00±21.00/PC+A/Carbamazepine, Mecobalamin, VitB114Ashi Xue①②③⑥(23)
Xing, 201936/36 68.25±7.42/67.94±6.39 3.23±1.05/3.47±0.74 PC+A/Gabapentin22Ashi Xue①②③(24)
Yu, 2018115/115 42.41±5.19/43.26±5.28 7.98±2.27/7.94±2.30 PC+A+TCM/Paracetamol, Codeine12Ashi Xue①②③⑤(25)
Zhao, 201342/38 54.26±0.00/51.72±0.00 6.12±0.00/6.28±0.00 PC+TCM/Carbamazepine21Ashi Xue①②③⑤(26)

[i] ①, Overall effective rate ②, cure rate ③, VAS score; ④, Pittsburgh sleep quality index; ⑤, incidence of adverse reactions; ⑥, recurrence rate; ⑦, start time of pain relief; ⑧, serological indicators (SP, IL-6); ⑨ McGill score. Exp, experimental group; Ctr, control group; TCM, Traditional Chinese Medicine; PC, blood-letting puncture and cupping; A, acupuncture.

Participants. The 13 RCTs (14-26) involved 1,129 patients with PHN, including 574 males and 555 females. Except for the 4 patients who dropped out from one study (22), all remaining patients were included in the statistical analysis.

Interventions in the treatment group. As indicated in Table I, among the 13 included RCTs (14-26), BLP-C was the intervention in three studies (15,19,22), BLP-C combined with acupuncture was used in five studies (16,18,21,23,24), BLP-C combined with TCM was used in two studies (20,26) and BLP-C combined with acupuncture and TCM were used in three studies (14,17,25).

The specific characteristics of the included BLP-C studies are listed in Table I. In all of the 13 studies included, Ashi Xue had been selected as the puncture site for BLP-C (14-26).

Interventions in the control group. Western medicine was used as the intervention for the control group. Pregabalin was used in five studies (15,16,16,19,21), carbamazepine was used in two studies (14,26), gabapentin was used in two studies (22,24) and ibuprofen was used in one study (20). In the other three studies (17,20,25), different combinations of two or three Western medicines (acetaminophen, codeine, mecobalamin, vitamin B1, Fenbid and carbamazepine) were used. The duration of intervention in the control group was the same as that in the treatment group.

Efficacy assessment. The overall efficacy was reported in 12 of the 13 eligible studies (14-26), the VAS score was reported by 12 studies (15-26), the PSQI was reported by 3 studies (14,16,21), the incidence of adverse reactions was reported by 4 studies (17,20,25,26) and the recurrence rate was reported by 2 studies (18,23). In addition, serum levels of pain-related factors, namely substance P and IL-6, were reported by two studies (19,22).

Quality assessment of included studies

Among the 13 included studies, the random sequence generation method was used in 11 studies (14,15,18-26), the random number table method was adopted in nine studies (14,18,19,21-26), random grouping was conducted according to the visit time in one study (20), random grouping was conducted according to the admission time in one study (15), and the term ‘random’ was mentioned in the remaining two studies (16,17) without describing the random grouping method. BLP-C was used as the intervention in these studies. Allocation concealment and blinding are not feasible for BLP-C because the traces left by the procedure are usually visible and may last for several days. Therefore, it is difficult to carry out the masking process and impossible to use any blinding methods. However, the patients showed good compliance and the non-blinding method was unlikely to affect the results. Follow-up at three months (18) and one year (23) were respectively mentioned in two studies (18,23) and the recurrence rate was statistically analyzed. One study (22) reported four cases of dropout and provided explanations. The outcome data were complete in the other 12 studies (14-21,23-26) and no dropout cases were reported. Baseline characteristics were comparable among the 13 studies (14-26), but selective reporting and other bias were unclear. The quality assessment results of the 13 studies (14-26) are summarized in Fig. 2.

Meta-analysis. Overall efficacy

The overall treatment efficacy in the experimental and control groups was reported in 12 studies. There were 1,061 patients, including 538 in the experimental group and 523 in the control group. Heterogeneity was low among the studies (P=0.76, I2=0%). The results showed that the overall efficacy was significantly higher in the experimental group (including BLP-C alone and BLP-C + acupuncture or TCM) than in the control group (drug treatments) [RR=1.21, 95% CI: 1.15-1.28, P<0.00001] (Fig. 3). There was low publication bias in the results (Fig. 4).

