SynthesisFrontiers in physiology2026
Transcranial direct current stimulation for pain threshold in knee osteoarthritis: a mechanism-oriented systematic review and meta-analysis of randomized controlled trials.
Synthesis in Frontiers in physiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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5 authors.
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Abstract
Background: Knee osteoarthritis (KOA) pain is increasingly recognized to involve altered central pain processing, including central sensitization and impaired descending inhibitory pathways. Transcranial direct current stimulation (tDCS) may alleviate pain by modulating cortical excitability and pain-related networks. However, evidence on pain threshold remains fragmented. Objective: To systematically evaluate the effects of tDCS on pain threshold in patients with KOA, and to assess its effects on pain intensity, physical function, walking capacity, and safety. Methods: This systematic review and meta-analysis followed PRISMA 2020. MEDLINE, Embase, Cochrane Library, and Web of Science were searched from inception to October 7, 2025 for randomized controlled trials (RCTs) involving patients with KOA. Primary outcomes consisted of pain thresholds that reflect pain sensitivity, namely pressure pain threshold (PPT), conditioned pain modulation (CPM), heat pain threshold (HPTh), and heat pain tolerance (HPTo). Secondary outcomes included pain intensity (VAS/NRS), physical function (WOMAC/KOOS), and walking capacity (6MWT/10MWT). Risk of bias was assessed using RoB 2.0. Results: Seventeen RCTs involving 1,113 participants were included. Compared with controls, tDCS significantly improved pain threshold overall (SMD = 0.55, 95% CI: 0.32 to 0.78; Conclusions: Current evidence suggests that tDCS may improve pain threshold and reduce pain intensity in patients with KOA. However, the effects on physical function remain less certain because of substantial heterogeneity and potential risk-of-bias effects. Future high-quality RCTs with mechanistic stratification and standardized stimulation and assessment protocols are warranted. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?, identifier CRD420261297687.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.