The Independent and Combined Effects of Mindfulness Meditation and Transcranial Direct Current Stimulation on Central Pain Processing in Adults with Knee Osteoarthritis.
Angela M. Mickle, Jared J Tanner, Samuel S Wu, Yunfeng Dai, Selenia Rubio, Pavithra A Thomas, Daniel A Kusko, Steven D. Pratscher, Song Lai, Kevin R Riggs, Hyochol Ahn, Adam J Woods, Roland Staud, Kimberly T. Sibille, Robert E Sorge, Fadel Zeidan, Roger B. Fillingim, Burel R Goodin
Arthritis Care & Research October 13, 2026 DOI: 10.1002/acr.80189 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 226 |
| Population | Middle-aged to older adults with knee osteoarthritis |
| Interventions | Breathing and Attention Training (BAT) transcranial direct current stimulation (tDCS) |
| Duration | 20-minute interventions for five consecutive days |
| Measures | quantitative sensory testing (QST), functional magnetic resonance imaging (fMRI), clinical knee pain assessment |
| Topics | Meditation |
| Key findings | No significant main effects of BAT or tDCS were found on clinical knee pain or pain modulatory balance. Active tDCS was associated with lower average pain-evoked cerebral blood flow than sham tDCS, though this did not survive multiple correction; a pre-planned comparison showed lower post-intervention pain-evoked blood flow in the active BAT/active tDCS group than the sham/sham group. |
Abstract
The Pain Relief for OsteoArthritis through Combined Treatment (PROACT) was a proof-of-principle mechanistic randomized controlled trial to examine the effects of Breathing and Attention Training (BAT), and transcranial direct current stimulation (tDCS) on pain modulatory balance, pain-related brain function, and clinical pain in middle-aged to older adults with knee osteoarthritis (OA). Participants completed baseline health screening, clinical knee pain assessment, quantitative sensory testing (QST), and functional magnetic resonance imaging (fMRI) in response to mechanical pain evocation of the index knee. They were randomized to receive concurrent sham BAT/sham tDCS, active BAT/sham tDCS, sham BAT/active tDCS or active BAT/active tDCS. Participants completed 20-minute interventions for five consecutive days. After, participants repeated the clinical knee pain assessment, QST, and fMRI. Adjusted analyses of 226 completers revealed no significant main effects of treatment on clinical pain or pain modulatory balance. However, average pain-evoked cerebral blood flow across pain-related regions of interest was significantly lower for active tDCS (-3.14 [CI:-4.83- -1.45]) vs. sham tDCS (-0.51 [CI:-2.19-1.17]), though this finding did not survive multiple correction. Pre-planned follow-up comparisons revealed that the active BAT/active tDCS group showed lower post-intervention pain-evoked cerebral blood flow than the sham BAT/sham tDCS group. The PROACT study found that mindfulness meditation in combination with tDCS may reduce pain-evoked cerebral blood flow in adults with knee OA. Future research is needed to determine if a longer duration of exposure to the combined active BAT/active tDCS treatment beneficially influences pain modulatory balance and clinical knee pain in this population.
Comparable studies
Other randomized controlled trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment | 2003 | Randomized controlled trial | n = 41 |
| Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients | 2000 | Randomized controlled trial | n = 145 |
| Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults | 2008 | Randomized controlled trial | n = 139 |
| Short-term meditation training improves attention and self-regulation Undergraduate Chinese students | 2007 | Randomized controlled trial | n = 40 |
| Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients | 2004 | Randomized controlled trial | n = 73 |