Synergistic pain relief in cervical radiculopathy: A randomized trial of topical methylcobalamin gel with phonophoresis and Mulligan mobilization.

Abstract

Objectives: Cervical radiculopathy is a neuropathic disorder caused by nerve root compression that presents as pain that refers to the upper limb, numbness, and weakness. The purpose of this study was to evaluate the clinical efficacy of topical MeCbl gel 6% w/w formulation by phonophoresis along with Mulligan traction/mobilization, compared to Mulligan mobilization alone.

Patients and methods: A single-blinded, randomized clinical trial was conducted in Pakistan between November 2024 and April 2025, involving 370 (consented) patients with cervical radiculopathy. Patients were randomly divided into two groups: Group A received treatment of MeCbl gel, along with phonophoresis plus Mulligan traction and mobilization, whereas Group B received Mulligan traction and mobilization with topical MeCbl gel without phonophoresis. Both groups received 12 sessions over a period of four weeks. Outcomes were measured using the validated 0-10 Numerical Pain Rating Scale (NPRS), a measure of pain intensity, and the Neck Disability Index (NDI), which measures cervical functional impairment on a scale from 0 to 50.

Results: The outcome demonstrated significantly increased pain reductions (NPRS, p < 0.01) and disability (NDI, p < 0.01) in Group A compared to Group B, along with an improvement in cervical range of motion (p < 0.02).

Conclusion: The findings of this study suggests that efficacy of MeCbl gel application by phonophoresis in combination with Mulligan manual therapy is higher when compared with conventional MeCbl gel application and Mulligan manual therapy in the treatment of cervical radiculopathy. The improved results from the use of phonophoresis are most probably due to increased absorption of medication and its deep penetration into the tissues.

Trial registration: Iranian registry of clinical trial IRCT20241220064105N2.