VAS score. Post-treatment VAS scores were reported in 12 studies (15-26). VAS scores were decreased after intervention and were significantly different between the experimental group and control group (WMD=-2.31, 95% CI: -2.42-2.31, P<0.00001] (Fig. 5). However, there was high heterogeneity among the studies (P<0.00001, I2=97%). Therefore, a subgroup analysis was conducted according to different interventions.

As shown in Fig. 6, three studies (15,19,22) compared BLP-C vs. Western medicine (Fig. 6A). Furthermore, seven studies (16,18,20,21,23,24,26) compared BLP-C plus acupuncture or TCM vs. Western medicine (Fig. 6C). In addition, two studies (17,25) compared BLP-C plus acupuncture and TCM vs. Western medicine. BLP-C was superior to pharmacological therapy in relieving pain in all three subgroups; however, there was high heterogeneity among the studies (I2 =85%, P=0.002, Fig. 6A; I2 = 94%, P<0.00001, Fig. 6D). Thus, a sensitivity analysis was further conducted. As shown in Fig. 6B, heterogeneity was decreased upon removal of the study by Liu (15) (I2=0%, P=0.62), but VAS scores were still significantly different between the BLP-C plus acupuncture and TCM group and the pharmacological therapy group. It was suspected that the observed heterogeneity may be attributed to variations in the duration of treatment and the specific Western medicines employed in the control group across the included studies. The differences in the duration of treatment may have influenced the treatment outcomes and given rise to heterogeneity. Each study may have adopted a different duration or frequency of treatment, leading to variations in patient response and overall treatment effects.

PSQI. The PSQI was reported by three studies (14,16,21). PSQI scores were decreased after intervention in both groups and were significantly lower in the experimental group than in the control group (WMD=-2.42, 95% CI: -2.87 to -1.96, P<0.00001, Fig. 7), which suggests that BLP-C is superior to Western medicine in improving sleep quality. However, PSQI scores were only reported by 3 RCTs with a small sample size. Therefore, further investigations are warranted to confirm this conclusion.

Safety. Adverse reactions were mostly caused by drugs, which resolved after treatment discontinuation. Of the 13 studies included, 3 studies (17,25,26) reported stomach discomfort in the pharmacological therapy group, including 2 cases receiving vitamin B1 injection, mecobalamin and Fenbid (n=30) (17), 4 cases receiving paracetamol and codeine (n=12) (25) and 2 cases receiving carbamazepine (n=12) (26). Furthermore, one study reported 11 cases of adverse reactions of the nervous system in the control group (paracetamol and codeine, n=12) (25). Conversely, only 4 cases (17,25) of adverse reactions were reported in the BLP-C group (Table SII).

Discussion

The present systematic review and meta-analysis were performed on 13 RCTs (14-26) published between 2013 and 2020. The findings showed that the BLP-C group had a better VAS score, PSQI score and safety profile than the Western medicine group. VAS and PSQI scores were used as outcome measures to quantify improvements in pain and sleep disorders, which are the most common symptoms of PHN. In addition, two studies (14,22) reported the start time of pain relief and the results showed that the BLP-C group had earlier pain relief than the Western medicine group. The duration of disease in the experimental group was 20.04±1.68 and 4.00±0.00 months, respectively, which indicates that BLP-C may be more effective for both a short and long disease duration.

The pathogenesis of PHN is highly complex and involves both peripheral and central sensitization, which makes treatment challenging (27). There is compelling evidence from skin biopsies, along with subcutaneous and cutaneous drug challenges, showing that the peripheral afferents may be a significant pain generator in a subset of patients with PHN (28). Furthermore, a previous clinical trial indicated that inhibiting inflammation of locally injured nerves may help reduce the intensity of pain in patients with PHN (29). These findings suggest that inhibiting peripheral nociceptor stimulations and inflammatory responses may contribute to PHN pain.

