Comprehensive Summary
The article investigates the central neural mechanisms of transcutaneous electrical nerve stimulation based on wrist–ankle acupuncture theory (TENS-WAA) for pain relief during colonoscopy.Since around 60% of patients that undergo non-sedated colonoscopy experience moderate to severe pain, the procedures have reduced diagnostic accuracy and are left incomplete. While sedated colonoscopy can help alleviate discomfort, it provides risks for patients as it increases risk for respiratory depression, hypotension, and bradycardia. The aim was to test whether TENS-WAA can provide effective pain relief by engaging the brain’s own pain-regulating networks. Using simultaneous electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) recording, the researchers assessed brain activity related to pain processing at multiple procedural points like hepatic flexure, splenic region, and ileocecal valve which are previously known to bring the most discomfort. The analysis focused on EEG alpha and beta power and haemodynamic markers like oxygenated haemoglobin. The TENS-WAA was shown to reduce mean VAS pain scores by 34% and decrease heart rate variability during insertion by 22%. It was additionally revealed that the EEG in the trial had increased alpha synchronization and decreased P300 amplitude in the TENS-WAA experimental group which shows a decreased cortical arousal and im-proved pain tolerance. The researchers hope to use this data and further combine brainwave fNIRS multimodal monitoring and blood flow data with AI deep learning models to uncover how TENS-WAA alters the brain’s response to pain and whether these signals can be used to predict individual pain sensitivity.
Outcomes and Implications
The study has significant medical implications as it establishes an effective pain management method that doesn’t rely on the side effects of medications. According to the researchers, colonoscopies remain one of the most common and painful diagnostic tests with around 20% of patients refusing to repeat this procedure due to discomfort. If TENS-WAA proves to be effective, it could offer a safe and low-cost alternative to sedatives and opioids and make colonoscopies more comfortable and accessible. The use of both EEG and fNIRS allows researchers to see how the brain processes and controls pain during stimulation. Previous clinical data for TENS-WAA shows that it activates descending inhibitory pathways, that are mediated through increased prefrontal and anterior cingulate cortex HbO levels and suppression of somatosensory beta oscillations, both of which are neural signatures of pain inhibition. By applying AI deep learning models to this brain data, the researchers also aim to create a predictive system that could automatically adjust stimulation intensity to match each patient's neural pain response, therefore allowing for tailored care. This type of adaptive pain control could reduce complications, shorten recovery times, and eliminate the need for anesthetic drugs in outpatient settings. Additionally, because of the combination of EEG-fNIRS monitoring with adaptive AI systems, this neural framework can be applied to other minor interventions like oncology pain management or endoscopy pain, which allows physicians to manage pain through this precise neural network rather than on medication.