Efficacy of electroacupuncture for painful cervical spondylotic radiculopathy and associated changes in cervical biomechanical measures: a study protocol for a randomized, sham-controlled clinical trial

Painful cervical radiculopathy due to cervical spondylosis (painful CSR) is characterized by radicular pain and neurological dysfunction. Conservative care commonly includes medication and physical therapy, but evidence for individual nonsurgical interventions remains uncertain. Electroacupuncture (EA) is a non-pharmacological option, but rigorous sham-controlled evidence in painful CSR remains limited. This trial aims to compare the complete EA protocol with the selected SEA protocol and to characterize accompanying changes in prespecified cervical biomechanical measures. This single-center, randomized, sham-controlled trial will enroll 80 participants with painful CSR and randomly assign them 1:1 to EA or SEA. Participants, outcome assessors, and the data analyst will be blinded. Both groups will receive identical standardized common care, with EA or SEA delivered in 20 sessions over 4 weeks, followed by 24 weeks of post-treatment follow-up. The primary outcome is the Week-4 Visual Analog Scale (VAS) score, analyzed with adjustment for baseline VAS. Supportive key secondary outcomes are the Week-4 Neck Disability Index (NDI) and Week-4 mean resting upper-trapezius shear-wave speed (SWS) on the primary symptomatic side. Other secondary outcomes include ultrasound- and surface electromyography (sEMG)-derived biomechanical measures, Patient Global Impression of Change (PGIC), rescue-medication use, and the Short Form Health Survey (SF-36). Adverse events will be recorded through Week 28. This trial will estimate the comparative clinical effects of the complete EA protocol relative to the selected SEA protocol and assess whether prespecified cervical biomechanical measures change alongside clinical outcomes. The findings may inform future evaluation of EA as a non-pharmacological treatment for painful CSR. The Chinese Clinical Trial Registry identifier is ChiCTR2300075726. Neck pain can spread into one arm and interfere with daily life. It can happen when a nerve in the neck is irritated or pressed on, sometimes causing numbness or weakness. Medicines and physical therapy are often used, but the benefits of individual treatments remain uncertain. This makes it important to study other options. Acupuncture has been studied for this condition, but the available evidence is limited. It is still unclear whether electroacupuncture can reduce pain more than a look-alike procedure. In our study, we will invite adults with this type of neck and arm pain to join. We will compare two groups: one receiving electroacupuncture, which uses thin needles and a gentle electrical current, and the other receiving a look-alike procedure with blunt needles that do not enter the skin and no electrical current. Everyone will receive the same advice about neck health and posture and the same supervised neck exercises. After 20 treatment sessions over four weeks, we will compare pain levels. We will follow participants for another 24 weeks and record any unwanted effects throughout the study. We will also assess daily activities and pain medicine use. Ultrasound scans will examine neck muscles and nerves, while sensors placed on the skin will record muscle activity. The findings may help patients and healthcare professionals make better-informed decisions about electroacupuncture for this type of neck and arm pain.