Patients with PHN are often troubled by debilitating pain of various sensations (e.g., burning pain or paroxysmal severe pain) in the region of damaged innervation. The current meta-analysis results indicated that the analgesic effect of BLP-C was superior to that of Western medicine. BLP-C combines both acupuncture and cupping to treat the painful area. After the cupping site is disinfected, it is punctured by a three-edged needle to release blood, henceforth blood-letting. Cupping is then performed at the bloodletting site, and the negative pressure inside the glass jar creates suction on the local skin and thus induces bleeding at the puncture site. It was recently reported that BLP-C may improve hemorheological abnormalities and local microcirculation, reduce proinflammatory factors and eliminate nerve root edema (30). Hence, BLP-C of the painful region of the skin may modulate the inflammatory microenvironment of the affected side of cases with PHN, effectively reduce the transmission of peripheral noxious stimuli to the spinal cord and inhibit the establishment of central sensitization, thereby successfully reducing pain.

Elderly individuals with a weakened immune system are most susceptible to PHN and related symptoms. It was shown that BLP-C therapy is closely related to endocrine and immunological regulation (31). Thus, controlling the activity of the immune and endocrine systems may be the therapeutic mechanism of BLP-C in PHN. Human nerve endings can release ‘endorphin-like chemicals’ when the acupoint is stimulated, increasing the pain threshold and decreasing susceptibility to pain (32). Signals triggered by the needles during BLP-C may reach the brain and induce the release of several central neurotransmitters, including acetylcholine, morphine and 5-hydroxytryptamine, thereby enhancing the analgesic effects (33). Cupping after puncture may help discharge blood stasis and dredge the meridians and Qi, which can effectively improve the local blood circulation and maintain nutritional supply.

BLP-C exerts neuromodulatory effects by controlling the release of neurotransmitters, such as endorphin (34) and substance P (19,22). The present meta-analysis showed that the serum level of substance P is decreased after treatment. Substance P can induce the accumulation of pain-causing and inflammatory substances, thereby leading to neurogenic inflammation and persistent or worsening pain. BLP-C may lead to higher oxygen saturation (35), which can remove oxidants, reduce oxidative stress and damage caused by free radicals, and protect cells and tissues. These effects are all associated with pain relief and the improvement of sleep quality. In addition, it was shown that substance P can influence sleep physiology through neurokinin receptors (36). Andersen et al (37) revealed that a certain dose of substance P led to decreased sleep efficiency and increased sleep onset latency.

PHN is often accompanied by sleep disorders (38). In addition to the improvement of pain, BLP-C is also better than Western medicine in improving sleep quality. There is a bidirectional relationship between sleep disturbance and pain (39). Chronic pain can interfere with sleep depth and continuity, as well as reduce sleep duration and quality (40). Furthermore, decreased sleep quality can increase pain sensitivity and severity (41). On the other hand, pain in patients with PHN often occurs in the chest, back, waist and abdomen (2). Compression of certain body parts during sleep may aggravate the patients' pain perception, increase their physiological stress response and thus affect their sleep quality. Altogether, this suggests that BLP-C may improve sleep quality by reducing pain.

The findings of the present review support that BLP-C is a safe and effective treatment for PHN. Western medicines generally have hepatorenal toxicity and elderly patients are less likely to tolerate long-term medication. Compared with Western medicine, BLP-C is performed directly on the skin and does not cause hepatorenal toxicity, which makes this treatment approach favorable for patients with weak gastrointestinal function or renal insufficiency. Collectively, the present results demonstrated that BLP-C is a promising complementary and alternative therapy for addressing pain and sleep loss in patients with PHN, particularly in those who are elderly and have poor liver and renal functions.

Although the literature on BLP-C treatment for PHN was comprehensively reviewed for the present study, certain limitations remain. First, the studies included in the present meta-analysis were of medium quality and there may be biases in the results due to language restriction. Furthermore, the subjectivity of assessors may have introduced bias. Finally, the duration of treatment varied among studies, which in turn may affect the accuracy of the results. Further studies with better design or higher quality are warranted to confirm the present findings.

In conclusion, the present systematic review showed that BLP-C is an effective therapy for reducing pain intensity and improving sleep quality in patients with PHN. The therapeutic effects of BLP-C are mediated through multiple targets and pathways, whereas Western medicine usually addresses a single target, which may explain the superior efficacy of BLP-C compared with Western medicine. Therefore, BLP-C is an effective external therapy worthy of further application in the treatment of PHN. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to ascertain these findings.

Supplementary Material

Search strategy for PubMed.
Incidence of adverse reactions.

Acknowledgements

Not applicable.

