Cupping therapy side effects: what's normal, what isn't, and who should avoid it

Cupping is, by most measures, a low-risk treatment. Dry cupping on healthy skin rarely causes anything worse than a mark and a day of tenderness. But low risk is not no risk, and the difference between a harmless session and a problem usually comes down to who is being treated, what kind of cupping is used, and whether the person applying it knows when to stop.

This article separates the effects you should expect from the ones you should not, explains why certain people are told to avoid cupping, and sets out when to seek help. It is part of our complete guide to cupping therapy.

Normal effects after cupping

• Circular marks. The signature of cupping. They range from pink to deep purple and fade over a few days to two weeks. They are caused by blood leaking from stretched capillaries under suction rather than by a crushing injury, which is why they are less tender than a bruise of the same colour. See cupping marks and what the colours mean.
• Tenderness for a day or two, similar to the feeling after a firm massage.
• Redness and warmth. Skin blood flow rises many times above baseline during and after cupping [1], so the area is often flushed for an hour or more.
• Raised skin in a ring where the cup rim sat, settling within hours.
• Tiredness or light-headedness, particularly after a first or long session. Sitting quietly for a few minutes usually resolves it.
• Mild itching as a mark fades.

This matches what trials report. In the largest meta-analysis of cupping for chronic pain, adverse events were more common with cupping than with no treatment, but not significantly different from sham or active treatments [2]. In neck pain trials, reported adverse events were mostly mild and temporary [3].

Uncommon effects

• Blisters. Blisters under or at the edge of a cup result from too much suction, too long an application, or fragile skin. They are the most common sign that a treatment has been overdone, and blister (bulla) formation appears in the published lists of cupping adverse events [7].
• Skin infection. Rare with dry cupping on intact skin, but possible if the skin is broken, cups are not cleaned between people, or a blister is opened.
• Fainting (vasovagal syncope). Reported in a few trial participants, particularly with wet cupping [5]. Treating lying down, with a short first session, reduces the risk.
• Burns. Specific to fire cupping. An Australian burns registry review found cupping-related burns were rare but mostly serious: almost all were flame burns involving an accelerant such as methylated spirits, most happened at home, and many needed surgery [6]. Pump and electric cupping carry no such risk.
• Skin changes. Persistent darkening (hyperpigmentation) can follow repeated cupping of the same area. Scarring is rare and generally associated with wet cupping or burns [7].
• Anaemia. Reported in people receiving frequent wet cupping, where blood loss adds up [4]. Not a concern with dry cupping.

Rare but serious complications

Serious harm from cupping is rare enough that it is documented mainly in case reports. A 2025 review in Complementary Medicine Research found fourteen patients in the literature with neurological complications linked to cupping, either vascular (bleeding in or around the brain or spinal cord) or infectious. Half involved cupping combined with other manual therapies, and most patients had no known underlying condition [8]. The authors' conclusion was not that cupping is dangerous, but that practitioners need to be aware of these cases and keep cups away from vulnerable structures: the front or sides of the neck, directly over the spine, and the head.

Who should avoid cupping, and why

Lists of contraindications are easy to find and rarely explained. Here is the reasoning behind each, drawing on a 2018 overview in the Journal of Acupuncture and Meridian Studies, which separates absolute contraindications from relative ones [7].

Do not cup

• Bleeding disorders such as haemophilia. Cupping draws blood into stretched tissue and, at higher pressures, out of small vessels. In someone whose blood does not clot normally, that leakage can be far larger than intended and can continue after the cup comes off.
• Organ failure (heart, kidney or liver). These conditions affect fluid balance, clotting and the ability to cope with physiological stress. The risk is poorly quantified, which is exactly why the advice is to avoid cupping.
• Cancer, particularly near the treatment area. Cupping increases local blood and lymphatic flow, and the effect on a tumour is unknown. Do not use it without the oncology team's agreement.
• Pacemakers and implanted devices. Listed as an absolute contraindication in the overview [7]. The concern is with electrical cupping devices and with cups over the device site.

Do not cup these areas, on anyone

• Broken, infected, inflamed or sunburnt skin, and skin affected by eczema, psoriasis or a rash.
• Varicose veins, and any area with a known or suspected deep vein thrombosis (a clot in a deep vein), which suction could in theory dislodge.
• Open wounds, recent scars and recent fractures.
• Large superficial arteries, nerves or lymph nodes: the front and sides of the neck, armpit, groin, inside of the elbow and back of the knee.
• The eyes, any body orifice, and the abdomen and lower back in pregnancy.

Cup only with medical advice

• Anticoagulant and antiplatelet medicines. Discussed below.
• Acute infection or fever. Wait until you are well.
• Severe long-term conditions such as heart disease, uncontrolled diabetes or peripheral vascular disease. In diabetes, slower healing and reduced skin sensation raise the risk of unnoticed damage.
• Anaemia, recent blood donation or recent wet cupping, mainly relevant to wet cupping.
• Epilepsy or a history of fainting. Treat lying down and watch the person.
• Very fragile or thin skin, including in older people and those on long-term steroids, which can blister at suction levels others tolerate.

Cupping and blood-thinning medicines

This is the interaction that matters most in practice, because so many UK adults take a medicine that affects clotting: warfarin, the direct oral anticoagulants (apixaban, rivaroxaban, edoxaban and dabigatran), heparin, or antiplatelet drugs such as aspirin and clopidogrel.

