Mode of action of cupping—Local metabolism and pain thresholds in neck pain patients and healthy subjects M. Emerich, M. Braeunig, H.W. Clement, R. Lüdtke,

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Mode of action of cupping—Local metabolism and pain thresholds in neck pain patients and healthy subjects M. Emerich, M. Braeunig, H.W. Clement, R. Lüdtke, R. Huber Complementary Therapies in Medicine Volume 22, Issue 1, Pages 148-158 (February 2014) DOI: 10.1016/j.ctim.2013.12.013 Copyright © 2014 Elsevier Ltd Terms and Conditions

Figure 1 Sites of interventions and measurements on the back. (A) On each side (left and right) of the neck microdialysis filaments (dotted line) were inserted. Above one randomly selected side cupping (circle) was performed. (B) Area on the lower back where pain thresholds were measured (dot). Cupping was performed on the contralateral side (dot with circle). Complementary Therapies in Medicine 2014 22, 148-158DOI: (10.1016/j.ctim.2013.12.013) Copyright © 2014 Elsevier Ltd Terms and Conditions

Figure 2 Time course of lactate, pyruvate, glucose and glycerin (changes in standard deviations and smoothed curves) of 6 healthy volunteers and 6 neck pain patients (n=12) after cupping. Baseline is taken from the first five probes before cupping at t=0. After replacing outliers by medians the individual signals are averaged to the mean. Thick lines are local polynomial fits. Complementary Therapies in Medicine 2014 22, 148-158DOI: (10.1016/j.ctim.2013.12.013) Copyright © 2014 Elsevier Ltd Terms and Conditions

Figure 3 Lactate/pyruvate ratio of medians of area of cupping and control side (n=12). Complementary Therapies in Medicine 2014 22, 148-158DOI: (10.1016/j.ctim.2013.12.013) Copyright © 2014 Elsevier Ltd Terms and Conditions

Figure 4 (A–D) Thickness of the subcutaneous tissue above the trapezius muscle measured by ultrasound before and after cupping with a negative pressure of 200hPa. (A) Before cupping (0.47cm), (B) immediately after cupping (0.89cm), (C) 130min after cupping (0.75cm) and (D) 18h after cupping (0.56cm). Complementary Therapies in Medicine 2014 22, 148-158DOI: (10.1016/j.ctim.2013.12.013) Copyright © 2014 Elsevier Ltd Terms and Conditions

Figure 5 (A–D) Means and standard deviation of subcutaneous lactate (A), pyruvate (B), glycerin (C) and glucose (D) in neck pain patients (n=6) and healthy controls (n=6) before and up to 280min after cupping. Side differences between cupping area and control area (contralateral side of the neck) are presented. Higher values mean an increase compared to the control area. Complementary Therapies in Medicine 2014 22, 148-158DOI: (10.1016/j.ctim.2013.12.013) Copyright © 2014 Elsevier Ltd Terms and Conditions

Figure 6 Lactate/pyruvate ratio of medians of neck pain patients and healthy controls in the area of cupping (n=6). Complementary Therapies in Medicine 2014 22, 148-158DOI: (10.1016/j.ctim.2013.12.013) Copyright © 2014 Elsevier Ltd Terms and Conditions