Adaptive dual-modality neuromodulation for chronic pain and muscle dysfunction: real-world insights from the NXTSTIM™...

Chronic musculoskeletal pain is often inadequately managed with pharmacologic therapy. Although transcutaneous electrical nerve stimulation (TENS) and electrical muscle stimulation (EMS) are established noninvasive modalities, conventional systems lack personalization and adherence monitoring.

To evaluate real-world outcomes associated with the EcoAI adaptive dual-modality (TENS+EMS) neuromodulation platform for chronic pain management.

Retrospective analysis of de-identified symptom diaries from 2,135 adults with chronic musculoskeletal pain using EcoAI at home in the United States between January 2023 and September 2025.

AI-modulated TENS/EMS delivered via wearable surface electrodes with continuous algorithmic adjustment based on patient feedback. Three modes were available: Relieve (pain-focused TENS), Relax (combined TENS+EMS), and Strengthen (EMS-focused).

Primary outcome was change in pain intensity measured on a 0-10 numeric rating scale. Secondary outcomes included muscle stiffness, fatigue, weakness, and spasm frequency measured on 0-4 ordinal scales. Longitudinal mixed-effects models assessed outcomes, with adherence evaluated as a modifier.

Significant improvements occurred in muscle weakness, fatigue, and spasm frequency among Strengthen-module users, while pain and stiffness remained stable. Higher adherence and baseline pain predicted greater pain reduction. No device-related adverse events occurred. Conclusion: Adaptive AI-guided TENS/EMS improved neuromuscular symptoms in real-world use significantly.