Transforming Chronic Pain Management: Integrating Neuromodulation with Advanced Technologies to Tackle Cognitive Dysfunction - A Narrative Review.

Journal: Journal of pain research
Published Date: May 16, 2025

Abstract

Chronic pain is a complex and multidimensional condition that disrupts both physical function and cognitive processing, creating a bidirectional cycle that amplifies symptom burden and complicates clinical management. Cognitive dysfunction, characterized by deficits in memory, attention, and executive function, further impairs treatment adherence and functional recovery. Conventional pharmacologic therapies frequently fail to address this dual burden and are associated with adverse effects, including dependence and cognitive impairment. Neuromodulation has emerged as a promising nonpharmacologic alternative, capable of modulating neuroplastic, neuroinflammatory, and neurotransmitter pathways implicated in both pain and cognitive decline. This narrative review examines the mechanisms and clinical applications of spinal cord stimulation (SCS), transcutaneous electrical nerve stimulation (TENS), and neuromuscular electrical stimulation (NMES), and evaluates emerging innovations such as EcoAI™, an artificial intelligence-driven, non-invasive neuromodulation platform. By integrating physiological and behavioral biomarkers with real-time adaptive therapy, EcoAI and similar technologies represent a shift toward personalized, precision-based interventions. Additional advances in remote patient monitoring (RPM) and closed-loop feedback systems further enhance therapeutic responsiveness and continuity of care. Collectively, these approaches offer a scalable, patient-centered framework for managing chronic pain and its cognitive comorbidities. Future priorities include the development of validated biomarkers, rigorous clinical evaluation of AI-integrated systems, and equitable implementation strategies to ensure broad access to next-generation neuromodulation.

Authors

  • Maja Green
    Clinical Research Organization, Solaris Research Institute, Wilmington, DE, USA.
  • Amie Hayley
    Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia.
  • Jenny M Gunnersen
    Anatomy and Physiology Department, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, Australia.
  • Vida Nazemian
    Clinical Research Organization, Solaris Research Institute, Wilmington, DE, USA.
  • Adam Cabble
    Clinical Research Organization, Solaris Research Institute, Wilmington, DE, USA.
  • Sandra Thompson
    Clinical Research Organization, Solaris Research Institute, Wilmington, DE, USA.
  • Krishnan Chakravarthy
    Clinical Research Organization, Solaris Research Institute, Wilmington, DE, USA.

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