Frequently Asked Questions

We clarify all your doubts regarding NESA® Non-Invasive Neuromodulation medical technology. If you don’t find your answer here, please write to us through our contact page and we will respond as soon as possible.

1.1 · What is NESA® and how does it differ from other electrotherapies?

NESA® is a non-invasive neuromodulation technology that applies sub-sensory microcurrents (0.1–0.9 mA, 1–14 Hz) via 24 peripheral electrodes placed on the wrists and ankles. It is specifically designed to modulate the autonomic nervous system (ANS).

What distinguishes NESA® from other forms of electrotherapy is not simply its intensity or frequency, but the physiological model on which it is based. Whilst TENS seeks to block pain transmission, radiofrequency generates local heat and ultrasound acts through mechanical cavitation, NESA® accesses the ANS through two complementary pathways:

Direct neural pathway: Microcurrents stimulate peripheral autonomic nerve fibres — branches of the median, ulnar and radial nerves in the hands, and the tibial, peroneal, saphenous and sural nerves in the feet — which connect to autonomic plexuses and, via the spinal cord and brainstem, to central ANS regulatory centres, including the hypothalamus, nucleus of the solitary tract and amygdala.
Fascial and connective tissue pathway: fascia is a continuous bioelectrical communication system that connects the body surface with deeper structures. NESA® microcurrents also travel through this network of collagen, fibroblasts and ground substance, which acts as a biological semiconductor. Fibroblasts in connective tissue generate and conduct piezoelectric signals, while the extracellular matrix transmits mechanical and electrical information systemically. This allows a signal applied at the periphery to reach tissues and organs that are not directly innervated by the stimulated fibres.

This dual model explains why NESA® produces systemic effects — such as improved sleep, regulation of vagal tone, stress reduction and digestive normalisation — that would not be expected from purely local stimulation. It is not simply another accessory within an electrotherapy toolkit; it is a systemic regulation tool, supported by more than 15 publications in indexed journals documenting objective clinical outcomes.

Published evidence supports effects in areas as diverse as elite sports recovery (+20% REM sleep in FC Barcelona players), dementia (+35% cognitive function), paediatrics (+1.74 hours of sleep in neurodevelopmental disorders), overactive bladder, where it has shown superiority to conventional tibial stimulation, and objective vascular changes in the carotid artery measured by ultrasound.

1.2 · What are microcurrents and why are they important in clinical practice?

Microcurrents are electrical currents in the microampere range — 0.1–0.9 mA in the case of NESA® — well below the intensity of perceptible electrotherapies such as TENS or interferential currents. However, this technical definition alone does not capture their clinical relevance.

What sets NESA® microcurrents apart is the combination of four factors:

Sub-sensory intensity: the patient does not perceive the current. This is not a limitation; it is a physiological advantage. Microcurrents operate within the range of endogenous bioelectric potentials, allowing them to interact with regulatory processes without triggering defensive responses or habituation.
Oscillatory frequency (1–14 Hz): this is not a direct current. Oscillation allows synchronisation with biological rhythms and helps prevent neural adaptation.
Multi-point distribution: the signal is not applied at a single point. It is distributed through 24 electrodes in a pattern that covers multiple nerve and fascial territories simultaneously.
Dual propagation pathway: Microcurrents travel both via peripheral autonomic nerve fibres — the direct neural pathway — and through the connective tissue and fascial network — the bioelectrical fascial pathway — achieving systemic effects that localised stimulation would not produce.

For you as a practitioner, this means you do not have to choose between effectiveness and imperceptibility. NESA® demonstrates that a small, well-designed bioelectric signal can generate objective clinical changes, measurable through HRV, sleep quality, validated scales and, as demonstrated by Mínguez-Esteban et al. (2024), even vascular changes visible on ultrasound.

References: (Mínguez-Esteban, et al., 2024) | (Oschman, 2016) | (Paton, et al., 2026)

1.3 · What role does bioelectricity play in treatment?

Bioelectricity is the phenomenon by which cells, tissues and biological systems generate, conduct and respond to electrical signals. It is not an abstract concept; it is one of the fundamental operating languages of the nervous system, the heart, the muscles and, increasingly recognised, the fascial network and connective tissue.

In the context of NESA®, bioelectricity matters for three specific clinical reasons:

Membrane potentials and neuronal excitability: each autonomic neuron maintains a resting potential of approximately -70 mV, regulated by Na+, K+ and Ca2+ ion channels. NESA® microcurrents (0.1–0.9 mA) operate within a physiological range that allows neuronal excitability to be modulated without forcing depolarisation. This is modulation, not forced stimulation.
Fascial conduction and collagen piezoelectricity: Fascia is not merely a mechanical envelope. Collagen has piezoelectric properties: it generates electrical currents when mechanically deformed and responds to external electrical currents by altering its organisation. Fibroblasts in connective tissue form cellular communication networks through gap junctions, transmitting bioelectric signals over considerable distances. This turns the fascial network into a bioelectric highway that complements the classical neural pathway. When NESA® is applied to the wrists and ankles, part of the signal travels through the fascial network, reaching organs and systems that a purely neural model would not fully explain.
Resonance with biological rhythms: NESA® frequencies (1–14 Hz) align with fundamental biological rhythms, including respiration (0.2–0.5 Hz), heart rate variability (0.04–0.4 Hz), deep-sleep delta waves (0.5–4 Hz) and alpha-theta activity (4–12 Hz). This alignment allows the external bioelectric signal to come into phase with endogenous regulatory rhythms, facilitating autonomic synchronisation and restoration.

For you as a clinician, this shifts the paradigm: you are not simply applying electricity to a nerve; you are introducing a bioelectric signal that is compatible with the body’s regulatory processes and travels through both neural pathways and the fascial network. This explains the range of systemic effects documented in more than 15 publications.

1.4 · Why is NESA® applied through the hands and feet?

Application to the wrists and ankles is not arbitrary. It reflects a combination of neuroanatomical, fascial and bioelectrical factors that make these locations an optimal access point to the ANS.

Neural pathway — density of autonomic fibres:

Hands: the median, ulnar and radial nerves, including their anterior and posterior branches, contain autonomic fibres that connect to the cervical sympathetic ganglia and, via the spinal cord, to ANS regulatory centres.
Feet: the tibial, superficial and deep peroneal, saphenous and sural nerves provide afferent pathways that ascend towards the nucleus of the solitary tract and the hypothalamus.
The distribution of 24 electrodes allows multiple dermatomes and nerve territories to be covered simultaneously, generating a multi-channel signal that the central ANS can interpret as a global input.

