One hundred and fifteen patients with mild KOA were randomized to receive wearable transcutaneous electrical nerve stimulation (TENS) + active transcranial direct current stimulation (tDCS) (n=58) or TENS + sham tDCS (n=57). The primary outcome was Brief Pain Inventory (BPI). Secondary outcomes included VAS pain, step length, cadence, 6-minute walking test (6MWT), active knee ROM, and quadriceps strength. Outcomes were assessed at baseline (T0), 2 weeks (T1), 4 weeks (T2), and 1 and 2 months after treatment cessation (T3–T4). Overall, the results of the study revealed greater pain reduction (BPI, VAS) and better walking performance (step length, 6MWT) with TENS + tDCS at T1–T3, with between-group differences no longer evident by T4. These findings suggest that coupling tDCS with TENS enhances short-term to one-month post-treatment analgesia and gait benefits compared with TENS alone.