The efficacy of prolonged gentle massage with herbal oil versus dry cupping in nonspecific neck pain - a randomized controlled clinical trial

Introduction
Dalk Layyin Kathīr (prolonged gentle massage) with Roghan Gul-i Ākh (herbal oil containing Calotropis procera as the chief ingredient) is a potent intervention for nonspecific neck pain in the Unani system of medicine, but scientific evidence is lacking. Therefore, this study was designed to compare the efficacy and safety of Dalk Layyin Kathīr with Roghan Gul-i Ākh versus Hijama bila Shart (dry cupping) in participants of nonspecific neck pain.

Methods
This open-label randomized control trial was carried out on 40 eligible participants with nonspecific neck pain after obtaining written informed consent. In the massage group, Dalk Layyin Kathir with Roghan Gul-i Ākh was applied for 15–20 min on the neck region, while the Hijama group received dry cupping on the neck region for 8–12 min every fourth day for 21 days. The primary outcome measure was the change in neck disability index (NDI), and the secondary outcome measure was the change in neck pain severity measured on a 10-point customised visual analogue scale (VAS).

Results
The observed mean difference of NDI and VAS between both groups was -0.80 (95% CI: -3.10, 1.50, p = 0.485, Cohen's d = 0.22) and -0.10 (95% CI: -0.78, 0.58, p = 0.769, Cohen's d = 0.09) after completion of the protocol therapy, respectively.

Conclusion
The study inferred that Dalk Layyin Kathir (prolonged gentle massage) with Roghan Gul-i Ᾱkh and Hijama bila Shart (dry cupping) have comparable efficacy and safety in reducing the non-specific neck pain.