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Abstract
Background and Aims Knee osteoarthritis (KOA) is a prevalent degenerative disease characterized by pain and functional impairment. While traditional pain management provides limited relief, Transcranial Direct Current Stimulation (tDCS) has emerged as a potential modality for non-invasive pain modulation. We conducted a systematic review and meta-analysis evaluating the efficacy of active versus sham tDCS in these patients.
Methods PubMed, EMBASE and Cochrane were searched for randomized controlled trials (RCTs) comparing active M1-SO tDCS to sham tDCS in patients diagnosed with KOA experiencing chronic pain. We assessed WOMAC (Western Ontario and McMaster Universities Osteoarthritis) index and pain score changes in different time points following treatment sessions. RevMan 5.4 and the RoB-2 tool were used for statistical analyses and risk of bias evaluation, respectively.
Pain scores reduction from baseline to the end of treatment significantly favoured the a-tDCS group
The reduction in pain scores from three to five weeks showed favourable results for the a-tDCS intervention
The a-tDCS group showed more significant reduction in WOMAC index following treatment when compared to sham tDCS
Results We pooled 9RCTs including 476 patients, 50% undergoing active tDCS. The initial assessment, comparing treatment-end pain scores with baseline scores revealed a significantly favorable effect for tDCS (figure 1). Two additional measurements were conducted after the conclusion of the treatment. The first, performed after 3-5 weeks, revealed significantly reduced scores in the active tDCS group (figure 2). The second, conducted after 2-3 months, indicated no statistically significant differences (Mean Difference -0.65; 95%CI -1.35 to 0.05; p<0.07; I2=49%; 3RCTs; 278 patients). Regarding the WOMAC scores, active tDCS also exhibited a significant decrease in comparison to the control group (figure 3).
Conclusions Our findings suggest that active tDCS holds promise as an adjunctive therapy to standard pain management of chronic pain in knee OA as it may decrease pain and increase function.