The Use of Wet Cupping for Persistent Nonspecific Low Back Pain: Randomized Controlled Clinical Trial.

OBJECTIVES: To evaluate the effectiveness and safety of wet cupping therapy as a single treatment for persistent nonspecific low back pain (PNSLBP). DESIGN: Randomized controlled trial comparing wet cupping versus no treatment in PNSLBP. SETTING: Outpatient clinic in three secondary care hospitals in Saudi Arabia. PATIENTS: Eighty eligible participants with PNSLBP for at least 3 months were randomly allocated to an intervention group (n=40) or to a control group (n=40). INTERVENTIONS: Six wet cupping sessions within 2 weeks, each of which were done at two bladder meridian (BL) acupuncture points among BL23, BL24, and BL25. Only acetaminophen was allowed as a rescue treatment in both groups. OUTCOME MEASURES: The Numeric Rating Scale (NRS), McGill Present Pain Intensity (PPI), and Oswestry Disability Questionnaire (ODQ) were used as outcome measures. Numbers of acetaminophen tablets taken were compared at 4 weeks from baseline. Adverse events were recorded. RESULTS: At the end of the intervention, statistically significant differences in the three outcome measures favoring the wet cupping group compared with the control group were seen: NRS score, 29.2 (95% confidence interval [CI], 24.6-33.8) versus 57.9 (95% CI, 53.3-62.6), respectively; PPI score, 1.17 (95% CI, 0.96-1.4) versus 2.3 (95% CI, 2.1- 2.7); and ODQ score, 19.6 (95% CI, 16.5-22.7) versus 35.4 (95% CI, 32.3-38.5) (p=0.0001). This improvement continued for another 2 weeks after the end of the intervention. Acetaminophen was used less in the wet cupping group, but this difference was not statistically significant. No adverse events were reported. CONCLUSIONS: Wet cupping is potentially effective in reducing pain and improving disability associated with PNSLBP at least for 2 weeks after the end of the wet cupping period. Placebo-controlled trials are needed.

Ozone therapy in postgraduate theses in Egypt: systematic review.

BACKGROUND: Systematic reviews of the studies published in the major medical data bases have not shown solid support for the use of ozone therapy. Unpublished or grey literature, including postgraduate theses, may solve this controversy. OBJECTIVES: To review the postgraduate theses published in Egypt in order to assess the clinical safety and effectiveness of ozone therapy in specific medical conditions. METHODS: The databases of the Egyptian Universities' Library Consortium and the databases of each university were searched for postgraduate theses that evaluated ozone therapy as an intervention for any disease or condition in any age group, compared with any or no other intervention and published before September 2010. RESULTS: A total of 28 quasi trials were included. The theses did not report any safety issues in terms of ozone therapy. With respect to its effectiveness, the studies suggested some benefits of ozone in the treatment of dental infection and recovery, musculoskeletal disorders, diabetes mellitus, chronic diseases, and obstetrics and gynaecology. However, the number of studies included was small and they were of limited quality. CONCLUSION: There is insufficient evidence to recommend the use of ozone in the treatment of dental infections, in facilitating faster dental recovery after extraction or implantation, in diabetes mellitus, musculoskeletal disorders, or obstetrics and gynaecology.

The use of and out-of-pocket spending on complementary and alternative medicine in Qassim province, Saudi Arabia.

BACKGROUND AND OBJECTIVES: The current picture of the Saudis' use of complementary and alternative medicine (CAM) has not yet been developed. The aim of this study was to assess the feasibility of using the international questionnaire to measure use of complementary and alternative medicine (I-CAM-Q) in Saudi Arabia to evaluate the use of and out-of-pocket spending on CAM. DESIGN AND SETTINGS: It was a cross-sectional study, conducted in 2011, in primary health care centers in Qassim. METHODS: In a multistage sampling technique, 12 primary health care centers were selected randomly in the Al-Qassim province in Saudi Arabia. From each center, 100 attendants were interviewed for a total of 1160 completed questionnaires. RESULTS: A total of 74% of subjects had visited CAM providers in 12 months before the survey. This percentage decreased to 47.6% when spiritual healers were excluded. The specific CAM providers who were visited were spiritual healers (26.7%), herbalists (23.2%), providers of honeybee products (14.9%), and hijama (wet cupping; 13%). Chronic illnesses were the main reason for the visits. A total of 50% of subjects were satisfied with their visit. Physicians were the providers of CAM for 11.3% of the participants. More than 75% of the subjects used herbs in the previous 12 months for medical and health reasons, while only 25% used vitamins or minerals. Self-help was used in 26% of the participants. Relaxation (10.3%) was the most common self-CAM practice followed by meditation (6.7%). The subjects spent 350000 (US$) on CAM visits and 300000 (US$) purchasing CAM products. CONCLUSIONS: I-CAM-Q can be used in different populations and cultures in the East including Saudi Arabia after customization to overcome its limitations, as the questionnaire was developed in Western societies.