Integrative medicine, including acupuncture, dry needling, and cupping, is being used increasingly in the United States. Evidence regarding their efficacy in the management of musculoskeletal conditions is heterogeneous and subject to several limitations. Despite these limitations, acupuncture consistently has been shown to be more effective than no treatment and is relatively safe. For chronic back pain, it is recommended as a first-line noninvasive therapy. For neck pain, acupuncture provides benefits when it is combined with other treatments. Dry needling is similar to acupuncture and frequently is regarded as a form of acupuncture. Evidence similar to that for acupuncture supports the use of dry needling for patients with localized musculoskeletal pain conditions. The effects of these procedures do not appear to persist beyond 6 months. Data on maintenance treatments are sparse. Cupping refers to the application of suction on tender musculotendinous areas via various devices. It is theorized to help relieve inflammation. Wet cupping appears to decrease low back and neck pain. Patients should be referred to appropriately credentialed clinicians. Health insurance companies may not provide coverage for these therapies.
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