Fascial pathway — bioelectrical conduction network:

The wrists and ankles are transition zones where the superficial fascia connects with the deep fascia, retinacula and tendon sheaths, acting as fascial transmission nodes.
The low skin impedance in these areas facilitates the entry of the microcurrent into the continuous fascial system.
From these nodes, the bioelectric signal can propagate through the collagen and fibroblast network towards deeper structures, including the peritoneum, pericardium and dura mater, all of which are connected through fascial continuity.
Langevin’s work has shown that the fascial network functions as a mechanical and electrical signalling system, connecting the body surface with internal organs.

Clinical and operational advantages:

Safe access, with no risk to vital organs.
Reproducible and standardised placement, allowing different practitioners to achieve the same configuration.
Good patient tolerance: with no pain or tenderness.
Suitability for repeated sessions without significant irritation.

This combination of direct neural access and fascial conduction explains why NESA® produces effects that go far beyond what local nerve stimulation alone could achieve. You are not simply stimulating peripheral nerves; you are accessing a bioelectrical communication network that connects the body surface with the body’s regulatory centres.

References: (Langevin, et al., 2006) | (Schleip, et al., 2012) | (Stecco, et al., 2011) | (Mínguez-Esteban, et al., 2024) | (Oschman, 2016)

1.5 · Does NESA® act exclusively through neural pathways, or could other mechanisms also be involved?

This is probably the most important question for understanding why NESA® produces effects that go beyond what would be expected from peripheral nerve stimulation alone. The answer is that NESA® accesses the autonomic nervous system through several complementary pathways.

ROUTE 1 — Direct neural pathway:

Microcurrents stimulate autonomic nerve fibres in the skin and subcutaneous tissue.
These fibres travel through afferent pathways to autonomic ganglia, the spinal cord and the brainstem.
From the brainstem, the information reaches the nucleus of the solitary tract, the hypothalamus and the insular cortex, which are key regulatory centres of the ANS.
The result is descending modulation of vagal tone, sympathetic-parasympathetic balance and hormonal regulation.

ROUTE 2 — Fascial and connective tissue pathway:

Fascia is a continuous bioelectrical communication system that surrounds the body’s organs, muscles, nerves and vessels.
El colágeno del tejido conectivo tiene propiedades piezoeléctricas: convierte señales mecánicas en eléctricas y viceversa
Fibroblasts form cellular communication networks through gap junctions, transmitting electrical signals over considerable distances.
The ground substance, or extracellular matrix, acts as a semiconductor that facilitates the propagation of microcurrents.
The wrists and ankles are transitional fascial nodes, where the superficial fascia connects with the deep fascia, retinacula and tendon sheaths.

ROUTE 3 — Vascular and endothelial pathway:

The study by Mínguez-Esteban et al. (2024) demonstrated that a single NESA® session produced measurable changes in the carotid artery, including increased luminal diameter and reduced intima-media thickness, compared with placebo. This suggests that the signal may also influence the vascular endothelium and autonomic vasomotor tone, representing a third mechanism of action.

Integration of pathways:

What makes NESA® unique is not one single pathway, but the convergence of multiple mechanisms acting simultaneously. Sub-sensory microcurrents modulate the ANS through neural pathways, travel through the fascial network as a bioelectrical communication route and produce measurable vascular effects. This multi-pathway architecture explains why clinical results span areas as diverse as sleep, pain, cognition, bladder function and sports recovery.

For your clinical reasoning, when you apply NESA®, you are not simply “applying current to nerves”. You are introducing a bioelectrical signal into a body-wide communication network that includes nerves, fascia and vessels. That is the difference.

1.6 · What is the purpose of the directional electrode?

The directional electrode performs a critical function: it establishes a polarised electric field that guides the microcurrent according to specific physiological parameters.
It acts as:

A signal polariser aligned with the clinical objective.
An amplifier of current coherence between the peripheral electrodes.
A regulator of signal depth according to the selected parameters.
A modulator of oscillatory frequency according to the autonomic response.

This configuration allows treatment to be customised without changing the physical electrode set-up, adapting the intervention to each patient and therapeutic objective.

References: (Mínguez-Esteban, et al., 2024)

1.7 · Why use a single directional electrode?

A single directional electrode optimises:

Consistency of the applied signal, avoiding unnecessary multi-point variables.
Clarity in the electrical circuit between the peripheral electrodes and the directional electrode.
Ease of use across repeated sessions.
Reproducibility when comparing sessions and monitoring progress.

Using multiple directional electrodes would increase interference, variability and monitoring complexity. The single-electrode design therefore maximises both therapeutic efficacy and clinical reproducibility.

References: (García, et al., 2022)

1.8 · Is the current configuration the most efficient?

Yes. The current system — 24 peripheral electrodes plus one directional electrode — has been optimised through:

Bioelectricity studies on peripheral autonomic access.
Clinical validation across more than 15 publications covering multiple conditions.
Comparative and efficacy-based clinical trials.
Follow-up of thousands of patients in clinical practice.

This architecture provides maximum regulatory efficacy with minimal operational complexity. Any future changes should always be based on new physiological evidence, not opinion.

References: (Medina-Ramírez, et al., 2024) | (Teruel-Hernández, et al., 2023)

1.9 · Is NESA® the same as TENS?

No. TENS — transcutaneous electrical nerve stimulation — and NESA® are fundamentally different technologies:

TENS:

Higher-amplitude currents (5–100 mA).
Objective: to block nociceptive pathways through the gate control mechanism.
Generally perceptible and often associated with paraesthesia.
Primarily local effect on sensory nerves.

NESA®:

Sub-sensory microcurrents (0.1–0.9 mA).
Objective: systemic autonomic modulation.
Imperceptible, without paraesthesia.
Systemic effect on ANS regulation.

NESA® works through entirely different mechanisms, inducing changes in HRV, sleep and recovery rather than producing analgesia through nociceptive blockade.