Funding

Funding: The current study was supported by the Shanghai Science and Technology Planning Project (grant no. 20Y21903100), Clinical Research Plan of Shanghai Shenkang Hospital Development Center (grant no. SHDC2020CR3102B), Shanghai Three-year Action Plan for Further Accelerating the Development of TCM [grant no. ZY(2018-2020)-ZYBZ-06] and Shanghai University of TCM Excellent Talents Training Program [grant no. TCM(2020)10].

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Authors' contributions

KW and CX conceived and designed the study and set the direction of the manuscript. WK and LX performed the literature search and KW made the final decision regarding study inclusion. WK and LX prepared the original manuscript, as well as figures and tables. YL and ZG analyzed the study data. SL visualized the study data. CX and KW reviewed and proofread the manuscript. All authors contributed to editorial changes to the manuscript. All authors have read and approved the final version of the manuscript. CX and KW have checked and approved the authenticity of the raw data.

Ethics approval and consent to participate

Not applicable.

Patient consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

References

1 

Sampathkumar P, Drage LA and Martin DP: Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clin Proc. 84:274–280. 2009.PubMed/NCBI View Article : Google Scholar

2 

Johnson RW and Rice AS: Clinical practice. Postherpetic neuralgia. N Engl J Med. 371:1526–1533. 2014.PubMed/NCBI View Article : Google Scholar

3 

Bollea-Garlatti ML, Bollea-Garlatti LA, Vacas AS, Torre AC, Kowalczuk AM, Galimberti RL and Ferreyro BL: Clinical characteristics and outcomes in a population with disseminated herpes zoster: A retrospective cohort study. Actas Dermosifiliogr. 108:145–152. 2017.PubMed/NCBI View Article : Google Scholar : (In English, Spanish).

4 

Yang F, Yu S, Fan B, Liu Y, Chen YX, Kudel I, Concialdi K, DiBonaventura M, Hopps M, Hlavacek P, et al: The Epidemiology of herpes zoster and postherpetic neuralgia in China: Results from a cross-sectional study. Pain Ther. 8:249–259. 2019.PubMed/NCBI View Article : Google Scholar

5 

Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS and Nurmikko T: EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 17:1113–e1188. 2010.PubMed/NCBI View Article : Google Scholar

6 

Dubinsky RM, Kabbani H, El-Chami Z, Boutwell C and Ali H: Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: Treatment of postherpetic neuralgia: An evidence-based report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 63:959–965. 2004.PubMed/NCBI View Article : Google Scholar

7 

Massengill JS and Kittredge JL: Practical considerations in the pharmacological treatment of postherpetic neuralgia for the primary care provider. J Pain Res. 7:125–132. 2014.PubMed/NCBI View Article : Google Scholar

8 

Mehta P and Dhapte V: Cupping therapy: A prudent remedy for a plethora of medical ailments. J Tradit Complement Med. 5:127–134. 2015.PubMed/NCBI View Article : Google Scholar

9 

Saha FJ, Schumann S, Cramer H, Hohmann C, Choi KE, Rolke R, Langhorst J, Rampp T, Dobos G and Lauche R: The effects of cupping massage in patients with chronic neck pain-a randomised controlled trial. Complement Med Res. 24:26–32. 2017.PubMed/NCBI View Article : Google Scholar

10 

Emerich M, Braeunig M, Clement HW, Lüdtke R and Huber R: Mode of action of cupping-local metabolism and pain thresholds in neck pain patients and healthy subjects. Complement Med Res. 22:148–158. 2014.PubMed/NCBI View Article : Google Scholar

11 

Guo Y, Chen B, Wang DQ, Li MY, Lim CH, Guo Y and Chen Z: Cupping regulates local immunomodulation to activate neural-endocrine-immune worknet. Complement Ther Clin Pract. 28:1–3. 2017.PubMed/NCBI View Article : Google Scholar

12 

Price DD, McGrath PA, Rafii A and Buckingham B: The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 17:45–56. 1983.PubMed/NCBI View Article : Google Scholar

13 

Buysse DJ, Reynolds CF III, Monk TH, Berman SR and Kupfer DJ: The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res. 28:193–213. 1989.PubMed/NCBI View Article : Google Scholar

14 

Gao J, Lou Z and Yu L: Therapeutic effects of acupuncture and pricking blood with cupping combined with Taohong Siwu decoction on herpes zoster and its effect on sequelae neuralgia. Shi Jie Zhong Yi Yao. 14:2163–2165. 2019.(In Chinese).