The NHS lists severe bruising among the signs of excessive bleeding on anticoagulants and advises seeking medical attention for any severe or recurrent bleeding [9]. Cupping deliberately causes small vessels to leak. In someone whose clotting is slowed by medication, the result is darker, larger and longer-lasting marks at best, and uncontrolled bleeding into the tissue at worst. Antiplatelet drugs and regular anti-inflammatory painkillers have a milder version of the same effect.

If you take any of these medicines, do not use cupping at home, and tell any practitioner before they treat you. Some will proceed with very light suction after discussion with your GP or anticoagulant clinic; many will decline. Wet cupping should not be carried out at all.

Cupping in pregnancy

Pregnancy is listed as a relative contraindication [7]. The standard advice is to avoid cupping of the abdomen, lower back and inner thighs throughout pregnancy, and to avoid cupping altogether in the first trimester. There is no good research either way; the caution reflects an absence of safety data rather than evidence of harm. Some therapists use light cupping on the upper back and shoulders in later pregnancy. Discuss it with your midwife or GP first, and do not self-treat.

Cupping and children

The research base in children is close to non-existent, and the overview we have drawn on does not address them [7]. Children's skin is thinner and more easily damaged, and they cannot always describe what they are feeling. Cupping has no place in home treatment of children, and any use in adolescents should be by a practitioner with paediatric experience. Home cupping sets, including ours, are intended for adults.

When to stop a session

Release the cups immediately if any of the following occur:

• Sharp, burning or stabbing pain under the cup, rather than a pulling sensation.
• Numbness, pins and needles or weakness in a limb.
• The skin under the cup turning very dark within the first minute or two, or blistering.
• Dizziness, nausea, sweating, pallor or feeling faint. Lie the person flat with legs raised until it passes.
• Any bleeding through the skin with dry cupping.

The way to avoid most of these is to start with less suction and less time than you think you need. A pump set lets you add pressure one stroke at a time and release it instantly; the Hansol sets in our cupping collection work this way, and our guide to using a cupping set at home explains how to build up.

When to seek medical help afterwards

See a pharmacist, GP or NHS 111 if:

• A blister is large, very painful, or shows signs of infection (spreading redness, warmth, pus, fever).
• A mark keeps growing after the cup is removed, or bruising appears in areas that were not cupped.
• Marks are far darker or last far longer than expected, especially if you take a medicine that affects clotting. St John Ambulance advises seeking medical attention for a bruise that has not gone after three weeks [10].
• Numbness, tingling, weakness or severe pain persists after the session.
• You develop a severe headache, confusion, neck stiffness, difficulty speaking or one-sided weakness at any point after cupping. These are emergency symptoms. Call 999.

Putting the risks in proportion

Everything above applies to dry cupping. Wet cupping, including hijama, adds skin incisions and blood loss, and with them the risks of infection, blood-borne virus transmission if equipment is reused, scarring and anaemia. It belongs only with trained, insured practitioners, as we explain in dry cupping vs wet cupping (hijama).

For a healthy adult receiving dry cupping with sensible suction, the expected outcome is a few marks, a little tenderness and nothing else. The serious complications in the literature cluster around fire cupping, wet cupping, cupping of the neck and head, and people with bleeding disorders, anticoagulant use or significant illness. Avoid those situations and the risk is low. If you are unsure which side of the line you fall on, ask a GP or practitioner first, and see our complete guide to cupping therapy for the wider picture.

References

1. Wang X, Zhang X, Elliott J, Liao F, Tao J, Jan YK. Effect of pressures and durations of cupping therapy on skin blood flow responses. Frontiers in Bioengineering and Biotechnology. 2020;8:608509. Full text
2. Cramer H, Klose P, Teut M, et al. Cupping for patients with chronic pain: a systematic review and meta-analysis. The Journal of Pain. 2020;21(9-10):943-956. PubMed
3. Kim S, Lee SH, Kim MR, et al. Is cupping therapy effective in patients with neck pain? A systematic review and meta-analysis. BMJ Open. 2018;8(11):e021070. Full text
4. Kim TH, Kim KH, Choi JY, Lee MS. Adverse events related to cupping therapy in studies conducted in Korea: a systematic review. European Journal of Integrative Medicine. 2014;6(4):434-440. Record
5. Kim JI, Lee MS, Lee DH, Boddy K, Ernst E. Cupping for treating pain: a systematic review. Evidence-Based Complementary and Alternative Medicine. 2011;2011:467014. Full text
6. Seifman MA, Alexander KS, Lo CH, Cleland H. Cupping: the risk of burns. Medical Journal of Australia. 2017;206(11):500. Full text
7. Aboushanab TS, AlSanad S. Cupping therapy: an overview from a modern medicine perspective. Journal of Acupuncture and Meridian Studies. 2018;11(3):83-87. Full text
8. Daneshfard B, Sadeghi S, Cordato D. Neurological complications of cupping therapy: a comprehensive review. Complementary Medicine Research. 2025;32(2):151-159. Abstract
9. NHS. Side effects: anticoagulant medicines. Page last reviewed September 2024. nhs.uk
10. St John Ambulance. Bruises: first aid advice. Clinically reviewed April 2025. sja.org.uk

This article is for general information only and is not medical advice. Always follow the instructions supplied with your equipment, and consult a qualified healthcare professional if you have a medical condition or are unsure whether a treatment is right for you.