References: (Blasco-Bonora, et al., 2025)

Physiological table

Axis	NESA XSIGNAL®	TENS	Clinical/physiological implications
Therapeutic paradigm	Non-invasive, systemic, subthreshold superficial neuromodulation, with a primary focus on autonomic nervous system regulation.	Transcutaneous electrical nerve stimulation, usually applied locally or segmentally.	These technologies do not pursue the same neurophysiological objective. NESA® aims to support systemic regulation; TENS is usually directed towards symptomatic or local modulation.
Waveform	Symmetrical square-wave biphasic current; depending on the programme, low-frequency monophasic sequences may also be used.	Highly variable depending on the manufacturer and mode; it may be symmetrical biphasic, asymmetrical, burst or another waveform.	Waveform alone does not define the therapeutic effect. Similar-looking waveforms may behave differently depending on frequency, intensity, pulse width and electrode configuration.
Frequency	Internal range described as 1.14–14.28 Hz, fixed or oscillatory depending on the programme.	Generally classified within a broader 1–250 Hz range; clinically, both low-frequency and high-frequency TENS devices are used.	NESA® operates within a very low, programmed frequency band; TENS covers a much wider range and is typically more analgesic or sensory-motor oriented.
Intensity	0.1–0.9 mA, minimal and subthreshold.	Usually adjusted until sensation is perceived; in some modes it seeks paraesthesia, and in others even a motor response.	In NESA®, the absence of sensation does not invalidate the stimulus. In TENS, perception is often part of dose setting.
Voltage	Described settings of 3 V or 6 V.	Varies by device and mode.	NESA® is a highly protocol-driven system; with TENS, the clinician usually has more direct control over output and perceived sensation.
Patient perception	Imperceptible or practically imperceptible.	Usually perceptible; often described as “strong but comfortable”.	NESA® does not depend on the patient feeling the stimulus. With TENS, perceived sensation is often used to guide dosage.
Internal dynamics of the programme	Frequency, intensity and polarity vary within the same programme.	In many TENS devices, parameters remain more stable during each phase, although some units include modulation modes.	NESA® is designed with internal stimulus variation, which may reduce neural adaptation. TENS modulation is usually managed through external parameter adjustment.
Accommodation / habituation	Internal documentation presents NESA® as a system that reduces accommodation through oscillation of parameters.	Classic TENS can lead to accommodation; clinicians often compensate by increasing intensity or changing mode.	A key difference lies in how habituation is managed: NESA® addresses it through programme design, whereas TENS often requires manual adjustment.
Electrode architecture	24 sub-electrodes distributed across the limbs plus one directional electrode.	Usually 2–4 adhesive electrodes placed over a painful area, dermatome, nerve pathway or motor point.	NESA® does not create a simple local circuit; it creates a distributed input with a directional current architecture.
Entrada al cuerpo	Relies on low-impedance areas and strategic peripheral nerves in the hands and feet.	Applied directly to the painful area, nerve pathway or muscle region being treated.	NESA® enters through preferential low-impedance autonomic access points; TENS is usually applied directly to the symptomatic region.
Electric field geometry	A more distributed and coherent field, guided by a single directional electrode.	A more localised field between pads.	NESA® distributes the input and uses a directed electrical field; TENS concentrates current density between local electrodes.
Directional electrode	Essential for closing the circuit, providing a reference and directing the microcurrent; its omission renders the treatment ineffective.	This logic of global systemic targeting does not exist in conventional TENS.	This feature alone reflects two distinct therapeutic physiologies.
Initial depth / target tissue	Action is described as dermal and subdermal, with preferential interaction with small peripheral fibres present in those areas.	Local transcutaneous targeting of sensory afferents and/or motor units, depending on the mode.	NESA® is not designed primarily for deep tissue stimulation; it acts superficially with a neuroregulatory intent.
Polar / thermal effects	Internal documentation emphasises that, due to its low intensity and low potential difference in low-impedance areas, NESA® does not aim to produce polar effects and should not cause thermal damage when used correctly.	TENS is also safe when used correctly, but it operates with perceptible outputs and greater emphasis on local current density.	NESA® is bioelectrically designed to modulate without producing a perceptible sensory or thermal response.
System heterogeneity	Highly programmed and protocol-driven system.	Highly heterogeneous technological category.	The term “TENS” encompasses a broader and more heterogeneous category of technologies. Comparisons should therefore focus on therapeutic principles, not devices alone.

Comparison table

Clinical focus	NESA XSIGNAL®	TENS	Practical interpretation
How to programme	Closed, predefined programmes with an internal physiological rationale.	The clinician usually adjusts the dose using frequency, pulse width, intensity and mode.	NESA® is based more on a “protocol architecture”, whereas TENS is based more on a “parameter architecture”.
How to begin treatment	Often starts with a central approach (C6–C7), progressing towards metameric or focal application depending on the patient’s response.	Usually begins directly at the symptomatic area.	NESA® does not necessarily begin “where it hurts”.
What is best measured	WeCardio/HRV, together with questionnaires and clinical scales related to the patient’s condition. Internally, it is used to assess sympathetic-parasympathetic balance: SDNN reflects overall variability, RMSSD reflects vagal tone, HF reflects parasympathetic activity, and LF/HF should be interpreted with caution.	Pain scales, function, range of motion (ROM), movement tolerance, palpation findings and, in some cases, EMG or other local measurements.	NESA® is best supported by objective physiological markers, whereas TENS is primarily supported by symptom improvement and local functional outcomes.

1.10 · How does it compare with other neuromodulators?

Compared with other neuromodulation options:

Invasive needle-based neuromodulation:

NESA® is non-invasive, with no risk of needle-related nerve injury.
NESA® offers a systemic autonomic effect, rather than a purely local one.
Peripheral access is simpler and more comfortable for the patient.

Transcranial neuromodulation:

NESA® is non-invasive and does not require cranial application, hair preparation or procedures that may cause discomfort.
NESA® offers a systemic autonomic effect, rather than a purely central one.
Peripheral access is simpler and more comfortable for the patient.

Posterior tibial neuromodulation:

NESA® has shown favourable results in overactive bladder and urinary incontinence.
NESA® offers a systemic autonomic effect, rather than a purely local one.
Peripheral access is simpler and more comfortable for the patient.

Implantable vagal neurostimulation:

NESA® is non-invasive, with no surgery or surgical risk.
It requires less technical training.
It involves significantly lower costs.
It may allow a faster and more practical clinical implementation.

Overall, NESA® provides a less invasive, more accessible approach to autonomic neuromodulation, with a favourable safety and usability profile.