15 

Liu F: A clinical analysis of treating post-herpetic neuralgia by blood-letting puncture and cupping. Zhong Guo Lin Chuang Yan Jiu. 11:72–73. 2019.

16 

Lu Y, Xiao H and Chen R: Clinical study of acupuncture checkpoint combined with lancet cupping in the treatment of postherpetic neuralgia in elderly people. Hubei Zhong Yi Yao Za Zhi. 41:49–51. 2019.(In Chinese).

17 

Ma X and Zhang W: Effects of Xuefuzhuyu tablets combined with acupuncture and pricking and cupping therapy in treating postherpetic neuralgia. Yi Xue Yan Jiu Yu Jiao Yu. 30:47–50. 2013.(In Chinese).

18 

Tang Q, Wang L and Zhao Z: Silver needle combined with needle cupping for the treatment of postherpetic pain in 30 cases. Shanxi Zhong Yi Yao Da Xue Xue Bao. 42:100–106. 2019.(In Chinese).

19 

Tian H, Tian Y, Wang B, Yang L, Wang YY and Yang JS: Moxibustion, impacts of bleeding and cupping therapy on serum P. substance in patients of postherpetic neuralgia. Zhong Guo Zhen Jiu. 33:678–681. 2013.PubMed/NCBI(In Chinese).

20 

Wang S: Tonic Yang also five decoctions combined with blood pricking cupping for the treatment of postherpetic neuralgia. Jilin Zhong Yi Yao. 36:844–846. 2016.(In Chinese).

21 

Wang N, Ceng S and Yu M: Clinical observation of 39 cases of postherpetic neuralgia with fire acupuncture combined with pricking cupping. Hunan Zhong Yi Yao Za Zhi. 35:73–74. 2019.(In Chinese).

22 

Wang L, Fang Y and Li Q: Effect of pricking and cupping on serum substance P and IL-6 in patients with postherpetic neuralgia. Zhong Guo Zhong Yi Yao Xian Dai Yuan Cheng Jiao Yu. 18:92–94. 2020.(In Chinese).

23 

Wen B, Li X and Deng X: Acupuncturing umbilical ring acupoints in Zhuang medicine and lotus needle cupping stasis on AIDS patients with postherpetic neuralgia a clinical observation. Shizhen Guo Yi Guo Yao. 26:2175–2177. 2015.(In Chinese).

24 

Xing Y, Yuan J and Zhang S: Clinical study of double surround needling combined with pricking-cupping bloodletting in the treatment of senile postherpetic neuralgia. Hebei Zhong Yi. 41:587–591. 2019.(In Chinese).

25 

Yu Z, Yao X and Liang R: Clinical study on the treatment of postherpetic neuralgia by traditional Chinese medicine comprehensive therapy under the guidance of the theory of dissolving stasis communication. Hebei Zhong Yi Yao Xue Bao. 40:1021–1024. 2018.(In Chinese).

26 

Zhao Y and Li C: The efficacy of Da Chai Hu Tang and Gui Zhi Zhuo Ling Pills combined with spiny cupping in the treatment of postherpetic neuralgia was observed. Shi Yong Zhong Yi Yao Za Zhi. 29:809–810. 2013.(In Chinese).

27 

Mallick-Searle T, Snodgrass B and Brant JM: Postherpetic neuralgia: Epidemiology, pathophysiology, and pain management pharmacology. J Multidiscip Healthc. 9:447–454. 2016.PubMed/NCBI View Article : Google Scholar

28 

Fields HL, Rowbotham M and Baron R: Postherpetic neuralgia: Irritable nociceptors and deafferentation. Neurobiol Dis. 5:209–227. 1998.PubMed/NCBI View Article : Google Scholar

29 

Sommer C, Leinders M and Üçeyler N: Inflammation in the pathophysiology of neuropathic pain. Pain. 159:595–602. 2018.PubMed/NCBI View Article : Google Scholar

30 

Wang X, Yuan A and Yuan L: Research progress on the functional mechanism of Blood-letting collateral puncture and cupping therapy and its clinical application. N Chin Med. 52:128–130. 2020.

