Wet Cupping (Hijama) as a Non-Pharmacological Approach for the Management of Musculoskeletal Pain and Inflammation

Author(s): Md Balal Hossain, Md Noman Azam, Sonya Ghosh, Musomi Khandaker, Most. Raihanul Jannat Roshni, Md Samiul Bashir

Background: Musculoskeletal pain is a leading cause of chronic disability and functional limitation. Due to limitations and adverse effects associated with long-term pharmacological therapy, non-pharmacological interventions such as wet cupping (Hijama) are increasingly being explored for pain and inflammation management. Objective: To evaluate clinical effectiveness, inflammatory response, and safety of wet cupping (Hijama) in patients with musculoskeletal pain.
Methods: A cross-sectional study was conducted among 180 patients with musculoskeletal pain between March 2025 and June 2025. Pain severity was assessed using the Visual Analogue Scale (VAS), and functional outcome in knee osteoarthritis was evaluated using the KOOS score. Inflammatory markers (CRP, ESR, serum uric acid) and biochemical safety parameters (ALT, AST, ALP, hemoglobin) were measured at baseline and after four weeks of wet cupping therapy. Paired statistical tests were applied to compare pre- and post-treatment values. Multivariable linear regression analysis was performed to identify predictors of pain reduction.

Results: A significant reduction in pain severity was observed across all musculoskeletal conditions following wet cupping therapy. Mean VAS scores decreased significantly in cervical spondylosis (7.8 ± 0.9 to 3.9 ± 0.8), low back pain (7.6 ± 0.8 to 4.0 ± 0.7), frozen shoulder (7.7 ± 0.7 to 3.8 ± 0.6), and sciatic pain (8.1 ± 0.6 to 4.1 ± 0.8) (p < 0.001 for all). Functional improvement was demonstrated by a significant increase in KOOS scores among knee osteoarthritis patients (48.2 ± 4.1 to 66.8 ± 3.2, p < 0.001). Inflammatory markers showed significant improvement, with CRP levels decreasing from 3.6 ± 1.1 mg/L to 2.7 ± 0.9 mg/L and ESR from 29.4 ± 8.2 mm/hr to 21.6 ± 7.1 mm/hr (p < 0.001 for both). Serum uric acid levels demonstrated a non-significant reduction (5.8 ± 1.0 to 5.6 ± 0.9 mg/dL; p = 0.08). Biochemical parameters including ALT, AST, and ALP showed mild but statistically significant reductions (p < 0.05), while hemoglobin levels remained unchanged, indicating good safety and tolerability. Multivariable regression analysis identified baseline CRP (β = 0.44, p < 0.001), duration of pain (β = 0.38, p < 0.001), male gender (β = 0.31, p = 0.002), and age (β = 0.02, p = 0.01) as independent predictors of pain reduction following wet cupping therapy.
Conclusion: Wet cupping (Hijama) is an effective and well-tolerated non-pharmacological intervention for musculoskeletal pain, demonstrating significant improvement in pain severity, functional outcomes, and inflammatory markers.