Physiological axis	NESA®	TENS	NMES / EMS	FES	MENS / Local microcurrent	tDCS / tES
Primary biological target	Autonomic regulation and physiological readaptation	Sensory / segmental analgesia	Muscle recruitment	Assisted functional movement	Local bioelectrical modulation	Cortical modulation
Primary plane of action	Systemic, central, metameric and focal	Local / regional	Muscular / peripheral	Task-specific motor function	Local / focal	Cranial / central nervous system
Physiological rationale	Homeostasis, adaptability, vagal-sympathetic balance and recovery capacity	Sensory gating and segmental pain modulation	Motor activation	Functional motor execution	Local tissue bioelectric environment	Cortical network excitability
Does the patient need to feel it?	No	Usually yes, as sensation often guides dosage	Yes, because muscular contraction is intended	Yes, because functional movement is intended	Not necessarily	Sometimes mild sensation may occur, but treatment does not depend on strong perception
Is visible contraction sought?	No	Not necessarily	Yes	Yes, for functional purposes	No	No
Is paraesthesia expected?	No	Often yes	Not the primary objective	Not typically the primary objective	No	Not typically the primary objective
Initial target tissue	Skin, subdermal tissue, small peripheral/autonomic fibres and systemic regulatory networks	Local sensory afferents	Motor units and muscle tissue	Task-related nerves and muscles	Local tissue	Cortex and central neural networks
Electrode architecture	24 sub-electrodes plus one directional electrode	Usually 2–4 local electrodes	2–4 muscle electrodes	2–4+ electrodes over motor units or nerves	Usually 2–4 local electrodes	Cranial electrodes
Electric field distribution	Distributed and directionally guided	Localised between electrodes	Local muscular field	Functional local field	Localised	Cranial
Clinical progression logic	Central → metameric → focal	Usually local → local adjustment	Músculo objetivo → progresión funcional	Task → synchronisation → function	Local focus	Cranial target → network modulation
Accommodation / habituation	Reduced through internal oscillatory design	Frequent if parameters remain fixed	Present; usually managed through adjustment	Depends on task and parameter selection	Variable	Variable
Parameters defining the intervention	Frecuencia, intensidad y polaridad oscilan dentro del programa	More manually adjusted and generally more stable	Motor parameters	Functional timing and synchronisation	Low local intensity	Polarity and cranial positioning
Preferred outcome markers	HRV / ECG plus clinical scales	Local pain and functional outcomes	Strength, ROM and muscle performance	Functional motor performance	Local symptom improvement	Neurocognitive tests and specific neurological scales
Typical indicators of success	Improvements in sleep, stress, fatigue, persistent pain, autonomic symptoms and recovery	Reduction in local pain	Increased activation, contraction and strength	Improved functional performance	Reduced local discomfort and improved tissue comfort	Changes in cortical activity and network function
Common misconception	“If you can’t feel it, it can’t be effective.”	“All electrotherapy works the same way.”	“It regulates the nervous system in the same way as NESA®.”	“It is just another type of electrical stimulator.”	“It is the same as NESA® because both use microcurrents.”	“Cranial stimulation is automatically superior.”

Table 2.

Key	NESA®	Why it is disruptive
1. Input architecture	24 subelectrodos en manos y pies + 1 direccionador	It is not a simple local circuit; it is a distributed and directed input
2. Access territory	Strategic low-impedance peripheral pathways	It changes which fibres and which network receive the stimulus
3. Bioelectric dose	Subthreshold, imperceptible microcurrent	Not based on paraesthesia or contraction
4. Therapeutic logic	Central, metameric or focal, depending on clinical reasoning	Does not require “starting where it hurts”
5. Assessment of the effect	HRV/ECG + clinical progression	Feedback is not merely subjective; it can be objectified via the ANS

Table 3.

Common confusion	Accurate correction
“NESA is a mild form of TENS”	No. TENS suele ser sensorial/local; NESA es subumbral, distribuido y con vocación autonómica/sistémica
“If there is no sensation, there is no effect”	With NESA®, the absence of sensation is consistent with a correctly administered session
“All microcurrents are the same”	No. The same order of magnitude does not imply the same architecture, the same field or the same physiological objective
“If there is pain, you must always start locally”	With NESA®, the reasonable entry point is often central, followed by metameric/focal
“The best neuromodulator is the one that works for everything”	The best is the one that best suits the objective, patient, context and adherence

Table 4.

Technology	Summary phrase
TENS	“Address the local symptom.”
NMES / EMS	“Talk to the muscle.”
FES	“Talk to the function.”
MENS / Local microcurrent	“Talk to the local tissue using low current.”
tDCS / tES	“Talk to the cortex.”
NESA®	“Communicates with the body’s regulatory system.”

Table 5.

If the practitioner is primarily looking for…	The family that usually fits best	Why
Local, rapid and simple analgesia	TENS	Targets local sensory modulation directly
Muscle re-education or strength	NMES / EMS	Recruits muscle and motor units
Restore a specific function (walking, foot drop, grip)	FES	Converts stimulation into a functional task
Local microcurrent with very low sensation	MENS / Local microcurrent	More focal, more tissue-specific/local
Cortical modulation	tDCS / tES	Its natural territory is the cranial CNS
A systemic approach to sleep + stress + pain + fatigue + autonomic symptoms + recovery	NESA®	Its unique selling point is integrated autonomic regulation

References: (Conde-Santos, Padilla-Fernández, 2025) | (Blasco-Bonora, et al., 2025)

1.11 · ¿Puede combinarse con otras técnicas?

Yes. NESA® integrates well with multiple clinical approaches and is designed to complement, rather than replace, existing treatments.

Conventional physiotherapy: may support recovery and help reduce pain.
Sports training and recovery: associated with improvements in sleep quality and recovery markers in published studies.
Psychotherapy: may support emotional regulation and stress tolerance through autonomic modulation.
Pharmacological treatment: does not present known pharmacological interactions and, in some cases, may support broader therapeutic management.
Other modalities: can be combined with radiofrequency (before or after treatment), ultrasound and manual therapy.

The principle is simple: NESA® should not compete with other interventions, but rather support their effectiveness through improved autonomic regulation. In many clinical settings, integration enhances outcomes.

References: (García, et al., 2022) | (Medina-Ramírez, et al., 2024)

1.12 · Is it compatible with radiofrequency?

NESA® is compatible with radiofrequency, but the two should not be applied simultaneously. They should be used either before or after one another, or in separate sessions.

Radiofrequency:

Produces a thermal effect on collagen and local tissue structure.
May support tissue elasticity and regenerative processes.

NESA®:

Supports systemic autonomic modulation.
May improve sleep, HRV and recovery capacity.

The combination can be complementary: radiofrequency acts primarily on local tissue, while NESA® supports whole-body regulation through the autonomic nervous system. They may be applied in the same session, before or after one another, or in separate sessions, according to clinical judgement.

References: (Mínguez-Esteban, et al., 2024)

1.13 · Can it generate heat or can it cause burns?

No. NESA® does not generate significant heat, for three main reasons:

Extremely low current amplitude (0.1–0.9 mA).
The energy required to produce a meaningful Joule heating effect is well above the levels applied by NESA®.
Its mechanism is based on bioelectrical modulation, not thermal stimulation.

The risk of burns is negligible when the device is used correctly. Safety protocols include:

Pre-session assessment of skin integrity.
Controlled contact resistance.
Programmed amplitude limits.
Recommended maximum session duration.

Across thousands of clinical sessions, no burns attributable to NESA® have been reported.

