Pioneering Non-Invasive Neuromodulatory Techniques for Amelioration of Radiculopathic Pain: A Systematic Review of Randomized Trials

Abstract

Radiculopathy refers to spinal nerve root issues causing pain, numbness, weakness, or reflex problems along specific nerve pathways. Numerous research endeavors have delved into the potential of non-invasive neuromodulation (NINM) for alleviating neuropathic pain stemming from diverse causes; however, its efficacy specifically in addressing radiculopathic pain remains under-explored. This systematic review offers an exhaustive synthesis of existing literature concerning the application of NINM in managing radiculopathy-induced pain. A meticulous search was conducted across four databases namely Scopus, PubMed, PEDro and The Cochrane Library up to September 2023 in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. which yielded six pertinent studies out of 75,182 studies that met the predefined inclusion criteria and underwent rigorous evaluation. Employing assessment tools such as PEDro, GRADE, and Level of Evidence, the quality and findings of these studies were critically appraised. Out of 75182 studies that were initially found, six studies (PEDro score 3-9, GRADE scores very low-high and 1B level of evidence) were found to be eligible. Three out of six studies have low bias across all domains, while one study has concerns about outcome measurement. Another study lacks information about the randomization process, and one indicates high bias in randomization and some concerns about missing outcome data bias. Although some variations existed among the research outcomes, a predominant trend highlighted a notable decrease in pain severity on Visual Analog Scale (VAS)/numeric pain rating scale with the adoption of diverse NINM methodologies. As per the inferences drawn from the review, two out of six studies exhibited highest quality followed by other studies demonstrating moderate to low quality as a whole. In summation, integrating these NINM approaches alongside conventional therapeutic strategies appears promising for enhancing the efficacy and sustainability of radiculopathic pain management.