The effects of anodal tDCS on pain reduction in people with knee osteoarthritis: A systematic review and meta-analysis

Objectives

To synthesise the literature on the efficacy of primary motor cortex anodal transcranial direct current stimulation (M1-a-tDCS), as a standalone or priming technique, for pain reduction in people with knee osteoarthritis (KOA).

Methods

The systematic literature search was conducted in MEDLINE, CINAHL, Embase and CENTRAL according to PRISMA statement.

Results

Fourteen studies involving 740 people with KOA were included. In the meta-analysis, six studies compared a-tDCS alone with sham stimulation, and five studies compared a-tDCS combined with other methods with sham stimulation. We found positive effect of a-tDCS alone on pain in KOA (standard mean difference (SMD) −0.52; 95% CI, −0.78 to −0.25; P=0.001; I2 = 69%). Further, a-tDCS with other treatments showed positive effect (SMD −1.23; 95% CI, −1.59 to −0.88; P<0.001; I2 = 48%) on pain in people with KOA. This evidence showed low certainty due to a high risk of bias and imprecision.

Discussion and Conclusion

A-tDCS could be considered as standalone and an adjunct treatment for pain reduction in people with KOA. Future randomised studies should address quality issues, including small sample size, to enhance the overall certainty of the findings.

Significance

A-tDCS can be used as a standalone and adjunct treatment for KOA.

Study registration

PROSPERO number CRD42021255114