References: (Azevedo, Medina-Ramírez, 2025)

1.14 · What does it mean that the frequency is oscillatory?

Oscillatory frequency refers to the number of cycles per second of the microcurrent, within the 1–14 Hz range. An oscillatory, non-constant pattern is important for several physiological reasons:

Alignment with biological rhythms: breathing, heart rate variability, delta waves during deep sleep, theta activity and alpha activity all operate within low-frequency biological ranges. NESA® frequencies overlap with some of these ranges, supporting physiological synchronisation.
Reduction of neural adaptation: a constant stimulus may lose effectiveness over time. Oscillation helps maintain responsiveness by preventing the nervous system from adapting too quickly to a fixed signal.
Fascial resonance: connective tissue may respond differently to static and oscillatory inputs. Fascial fibroblasts and collagen-rich structures are sensitive to mechanical and bioelectrical signalling, which may support the fascial pathway as a complementary bioelectrical conductor.
Dynamic modulation of autonomic tone: oscillation allows the signal to move between frequency ranges associated with parasympathetic activation and sympathetic normalisation.
Neurophysiological frequency response: EEG studies conducted at the University of Alcalá de Henares identified an optimal response around 7.8 Hz, a frequency close to the Schumann resonance and associated with alpha-range brain activity.

Oscillation is what helps transform a simple electrical current into a biologically relevant regulatory signal. Without it, there is stimulation; with it, there is modulation.

References: (Schleip, et al., 2012) | (Oschman, 2016) | (Paton, et al., 2026)

1.15 · How deeply does the signal reach?

The question “how far does it reach?” has a more complex answer than it may first appear, because the NESA® signal does not follow a single linear pathway. Its effects may involve two complementary mechanisms.

Neural access:

The microcurrent directly reaches nerve fibres in the dermis and subcutaneous tissue.
From these peripheral nerve plexuses, the signal travels through afferent pathways to the spinal cord and brainstem.
At central level, it interacts with ANS-related circuits, including the nucleus of the solitary tract, hypothalamus, amygdala and insular cortex.
The systemic effect — including changes in sleep, vagal tone and HRV — occurs because the signal modulates autonomic regulatory centres, not because it physically penetrates each organ.

Propagation through fascial and bioelectrical pathways:

The fascial network may act as a continuous bioelectrical conductor, with collagen showing piezoelectric and semiconductive properties.
Fibroblasts in connective tissue form communication networks through gap junctions, allowing signals to be transmitted over considerable distances.
NESA® microcurrents may propagate through this network from the surface, where the electrodes are applied, towards deeper fascial structures, including mesenteric, pericardial, pleural and peritoneal fasciae.
This may allow the signal to influence tissues and organs well beyond the area of direct superficial stimulation.
The work of Langevin and Oschman supports the concept of fascia as a bioelectrical communication system connecting the body surface with deeper structures.

Clinical evidence of systemic effects:

The study by Mínguez-Esteban et al. (2024) demonstrated ultrasound changes in the carotid artery, including increased luminal diameter and decreased intima-media thickness, after a single NESA® session. This deep cervical vascular response is not explained by direct electrical penetration alone, but is more consistent with a combination of autonomic neural modulation and systemic bioelectrical signalling.

In summary, the NESA® signal does not need to physically reach the heart, gut or other organs directly. It modulates the central autonomic control system and may propagate through the fascial bioelectrical network, producing documented systemic effects.

References: (Mínguez-Esteban, et al., 2024) | (Langevin, et al., 2006) | (Oschman, 2016) | (Schleip, et al., 2012) | (Paton, et al., 2026)

2.1 · What is the ANS and why should I care about it as a professional?

The autonomic nervous system (ANS) controls functions that do not require conscious decision-making, including heart rate, blood pressure, digestion, breathing, sleep, thermoregulation, muscle recovery and the stress response.

It underlies symptoms you see every day: insomnia, anxiety, chronic fatigue, persistent pain, digestive problems and bladder dysfunction all have a documented autonomic component.
Many patients with “no clear diagnosis” may have underlying dysautonomia: the ANS is often a common denominator in functional syndromes that frustrate both clinicians and patients.
Measuring the ANS allows you to assess progress objectively: heart rate variability (HRV) provides a quantifiable biomarker of autonomic function before and after treatment.
Autonomic regulation is a prerequisite for recovery: without sympathetic-parasympathetic balance, sleep is less restorative, exercise adaptation is weaker and rehabilitation may progress more slowly.

There is also one aspect many professionals overlook: the ANS does not function in isolation from connective tissue. The body’s fascial and collagen networks act as a bioelectrical communication system that complements the nervous system. Fibroblasts in connective tissue form gap-junction networks that transmit electrical signals, while collagen has piezoelectric properties that allow mechanical signals to be converted into electrical ones, and vice versa. In this sense, the ANS may be understood as having a fascial extension, connecting regulatory centres with the periphery through pathways that are not purely neural.

NESA® works precisely at this interface. It accesses the ANS through both autonomic nerve fibres and the bioelectrical fascial network, helping to explain the breadth and diversity of its documented clinical effects. Across more than 15 publications in indexed journals, studies report measurable improvements in sleep, pain, cognitive function, overactive bladder, sports recovery and other areas linked to autonomic regulation.

2.2 · What is HRV, and why does NESA® include a portable ECG?

HRV, or heart rate variability, is the variation in milliseconds between consecutive heartbeats. It reflects the ANS’s ability to adapt to changing physiological demands, increasing activity when required and supporting recovery at rest.

Autonomic function: higher HRV is generally associated with better autonomic adaptability.
Resilience: the ability to recover from stress and physiological load.
Systemic inflammation: lower HRV is often associated with chronic inflammatory states.
Prognosis: HRV has been studied as a prognostic marker in several clinical conditions.

NESA® includes a portable ECG because it provides:

An objective pre-treatment baseline.
Quantifiable monitoring of the patient’s response.
A clear, motivating reference point for the patient.
Evidence of changes in autonomic regulation over time.

Referencias: (Medina-Ramírez, et al., 2024) | (García, et al., 2022)

2.3 · Does the portable ECG really provide meaningful clinical value?

A NESA® portable ECG allows:

Objective measurement: comparison of baseline HRV before treatment and changes over time, helping reduce subjective bias.
Risk stratification: identification of patients who may present greater autonomic dysregulation.
Clinical personalisation: adaptation of protocols according to the patient’s autonomic profile and baseline HRV.
Patient engagement: numerical changes, such as improvements in HRV values, may help patients better understand their progress.
Clinical documentation: objective physiological data that can support clinical records and treatment follow-up.

