Background. Cupping therapy is one of the treatments for myofascial pain that has not been sufficiently studied. This study aimed to compare the effects of cupping massage and exercise training on pain, disability and Fatigue severity in patients with trapezius myofascial syndrome. Patients and methods. Forty-four patients were randomly divided into two groups of cupping massage and conventional exercise training. The outcome measure included pain intensity, disability, and fatigue. The duration of intervention was 4 weeks (3 times a week) for both groups. The intervention included moving cup with negative pressure on the trapezius muscle for 5 minutes in each session in the cupping group and strengthening and stretching exercises for trapezius muscle in the exercise group. Questionnaires were completed and analyzed immediately after the last intervention session and three months later. Results. Immediately after the intervention and three months later, in both groups, pain, disability and fatigue severity were significantly reduced (P value < 0.01). These changes were significantly greater in the cupping group than in the exercise group (P value < 0.01). Conclusions. Massage cupping should be considered as a feasible, safe, fast, and effective method for patients with trapezius pain syndrome, also, can be combined with other rehabilitation programs in the treatment of myofascial pain and muscle strain.