CF 367: Transcranial Direct Current for Fibromyalgia & Methotrexate For Knee Osteoarthritis Today we’re going to talk about Transcranial Direct Current for Fibromyalgia & Methotrexate For Knee Osteoarthritis But first, here’s that sweet sweet bumper music    

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic.

I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [email protected] If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #367 Now if you missed last week’s episode, we talked about Europe, SMT Review, & Informed Consent.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. OK, on to week two of my post-Europe, post-14-day vacation. The first 2-week vacation I’ve taken in almost 30 years. The vacay I was anxious about and borderline freaking about because I thought my practice would be a ghost town when I got back.  In last week’s episode, I gave you a precise guideline of how I was able to avoid the ghost town scenario so I won’t re-hash it. Go listen to episode #366 if interested in my exact timeline and strategy.  Remember, I want to see around 165 for so per week but have been a little slow this year for many reasons. One would be me losing both my Mom and my Dad within 2 months of each other and my truck dying and having to be replaced within that time frame at the same time. There’s no way that doesn’t affect your work life in some way.  So, although I want to see 165+, this year I’ve been seeing closer to 140 or so per week. Not something I’ve been happy about either.

Several factors play in on that. One being that the VA hired a chiropractor and all of the veterans went away. That was a big hit. But that chiro went back to Pennsylvania and now the veterans are returning. Thank the good Lord.  All of that to tell you this: I’m looking at 151 on the schedule at the moment and that’s on a Tuesday so we’ll end up with more as we have new ones pop on and some re-schedule. Maybe we’ll wind up around 160+ and that’s in June, which is not typically our busiest time of the year. 

Once again, take that vacation!! One more tip from your Ol’ Uncle Jeffro. 

Item #1

Our first one today is called, “Home-Based Transcranial Direct Current Stimulation vs Placebo for Fibromyalgia A Randomized Clinical Trial” by Caumo et al and published in JAMA Network Open on June 6, 2025 and that’s D-Day hot damnit!! Remember, the citations can be found at chiropracticforward.com under this episode. 

Caumo W, Franca BR, Orzechowski R, et al. Home-Based Transcranial Direct Current Stimulation vs Placebo for Fibromyalgia: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(6):e2514262. doi:10.1001/jamanetworkopen.2025.14262

Why They Did It Previous trials with smaller samples and shorter follow-up periods showed that multiple-session home-based anodal transcranial direct current stimulation (A-tDCS) on the left dorsolateral prefrontal cortex (DLPFC) improved fibromyalgia symptoms. However, the duration of the effect, the influence of exercise and pain neuroscience education (PNE), and the role of placebo remain unclear.

Objective  To evaluate whether A-tDCS targeting the left DLPFC, combined with exercise and PNE, is more effective than sham tDCS in reducing pain and disability, based on placebo-test responses (responders vs nonresponders).

How They Did It This double-blind, sham-controlled randomized clinical trial enrolled women aged 18 to 65 years with fibromyalgia.  Participants were randomized to receive the real deal or the sham treatment between April 2022 and April 2024.  They were treated at home and at the outpatient Clinical Research Center

What They Found I’m not going to tell you. Because I want you to enjoy this podcast and not question your life choices by listening to it so instead of diving head first into weeds most of us do not frequent, we’ll just go to the Wrap Up 

Wrap It Up This trial found that anodal transcranial direct current stimulation along with exercise and pain neuroscience education improved disability due to pain, especially in placebo test responders. The findings support fibromyalgia management and enhance understanding of dorsolateral prefrontal cortex-related placebo effects. Just another feather in your cap if you have Fibro patients that are at the end of their ropes and you can send them somewhere or tell them about some new research you just became aware of that could potentially help.  Just a random tip from your Ol’ Uncle Jeffro. 

Item #2

Our last one this week is called, “Low-Dose Methotrexate for the Treatment of Inflammatory Knee Osteoarthritis A Randomized Clinical Trial” by Zhu et al published in JAMA Intern Med on June 2, 2025……the roof is on fire!

Zhu Z, Yu Q, Leng X, et al. Low-Dose Methotrexate for the Treatment of Inflammatory Knee Osteoarthritis: A Randomized Clinical Trial. JAMA Intern Med. Published online June 02, 2025. doi:10.1001/jamainternmed.2025.1359

Why They Did It A recent study reported that methotrexate may reduce joint pain in patients with inflammatory hand osteoarthritis (OA). However, it remains unknown whether methotrexate has similar effects on inflammatory knee OA.

Objective  To examine whether methotrexate has symptom-relieving and disease-modifying effects for participants with knee OA and effusion-synovitis.

How They Did It This multicenter, placebo-controlled randomized clinical trial was conducted at 11 sites in China between July 18, 2019, and January 15, 2023.  Community-dwelling patients with inflammatory knee OA with effusion-synovitis on magnetic resonance imaging were included. Participants were randomly assigned (1:1) to receive methotrexate, up to 15 mg weekly, or placebo using block randomization, stratified by study site. The primary outcomes were knee visual analog scale (VAS) pain change and effusion-synovitis maximal area change, over 52 weeks in the intention-to-treat population.

What They Found Of 278 participants screened, 215 participants, and 175 (81%) completed the trial.  Changes in VAS pain and effusion-synovitis maximal area were not significantly different between the methotrexate and placebo group over 52 weeks.  No significant between-group differences were found for any of the pre-specified secondary outcomes.  At least 1 adverse event occurred in approximately 32 participants (29.6%) in the methotrexate group and 26 participants (24.3%) in the placebo group.

Wrap It Up The results of this randomized clinical trial show that, compared to placebo, low-dose methotrexate did not reduce pain or effusion-synovitis over 52 weeks in patients with knee OA and effusion-synovitis. So, remember, in most places, it is beyond our scope to put people on or try to take them off of meds.

However, if you get a knee OA patient that’s taking methotrexate, you can absolutely share this info with them and suggest they share it with the one that prescribed it and have a discussion. That’s appropriate in my opinion. 

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger    

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