Published NESA® studies have reported improvements in HRV-related markers after several sessions, supporting the use of autonomic monitoring as part of clinical evaluation and follow-up.

References: (Teruel-Hernández, et al., 2023) | (Medina-Ramírez, et al., 2024)

2.4 · When and how should HRV be recorded?

Recommended protocol for maximum validity:

Timing:

Pre-treatment: on the first day of NESA® treatment, before the initial session.
Acute post-treatment: immediately after the session, to assess short-term changes.
Consolidated post-treatment: the following day or 48 hours later, to assess more stable changes.
Follow-up: weekly or every two weeks during the treatment programme.

Recording procedure:

Seat the patient comfortably and allow 5 minutes of rest before recording.
Record the ECG in a standardised position, before and after NESA® neuromodulation when appropriate.
Ask the patient to breathe normally, without voluntary apnoea or controlled breathing unless this is part of the protocol.
Record the data in the clinical notes, including date, time and relevant context.
Compare trends over time rather than interpreting isolated values.

Consistency of the recording protocol is essential for valid interpretation.

References: (Báez-Suárez, et al., 2025)

2.5 · Is there a connection between the ANS and inflammation?

Yes. The relationship between the ANS and inflammation is bidirectional, well documented and clinically relevant. It is one of the mechanisms through which autonomic modulation may produce measurable clinical effects.

ANS → inflammation: the anti-inflammatory reflex

The vagus nerve detects peripheral inflammatory signals and activates the cholinergic anti-inflammatory reflex described by Tracey (2002). Acetylcholine released by vagal nerve endings can inhibit the production of TNF-α, IL-1β and IL-6 by macrophages.
Chronic sympathetic hyperactivity, often associated with sustained stress, increases cortisol, noradrenaline and pro-inflammatory cytokine activity.
Reduced vagal tone, reflecting lower parasympathetic activity, may weaken the body’s endogenous anti-inflammatory capacity.

Inflammation → ANS

Pro-inflammatory cytokines can alter the sensitivity of baroreceptors and chemoreceptors.
La inflamación crónica desregula el eje HPA (hipotálamo-hipófisis-adrenal), perpetuando disautonomía
Se crea un círculo vicioso:inflamación → disautonomía → más inflamación → más síntomas

Fascia as an additional link

Inflamed fascia may lose part of its bioelectrical and conductive properties. Fascial fibrosis can disrupt the transmission of piezoelectric and mechanical signals, creating less responsive areas within the body’s communication network. This means that inflammation may not only dysregulate the ANS through neural pathways, but also impair the fascial regulatory pathway. The result is a dual impact that can amplify dysfunction.

NESA® may help interrupt this cycle in several ways:

Increased vagal tone → activation of the cholinergic anti-inflammatory reflex.
Reduction in chronic sympathetic activation → lower stress-related autonomic load.
Restoration of heart rate variability → improved overall autonomic regulation.
Fascial modulation → support for bioelectrical conduction in connective tissue.

NESA® evidence supports this mechanism: the study by Melián-Ortíz et al. (2025) on Long COVID reported a +62.9% improvement in tibial pressure pain threshold (PPT), a marker associated with central sensitisation and neuroinflammatory processes.

2.6 · What is the relationship between the ANS and mental health conditions?

The ANS is the physiological basis of emotion and mental health:

Anxiety: chronic sympathetic activation maintains a state of alertness
Depression: low vagal tone causes apathy and an inability to experience pleasure
Trauma: persistent dysautonomia perpetuates PTSD symptoms
Insomnia: ANS imbalance prevents transition to deep sleep
Irritability: poor parasympathetic regulation causes emotional reactivity

Modulating the ANS modulates mental health. NESA® improves:

Emotional tolerance (increased vagal tone)
Recovery from stress
Restorative sleep
Less reactive response to triggers

It works synergistically with psychotherapy: improved autonomic regulation facilitates the patient’s psychological processing. It does not replace therapy; it enhances it.

References: (Contreras-Polo, et al., 2023) | (Bonilla-Eizaguirre, et al., 2024)

3.1 · What scientific evidence does NESA® have?

NESA® is supported by more than 15 peer-reviewed scientific publications covering multiple clinical areas.
The evidence can be structured as follows:

Physiology and mechanism:

(Paton, et al., 2026) — Basis in vagal neuromodulation.
(Mínguez-Esteban, et al., 2024) — Objective vascular changes in the carotid artery.

Performance and recovery:

(García, et al., 2022) — Improvement in recovery markers in athletes.
(Medina-Ramírez, et al., 2024) — Improved sleep quality and reduced night-time awakenings.
(Vega-Delgado, et al., 2024) — Clinical outcomes in sleep disorders.

Cognition and ageing:

(Teruel-Hernández, et al., 2023) — Improved sleep and cognitive function in dementia.
(Báez-Suárez, et al., 2025) — Improved sleep parameters in institutionalised older adults.
(Báez-Suárez, et al., 2023) — Improvements in sleep quality and gastrointestinal function in children with neurodevelopmental disorders.

Specific medical conditions:

(Azevedo, Medina-Ramírez, 2025) — Pain modulation and the ANS.
(Blasco-Bonora, et al., 2025) — Overactive bladder outcomes compared with tibial neuromodulation.
(Conde-Santos, Padilla-Fernández, 2025) — Autonomic nervous system targeting in urinary incontinence.
(Molina-Cedrés, et al., 2025) — Autism spectrum disorder, with improvements in sleep, behaviour and sensory profile.
(Melián-Ortíz, et al., 2025) — Long COVID and dysautonomia.
(Contreras-Polo, et al., 2023) — Multiple sclerosis, with sleep, pain and bladder outcomes.
(Bonilla-Eizaguirre, et al., 2024) — Post-traumatic neck pain.
(Hernández Pérez, Etopa Bitata, 2025) — Detailed clinical case in autism spectrum disorder.

Regulatory framework:

MDR 2017 — European Medical Devices Regulation.
ISO 13485 — International quality management standard for medical devices.
Registrations and approvals in more than 20 countries outside the European Union.

3.2 · Are there any clinical trials currently underway?

Yes. NESA® has active clinical trials registered on ClinicalTrials.gov:

NCT05207943 – Anterior cruciate ligament injury (ACL recovery)

Protocol: Evaluation of NESA® in post-surgical ACL recovery, measuring HRV, sleep, neuromuscular function and time to return to sport.

NCT06134999 – Knee prosthesis (Knee prosthesis outcomes)

Protocol: Comparison of NESA® versus standard care in post-knee replacement functional recovery, assessing pain, mobility and HRV.

NCT05648695 – Fibromyalgia (Fibromyalgia syndrome)

Protocol: Evaluation of NESA® in the modulation of fibromyalgia pain, associated dysautonomia and sleep improvement.

