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

Maja Green,1,2 Amie Hayley,3 Jenny M Gunnersen,4 Vida Nazemian,1,2 Adam Cabble,1,2 Sandra Thompson,1 Krishnan Chakravarthy1,2 1Clinical Research Organization, Solaris Research Institute, Wilmington, DE, USA; 2Department of Pain Medicine, NXTSTIM Inc, San Diego, CA, USA; 3Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia; 4Anatomy and Physiology Department, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, AustraliaCorrespondence: Maja Green, Department of Pain Medicine, NXTSTIM Inc, San Diego, CA, USA, Email [email protected]: 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.Keywords: chronic pain, neuromodulation, cognitive dysfunction, neuroinflammation