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Randomized Controlled Trial
. 2025 Jul 14;22(1):160.
doi: 10.1186/s12984-025-01692-y.

Effects of transcranial direct current stimulation combined with acupuncture therapy on brain network functional connectivity in patients with knee osteoarthritis: a single-center randomized controlled trial

Qiu Nie #  1 , Fang He #  1 , Linghui Dong #  2 , Xikai Lin  3 , Jingyi Lin  1 , Yinxu Wang #  4 , Yulei Xie #  5   6
Affiliations
Randomized Controlled Trial

Effects of transcranial direct current stimulation combined with acupuncture therapy on brain network functional connectivity in patients with knee osteoarthritis: a single-center randomized controlled trial

Qiu Nie et al. J Neuroeng Rehabil. .

Abstract

Background: In this study, we investigated the effects of transcranial direct current stimulation (tDCS) combined with acupuncture therapy on pain, dysfunction and functional connectivity in patients with knee osteoarthritis (KOA), and to evaluate its potential therapeutic value.

Method: In this single-center, randomized controlled trial, patients were recruited from May 2023 to August 2024 from the Departments of Rehabilitation, Orthopedics, and Pain Management at the Affiliated Hospital of North Sichuan Medical College. The patients were randomly assigned to three groups, including the acupuncture group, the tDCS group, and the combined acupuncture and tDCS group. All treatments were administered five times a week for two weeks. The condition of the patients was evaluated by the visual analog scale (VAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Lequesne index, and functional near-infrared spectroscopy (fNIRS) before treatment and after two weeks of treatment, respectively.

Results: In total, 63 patients were enrolled and randomly assigned to three groups. Three patients were excluded for work-related reasons, fear of acupuncture, or time conflicts repectively, which prevented further follow-up. The VAS score, WOMAC score, and Lequesne indexes of all patients were significantly lower after treatment than before treatment (P < 0.01). Compared to the tDCS group and the acupuncture group, the combined group showed greater improvements in the VAS score, WOMAC score, and Lequesne indexes (P < 0.05). The fNIRS results indicated a significant reduction in the mean cerebral functional connectivity strength based on oxyhemoglobin (HbO2) and deoxyhemoglobin (HbR) across all three groups following treatment (P < 0.05). The functional connectivity strengths of the HbO2-based LPFC ~ LPFC, RPFC ~ RPFC, LMC ~ LMC, RMC ~ RMC, LPFC ~ RPFC, LPFC ~ LMC, LPFC ~ RMC, RPFC ~ LMC, RPFC ~ RMC, LMC ~ RMC; HbR-based LPFC ~ LPFC, RPFC ~ RPFC, LMC ~ LMC, RMC ~ RMC, LPFC ~ LMC, LPFC ~ RMC and LMC ~ RMC in the combined group were significantly lower than those in the acupuncture group (P < 0.05).The HbO2-based LPFC ~ LPFC, RPFC ~ RPFC, LMC ~ LMC, and RMC ~ RMC in the combined group were significantly lower than those in the tDCS group (P < 0.01). Compared to those in the acupuncture group, the HbR-based LPFC ~ LPFC and LMC ~ LMC of the patients in the tDCS group were lower (P < 0.05).

Conclusions: The combination therapy of tDCS and acupuncture is better than monotherapy in relieving pain and dysfunction in patients with KOA. The improvement in efficacy may be related to the reduction in brain functional connectivity and may become a new treatment method for treating KOA.

Trial registration: ChiCTR2300073819.

Keywords: Acupuncture therapy; Functional near-infrared spectroscopy (fNIRS); Knee osteoarthritis (KOA); Transcranial direct current stimulation (tDCS).

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Conflict of interest statement

Declarations. Ethics approval: This study involves human participants and was carried out in accordance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects. The protocol was approved by the Ethics Committee of our hospital (2023ER145-1). Participants gave informed consent to participate in the study before taking part. Disclaimer: The funder was not involved in the study design, data analysis or interpretation. Patient and public involvement: Patients and/or the public were not involved in the design, conduct, reporting, or dissemination plans. Patient consent for publication: Consent obtained from Patient/family member. Provenance and peer review: Not commissioned; externally Peer Reviewed. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT (Consolidated Standards of Reporting Trials) flow diagram. tDCS, transcranial direct current stimulation
Fig. 2
Fig. 2
A: Results of the VAS; B: Results of the WOMAC; C: Results of Lequesne. Note: Pre, before treatment; Post, after treatment; Comparison between the values obtained in each group before and post treatment: *P < 0.05, and **P < 0.01. Comparisons between groups: #P < 0.05, and ##P < 0.01
Fig. 3
Fig. 3
Whole-brain mean functional connectivity strength in the three groups. A: Comparing functional connectivity of homologous brain networks based on HbO2. B: Comparing functional connectivity of heterologous brain network based on HbO2. C: Comparing functional connectivity of homologous brain networks based on HBR. D: Comparing functional connectivity of heterologous brain network based on HBR. Note: tDCS, transcranial direct current stimulation; Pre, before treatment; Post, after treatment. Comparison between before and post intervention values in each group: **P < 0.01
Fig. 4
Fig. 4
Statistical analysis of the differences in the strength of functional connectivity of each network in the cerebral cortex in the three groups. A: Strength of homologous brain network connections after treatment based on HbO2. B: Strength of heterologous brain network connections after treatment based on HbO2. C: Strength of homologous brain network connections after treatment based on HBR. D: Strength of heterologous brain network connections after treatment based on HBR. Note: tDCS, transcranial direct current stimulation; LPFC, left prefrontal lobe; RPFC, right prefrontal lobe; LMC, left primary motor corte; RMC, right primary motor cortex; LOL, left occipital lobe; ROL, right occipital lobe. Comparison between group difference: #P < 0.05, ##P < 0.01
See this image and copyright information in PMC

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