Transcranial direct current stimulation (tDCS) has been shown to be effective for reducing pain, and a growing body of literature shows the potential analgesic effects of mindfulness-based meditation (MBM). However, few studies have investigated the potential benefits associated with combining tDCS and MBM in older adults with knee osteoarthritis (OA). Therefore, the aim of this study was to examine the feasibility and preliminary efficacy of home-based tDCS paired with MBM in older adults with knee OA. Thirty participants 50-85 years old with symptomatic knee OA were randomly assigned to receive 10 daily sessions of home-based 2 mA tDCS paired with active MBM for 20 min (n = 15) or sham tDCS paired with sham MBM (n = 15). We measured clinical pain and OA symptoms via a Numeric Rating Scale and the Western Ontario and McMaster Universities Osteoarthritis Index. Pressure pain sensitivity and conditioned pain modulation were measured using quantitative sensory testing. Participant satisfaction and side effects were assessed via a questionnaire. Active tDCS paired with active MBM significantly reduced scores on the Numeric Rating Scale and Western Ontario and McMaster Universities Osteoarthritis Index and increased pressure pain thresholds and conditioned pain modulation. Participants tolerated tDCS paired with MBM well without serious adverse effects and were satisfied with the treatment. Our findings demonstrate promising clinical efficacy of home-based tDCS paired with MBM for older adults with knee OA.