31 

Ahmed SM, Madbouly NH, Maklad SS and Abu-Shady EA: Immunomodulatory effects of Blood Letting cupping therapy in patients with rheumatoid arthritis. Egypt J Immunol. 12:39–51. 2005.PubMed/NCBI

32 

Patil S, Sen S, Bral M, Reddy S, Bradley KK, Cornett EM, Fox CJ and Kaye AD: The role of acupuncture in pain management. Curr Pain Headache Rep. 20(22)2016.PubMed/NCBI View Article : Google Scholar

33 

Chen T, Zhang WW, Chu YX and Wang YQ: Acupuncture for pain management: Molecular mechanisms of action. Am J Chin Med. 48:793–811. 2020.PubMed/NCBI View Article : Google Scholar

34 

Subadi I, Nugraha B, Laswati H and Josomuljono H: Pain relief with wet cupping therapy in rats is mediated by heat shock protein 70 and ß-endorphin. Iran J Med Sci. 42:384–391. 2017.PubMed/NCBI

35 

Tagil SM, Celik HT, Ciftci S, Kazanci FH, Arslan M, Erdamar N, Kesik Y, Erdamar H and Dane S: Wet-cupping removes oxidants and decreases oxidative stress. Complement Ther Med. 22:1032–1036. 2014.PubMed/NCBI View Article : Google Scholar

36 

Zielinski MR and Gerashchenko D: Sleep-inducing effect of substance P-cholera toxin A subunit in mice. Neurosci Lett. 659:44–47. 2017.PubMed/NCBI View Article : Google Scholar

37 

Andersen ML, Nascimento DC, Machado RB, Roizenblatt S, Moldofsky H and Tufik S: Sleep disturbance induced by substance P in mice. Behav Brain Res. 167:212–218. 2006.PubMed/NCBI View Article : Google Scholar

38 

Zilliox LA: Neuropathic pain. Continuum (Minneap Minn). 23 (2, Selected Topics in Outpatient Neurology):512–532. 2017.PubMed/NCBI View Article : Google Scholar

39 

Shyen S, Amine B, Rostom S, E L Badri D, Ezzahri M, Mawani N, Moussa F, Gueddari S, Wabi M, Abouqal R, et al: Sleep and its relationship to pain, dysfunction, and disease activity in juvenile idiopathic arthritis. Clin Rheumatol. 33:1425–1431. 2014.PubMed/NCBI View Article : Google Scholar

40 

Melikoglu MA and Celik A: Does neuropathic pain affect the quality of sleep? Eurasian J Med. 49:40–43. 2017.PubMed/NCBI View Article : Google Scholar

41 

Covarrubias-Gomez A and Mendoza-Reyes JJ: Evaluation of sleep quality in subjects with chronic nononcologic pain. J Pain Palliat Care Pharmacother. 27:220–224. 2013.PubMed/NCBI View Article : Google Scholar

Related Articles

Journal Cover

February-2024
Volume 20 Issue 2

Print ISSN: 2049-9434
Online ISSN:2049-9442

Sign up for eToc alerts

Recommend to Library

Copy and paste a formatted citation
x
Spandidos Publications style
Kui W, Xie L, Li Y, Gu Z, Liu S, Xue C and Wang K: Efficacy and safety of bloodletting puncture and cupping in postherpetic neuralgia: A systematic review and meta‑analysis. Biomed Rep 20: 30, 2024.
APA
Kui, W., Xie, L., Li, Y., Gu, Z., Liu, S., Xue, C., & Wang, K. (2024). Efficacy and safety of bloodletting puncture and cupping in postherpetic neuralgia: A systematic review and meta‑analysis. Biomedical Reports, 20, 30. https://doi.org/10.3892/br.2023.1718
MLA
Kui, W., Xie, L., Li, Y., Gu, Z., Liu, S., Xue, C., Wang, K."Efficacy and safety of bloodletting puncture and cupping in postherpetic neuralgia: A systematic review and meta‑analysis". Biomedical Reports 20.2 (2024): 30.
Chicago
Kui, W., Xie, L., Li, Y., Gu, Z., Liu, S., Xue, C., Wang, K."Efficacy and safety of bloodletting puncture and cupping in postherpetic neuralgia: A systematic review and meta‑analysis". Biomedical Reports 20, no. 2 (2024): 30. https://doi.org/10.3892/br.2023.1718