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April 1, 2026Open Access

Effects of transcranial direct current stimulation and neural mobilization on pain and disability in people with chronic radicular pain: a protocol for a sham-controlled randomized trial

AFAryostennes Miquéias da Silva FerreiraUniversidade Federal do Rio Grande do Norte CSCésar Augusto Medeiros SilvaUniversidade Federal do Rio Grande do Norte RFRodrigo Pegado de Abreu FreitasUniversidade Federal do Rio Grande do Norte

Key Points

This study aims to evaluate the combined effects of transcranial direct current stimulation and neural mobilization on pain and disability in chronic radicular pain.
Participants are divided into two groups: active tDCS + neural mobilization and sham tDCS + neural mobilization.
Primary outcome measured is pain intensity using a numerical pain scale.
Secondary outcomes include disability and neuropathic symptoms assessed by specific questionnaires.
Assessments occur before and after a five-day intervention, with follow-ups at 7 and 14 days.
Data analysis includes normality tests and repeated measures ANOVA.
The study is expected to show a significant reduction in pain intensity in the experimental group compared to the control group.
Improvements in disability levels are anticipated based on secondary outcomes measurement.
Potential benefits of tDCS in alleviating neuropathic symptoms will be explored.

Abstract

Radicular pain is a very common condition that occurs when spine discopathy leads to nerve root damage; it radiates to the leg with somatotopic distribution. It could cause high levels of pain and disability. When it becomes chronic, central sensitization may be present, which can lead to neuropathic pain. Neural mobilization is a manual approach recommended for the treatment of this condition. Transcranial direct current stimulation (tDCS) has emerged as an alternative treatment for neuropathic chronic pain in an attempt to modulate brain function. The aim of this study is to verify if the effects of tDCS add benefits in decreasing pain intensity, neuropathic symptoms, and disability in individuals with chronic radicular pain when associated with neural mobilization. It is a protocol for a randomized controlled trial to be conducted with individuals with chronic radicular pain divided in two groups: Experimental group (active tDCS + neural mobilization) and control group (sham tDCS + neural mobilization). The primary outcome will be pain intensity, measured through the numerical pain scale; secondary outcomes are disability, assessed by Roland Morris, and neuropathic symptoms, assessed by Douleur Neuropathique Questionnaire and Pain Detect Questionnaire, range of motion on the Single Leg Raise Test, pressure pain threshold, and two-point discrimination. Perceived Global Effect Scale will also be used. The assessment will be performed before and after the five consecutive days’ intervention protocol and at 7 and 14 days of follow-up for pain intensity. Data will be analyzed by SPSS software; Kolmogorov-Smirnov and Levene tests will be applied to verify the normality and homogeneity of the sample. Then, a repeated measure ANOVA will be performed for comparison over time. A statistical significance level of 5% and a 95% confidence interval will be assumed. This study would elucidate the possible tDCS effects on radicular pain, which could be pointed out as a new therapeutic tool for this difficult management condition. RBR-2d3jj9t/U1111-1289-8248 REBEC. Registered on 04/06/2023

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