Attal 2016

Methods	Parallel RCT
Participants	Country of study: France Setting: hospital pain units Condition: lumbar radicular pain Prior management details: stable pharmacological treatment for pain and sleep disorders for at least 1 month prior to study n = 36 Age, mean (SD): active group 53.4 (8) years, sham group 51.5 (13) years Duration of symptoms: not reported Gender distribution: 17 F 18 M
Interventions	Stimulation type: rTMS and tDCS (order randomised in active group) Stimulation parameters: rTMS frequency 10 Hz; coil orientation anteroposterior induced current; 80% RMT; number of trains 30; duration of trains 10 s; ITI 20 s; total number of pulses 3000 tDCS: 2 mA intensity, 30 min Stimulation location: M1 contralateral to painful side Number of treatments: 3 stimulation visits on 3 consecutive days for each stimulation type. 3 week washout period. Control type: sham coil ‐ same sound and appearance, no control for sensory cues
Outcomes	Primary: pain NRS anchors 0 = no pain, 10 = maximal pain imaginable When taken: postintervention Secondary: BPI interference scale AEs
Notes	Funding source: The study received financial support from the Institut National de la Sante´ et de la Recherche Médicale (INSERM) COI: the authors declared no COI
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: “The 2 successive randomisations were prepared by a study nurse not involved in the running of the study or in data analysis, using validated software and a centralised randomisation schedule.”
Allocation concealment (selection bias)	Low risk	Quote: “The treatment allocation code was kept in a sealed envelope until the completion of the study.”
Adequate blinding of participants?	Unclear risk	Comment: rTMS sham described as controlling for sensory, auditory and visual cues. tDCS 2 mA intensity ‐ evidence that blinding can be inadequate at intensity of 2 mA. No formal assessment of blinding success
Adequate blinding of assessors?	Unclear risk	tDCS 2 mA intensity ‐ evidence that blinding can be inadequate at intensity of 2 mA. No formal assessment of blinding success
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: ITT analysis used and low dropout
Selective reporting (reporting bias)	High risk	Comment: point estimates for pain scores not provided ‐ only a responder analysis was presented
Free from carry‐over effects?	Unclear risk	Comment: the order of active stimulation types was randomised but it is not clear that there were not baseline differences between pre‐rTMS and pre tDCS from the presented data
Study Size	High risk	n = 36
Study duration	High risk	Comment: 5 days post intervention was the longest follow up
Other bias	Low risk	Comment: no other bias detected