These trials expand the evidence base for conditions with high prevalence. Results expected 2026–2028.

References: (García, et al., 2022) | (Medina-Ramírez, et al., 2024) | (Azevedo, Medina-Ramírez, 2025)

3.3 · Are there any posters and academic agreements?

Yes. NESA® is actively involved in academic research through:

Conference presentations:

Presentations of results at international conferences on neurology, physical medicine and sports rehabilitation
Over 1,000 scientific posters detailing findings from clinical studies
Research sessions presented by NESA® authors

Academic collaborations:

Agreements with European universities for prospective research
Participation in multi-centre protocols
Access to NESA® for independent researchers (by agreement)
Open publication of methods and results

Transparency:

Registration of trials on ClinicalTrials.gov (non-confidential)
Publication of negative results, if any
Availability of safety and efficacy data

This open approach distinguishes NESA® from products that restrict access to evidence.

References: (Teruel-Hernández, et al., 2023) | (Molina-Cedrés, et al., 2025)

3.4 · Where can I learn more about physiology?

Resources for continuing education in NESA® physiology:

Scientific references library

Access to abstracts of more than 15 published NESA® papers, organised by system and clinical condition. Includes links to databases such as PubMed and Web of Science.

NESA® Academy online course

Structured training modules including

Module 1: Fundamentals of bioelectricity and the ANS

Module 2: Mechanisms of action of oscillatory microcurrents

Module 3: HRV as a biomarker — assessment and interpretation

Module 4: Dysautonomia in specific clinical conditions

Module 5: Critical appraisal of clinical trials

Monthly webinars

Live presentations delivered by NESA® authors and collaborators discussing new findings and clinical cases.

Clinical case library

Documentation of more than 50 real clinical cases, including HRV, sleep and symptom data, allowing clinicians to identify response patterns and treatment approaches.

Open research protocol support

If you wish to publish your own NESA® data, NESA® provides protocol templates and methodological guidance free of charge.

References: (Blasco-Bonora, et al., 2025) | (Conde-Santos, Padilla-Fernández, 2025)

3.5 · How can I contribute to research?

NESA® invites healthcare professionals to collaborate on research.

Collaboration models:

Observational research

Document your NESA® cases using a standardised format, including pre- and post-treatment HRV, symptoms and sleep data. NESA® can provide a template and support with biostatistical analysis, with potential for joint publication.

Multi-centre clinical trials

If your institution has recruitment capacity, NESA® can provide an ethics-approved protocol where available. Participating centres share data, and NESA® supports the analysis.

Mechanistic research

If you are interested in studying how NESA® works in a specific population, you can design a protocol and NESA® can provide devices and biostatistical support

Publication of clinical cases

Document a detailed clinical case, with patient consent. NESA® can provide a publication framework and editorial guidance.

Steps to collaborate:

Contact the NESA® scientific team via the form.
Submit an initial idea or protocol proposal.
Review by the NESA® scientific committee.
Collaboration agreement, where applicable.
Access to devices and documentation.
Data analysis and manuscript preparation.

NESA® supports open science: each publication strengthens the global evidence base and contributes to better clinical understanding.

References: (Melián-Ortíz, et al., 2025) | (Hernández Pérez, Etopa Bitata, 2025)

4.1 · What are the contraindications?

NESA® has a high safety profile, with a limited number of contraindications.

Absolute contraindications:

Implanted pacemaker.
Implanted defibrillator.
Implanted nerve stimulator.
Pregnancy, as safety has not been studied in this population.
Active infection at the application sites.

Relative contraindications requiring case-by-case assessment:

Active deep vein thrombosis, due to the theoretical risk of embolisation.
Significant active bleeding.
Severe decompensated heart failure.
Hypersensitivity to electrodes or adhesives.
Severe fear of electrical therapies.

Special precautions, not contraindications but requiring caution:

Muscular dystrophy: apply low-intensity protocols.
Severe neuropathy: check skin sensitivity before the session.
Severe atopic dermatitis: monitor skin contact with the electrodes.
Diabetes with ulcers: avoid direct application to the affected area.

Assessment: In most cases, these conditions can be identified through a standard clinical history. NESA® is applicable to most patients when used according to professional judgement and the device’s instructions for use.

References: (Paton, et al., 2026)

The core element, the NESA XSIGNAL® neuromodulator, remains the same. What changes between purchasing structures is the level of implementation, the material included, the support provided, and the speed at which the centre can start using it consistently.

That difference matters because many healthcare professionals are not so much unsure about the technology itself as about the path to integrating it. A well-chosen package reduces friction, shortens the adoption curve, and helps the team feel capable from the very first month.

The ecosystem can usually include: the XSIGNAL® device, GDCN cable, glove and ankle strap kits, power supply and adapters, transport case/backpack, manuals, specialty-specific protocols, adapted furniture, and support tools for physiological objectification, depending on the configuration.
Purchasing structures are usually organised around a Basic / Advanced / Premium logic, or an equivalent model: the same technological foundation, with different levels of deployment, support, and resources.
The highest-value complements for implementation are usually initial training, the campus/clinical guides, start-up mentoring, and presence within the clinic ecosystem.

4.2 · Which patients benefit most?

NESA® has broad applicability, but certain patient profiles may respond particularly well.
Patients commonly considered good candidates include:

Patients commonly considered good candidates include:

Athletes and sports-performance patients: recovery optimisation and improved sleep-related recovery markers.
Patients with insomnia or fragmented sleep: improved sleep quality and fewer night-time awakenings.
Patients with chronic pain and signs of dysautonomia: support for pain modulation, sleep and autonomic regulation.
Older adults: improved sleep parameters and cognitive-function outcomes reported in published studies.
Patients on the autism spectrum: documented improvements in sleep, behaviour and sensory profile in specific studies.
Patients with Long COVID or dysautonomia: support for autonomic regulation, fatigue and recovery capacity.
Patients with fibromyalgia: integrated pain management through autonomic modulation.
Patients with urinary incontinence or overactive bladder: documented clinical outcomes in published studies.

Other profiles may also be suitable, including:

Anxiety or chronic stress.
Mild to moderate depression, as an adjunct to standard care.
Post-surgical recovery, including ACL and prosthetic rehabilitation contexts.
Professionals exposed to high occupational stress.

The critical factor is not the diagnosis alone, but the presence of underlying autonomic dysregulation. Baseline HRV< can be useful as a screening and monitoring tool, helping identify patients with reduced autonomic adaptability who may be suitable candidates for NESA®.

