Neuromodulation techniques show promise for pain and function in knee osteoarthritis, but evidence is low certaintyNeuromodulation Shows Promise for Managing Knee Osteoarthritis Pain

Frontiers in Medicine Published July 16, 2026 DOI ↗ Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain

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Key Takeaway

Consider neuromodulation as an adjunctive option for KOA, but note low certainty and need for standardized protocols.

This scoping review synthesized evidence from 23 studies (18 RCTs, 3 self-controlled before-after trials, 1 retrospective case series, 1 cross-sectional study) on neuromodulation for knee osteoarthritis (KOA). Interventions included peripheral techniques (TENS, NMES, PNS, electroacupuncture, electrical dry needling, tVNS), central techniques (tDCS), and combined approaches (TENS + tDCS). All techniques demonstrated certain efficacy for pain relief and functional improvement, but no pooled effect sizes were reported.

The authors note several limitations: intervention protocols varied widely, optimal parameters are not standardized, and there are deficiencies in long-term efficacy evaluation and mechanism exploration. The evidence is considered low certainty due to heterogeneity and lack of standardized protocols.

Practice relevance: Neuromodulation shows promise as a non-pharmacological strategy for KOA, but standardized clinical protocols are not yet established, and long-term efficacy is not fully evaluated. Clinicians should interpret these findings cautiously and await more rigorous, large-scale studies with uniform protocols.

How this fits prior evidence

This scoping review extends prior coverage of non-pharmacological interventions for knee osteoarthritis. It complements findings that TENS reduces pain (MD -0.82) and improves muscle strength, and that mind-body exercises like Tai Chi and Wuqinxi reduce pain while Pilates and Baduanjin improve physical function. The review broadens the scope to include multiple neuromodulation techniques but confirms the need for standardized protocols and long-term data, consistent with limitations noted in prior coverage of TENS and other modalities.

Researchers looked at 23 different studies to see how neuromodulation affects people with knee osteoarthritis. Neuromodulation involves using electrical currents to affect the nervous system. The methods studied included several types of peripheral stimulation, such as TENS and electroacupuncture, as well as central stimulation like tDCS.

The review found that all of these techniques showed some effectiveness in reducing pain and improving physical function. Because these methods do not involve medication, they are being looked at as potential non-drug options for managing the symptoms of joint wear and tear.

However, there are reasons to be cautious about these results right now. The studies used very different settings and protocols, and there is not enough data on how well these treatments work over a long period of time. Because the evidence is currently limited and inconsistent, it is not yet clear which specific method works best for every patient.

What this means for you:

Neuromodulation shows promise for knee pain, but more large studies are needed to establish standard treatments.

Common questions

What is neuromodulation for knee pain?

Neuromodulation uses electrical currents to affect the nervous system. In this review, it included several types of stimulation like TENS, electroacupuncture, and tDCS. These methods are being studied as non-pharmacological ways to help people with knee osteoarthritis manage their daily pain and improve their physical movement.

Is neuromodulation effective for osteoarthritis?

The review of 23 studies found that all the techniques tested showed some effectiveness in providing pain relief and improving function. However, because the study types were varied and protocols were not standardized, the evidence is currently considered to be of low certainty regarding which specific method is best.

Are there any risks or side effects?

The provided data did not report any specific adverse events, serious incidents, or issues with how well patients tolerated the treatments. However, because many studies were small or used different methods, more research is needed to fully understand the safety and long-term results of these techniques.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJul 2026

View Original Abstract ↓

BackgroundKnee osteoarthritis (KOA) is a highly prevalent degenerative joint disease with a growing global disease burden, yet traditional interventions have limited efficacy. Neuromodulation has emerged as a promising non-pharmacological rehabilitation strategy for KOA, but existing reviews have not systematically synthesized the clinical protocols, efficacy characteristics, and full spectrum of research gaps for mainstream neuromodulation techniques. This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, aiming to describe the current application status and identify critical research gaps.MethodsA systematic search was performed in PubMed and Web of Science databases for clinical studies on neuromodulation for KOA published between May 13, 2021 and May 13, 2026. Two researchers independently completed literature screening, data extraction, and cross-verification according to pre-specified inclusion and exclusion.ResultsA total of 131 records were initially retrieved. After deduplication, title/abstract screening, and full-text evaluation, 23 studies were finally included, comprising 18 randomized controlled trials, 3 self-controlled before-after trials, 1 retrospective case series, and 1 cross-sectional study. The included studies covered three core categories of neuromodulation: peripheral neuromodulation (TENS, NMES, PNS, electroacupuncture, electrical dry needling, tVNS), central neuromodulation (tDCS), and combined neuromodulation (TENS + tDCS). All techniques demonstrated certain efficacy in pain relief and functional improvement, but intervention protocols varied widely, and optimal parameters have not been standardized.ConclusionNeuromodulation, as a non-pharmacological rehabilitation strategy, has broad application prospects in KOA treatment. However, existing studies still have deficiencies in intervention standardization, long-term efficacy evaluation, and mechanism exploration. Future high-quality, large-sample studies are needed to optimize clinical protocols and clarify mechanisms of action, providing evidence support for the standardized application of neuromodulation in KOA rehabilitation.Systematic review registrationRetrospective registration for this study on Open‑Science Framework (OSF). The publicly available link is https://osf.io/vyz8q/overview.

Neuromodulation techniques show promise for pain and function in knee osteoarthritis, but evidence is low certaintyNeuromodulation Shows Promise for Managing Knee Osteoarthritis Pain

How this fits prior evidence

Common questions

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Neuromodulation techniques show promise for pain and function in knee osteoarthritis, but evidence is low certaintyNeuromodulation Shows Promise for Managing Knee Osteoarthritis Pain

How this fits prior evidence

Common questions

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