AAPM Consensus Guidelines on Neuromodulation Technologies and Neurocomputer Interfaces for Pain Management and...

To provide an evidence-based framework for healthcare professionals to use neuromodulation technologies to restore neuromuscular function and relieve pain.

An expert panel, convened by the American Academy of Pain Medicine Foundation, conducted a literature review of English-language studies published between 2015 and 2025 using PubMed, the Cochrane Library, Web of Science, and Scopus (detailed in Supplement 2). The panel screened abstracts, extracted key data, and evaluated evidence quality using a modified United States Preventive Services Task Force criteria. A Delphi process was used to achieve expert consensus on clinical recommendations for various neuromodulation technologies: Artificial intelligence-guided and robotic rehabilitation systems, virtual/augmented reality interfaces, brain-computer interfaces, electrical nerve stimulation (encompassing peripheral nerve stimulation transcutaneous electrical stimulation), vagus nerve stimulation, multifidus neurostimulation, surgery (eg,, regenerative peripheral nerve interface), scrambler therapy, spinal cord stimulation for motor restoration, and transcranial magnetic stimulation.

The panel provided clinical recommendations and discussed mechanisms of action, evidence, and clinical considerations for each intervention. Evidence for these technologies is evolving, with some showing promising results in areas like improving upper limb function post-stroke, improving functional spine-related outcomes, and reducing chronic pain.

Neuromodulation technologies offer a promising approach for neuromuscular restoration, focusing on interventions that promote functional recovery rather than solely providing symptomatic care. Areas for future research include more high-quality, large-scale studies with consistent outcome measures.