References: (García, et al., 2022) | (Medina-Ramírez, et al., 2024) | (Teruel-Hernández, et al., 2023)

4.3 · Why is the therapy imperceptible, and how should I explain this to patients?

Imperceptibility is a feature, not a limitation. Patient explanation:

“NESA® works with currents so small that you cannot feel them. This is intentional. Other electrical treatments, such as TENS, often aim to produce a tingling sensation to help block pain. NESA® works differently: it supports the way your body regulates sleep, recovery and stress, without needing to create a sensation.

A simple way to understand it is this:

TENS: helps distract the nervous system from pain.

NESA®: helps the body regulate itself more effectively.

You should not expect to feel anything during the session. Changes usually appear gradually, often over the following days or weeks: better sleep, fewer night-time awakenings, improved energy or reduced discomfort. The aim is not to block the symptom, but to help the body regulate the systems that influence it.”

Esto es tan efectivo que nuestros estudios muestran +40% mejora de sueño, -64.4% despertares nocturnos. Si fuera solo placebo, nunca veríamos números tan específicos.”

Set clear expectations during the first session. Explain that early changes may appear around sessions 4 to 6 for primary symptoms, while broader or secondary changes may require more sessions and consistent follow-up.

References: (Blasco-Bonora, et al., 2025) | (Conde-Santos, Padilla-Fernández, 2025)

4.4 · Passive or active therapy: when should each approach be used?

NESA® offers two modalities with different clinical uses.

Passive therapy:

The patient remains seated or reclined at rest during the session. NESA® sessions typically last between 30 and 120 minutes, with 55 minutes being the most common duration in standard clinical practice.

Active therapy:

NESA® is used while the patient is undergoing another form of therapy, such as manual therapy, psychotherapy, speech and language therapy or another clinical technology, or while performing light movement or exercise, such as walking, stretching, kinesiotherapy or sport-specific work.

References: (Blasco-Bonora, et al., 2025) | (Conde-Santos, Padilla-Fernández, 2025)

4.5 · How can I integrate NESA® into my daily clinical practice?

Some examples of practical integration according to your specialism:

Physiotherapy:

Pre-session (5 mins): Baseline HRV ECG
Passive NESA® treatment (20–30 mins) + simultaneous manual therapy
Transition to active NESA® during therapeutic exercise
Post-session (5 mins): Post-session ECG for comparison

Benefit: Accelerates functional recovery, improves adherence (objective results).

Sports/Performance:

Pre-training: active NESA® session (10–15 mins) to optimise HRV
Post-training: passive NESA® session (20 min) for recovery
Monitoring: Weekly HRV, adjust training volume according to HRV

Benefit: +40% improvement in recovery documented in athletes.

Internal Medicine/General Practice:

Patients with insomnia: 2–3 passive sessions per week
Patients with stress: passive session after consultation as a therapeutic conclusion
HRV monitoring: tool for assessing progress

Benefit: Objective metrics for follow-up, improved patient satisfaction.

Neurology/Psychiatry:

Anxiety/depression: passive session 2–3 times a week + conventional therapy
Dementia: daily passive session to improve sleep and cognition
Autism: passive session before school or social activities

Benefit: Improves emotional regulation, facilitates conventional therapy.

Key point: NESA® does not replace your treatment; it enhances it. Natural integration without disrupting clinical workflow.

References: (Molina-Cedrés, et al., 2025) | (García, et al., 2022)

4.6 · How do I prepare a passive therapy session?

Step-by-step protocol for a standard passive session following the patient’s initial assessment:

Pre-session assessment (1 minute):

Quick assessment: current symptoms, previous night’s sleep and stress level on a 1–10 scale.
Skin check: assess the integrity of the skin on the hands and feet and ensure there are no wounds.

Set-up (5 minutes):

Positioning: seat or recline the patient comfortably, with arms supported and feet relaxed.
Electrode preparation: apply the ECG electrodes from the lead set according to the device specifications.
Peripheral electrode placement: place the hand and foot electrodes in the standard position.
Lead placement: position the lead according to the relevant specialist protocol, for example on the chest for sleep protocols or on the abdomen for digestive protocols.
Contact check: ensure good adhesion and adequate skin contact.
Baseline ECG: record 5 minutes of ECG and document HRV before starting, usually during the first, fifth and tenth sessions.

Session (50–55 minutes):

Start NESA® according to the selected protocol, using the appropriate frequency and amplitude settings.
Patient communication: maintain a calm environment. If the patient needs to be accompanied, keep dialogue relaxed and avoid unnecessary interruptions. Otherwise, allow the patient to remain undisturbed during treatment. It is advisable to provide a call device in case they need assistance.

Post-session (5 minutes):

Switch off the NESA® device.
Carefully remove the electrodes.
Post-session ECG: record 5 minutes of ECG and compare it with baseline, usually during the first, fifth and tenth sessions.
Patient education: explain expected changes and reinforce realistic expectations.

Total time: approximately 65 minutes for the first session, plus documentation. Subsequent sessions usually last around 55 minutes.

References: (Báez-Suárez, et al., 2025)

4.7 · How is active therapy applied in clinical practice?

Protocol for active therapy: NESA® combined with movement.

Compatible activities:

Walking: slow to moderate pace, ideally on flat terrain or in a supervised clinical setting.
Dynamic stretching: controlled movements without explosive force.
Gentle resistance exercise: elastic bands or low-load machines.
Kinesiotherapy: re-educational movements and supervised physiotherapy.
Sports training: for trained athletes, mainly during recovery-focused sessions.

Active configuration:

Peripheral electrodes: same configuration as passive mode, applied to the hands and feet.
Directional electrode: positioned according to the clinical objective, ensuring that it does not interfere with movement.
Duration: usually 15–60 minutes, depending on the patient profile, activity and protocol.

Key benefit: Combining NESA® with active therapy may support recovery cycles related to autonomic regulation, while allowing neuromodulation to be integrated into movement, rehabilitation or performance-based work.

References: (Medina-Ramírez, et al., 2024) | (Teruel-Hernández, et al., 2023)

4.8 · How do I conduct an ANS-focused clinical history?

Specific clinical assessment for identifying signs of dysautonomia (typically completed during the first session, lasting approximately 30–60 minutes).

Sleep (key area):

How many hours do you sleep per night? (Typical target: 7–8 hours.)
How many times do you wake during the night? (Frequent awakenings may suggest autonomic dysregulation.)
What time do you usually wake up? Are you able to fall asleep again easily?
Do you remember your dreams or feel that you reach restorative sleep stages?
Do you wake feeling restored, or still fatigued?

Where possible, the use of actigraphy devices such as WHOOP, Oura Ring or equivalent wearable technologies may help support objective sleep assessment. Some clinics choose to collect baseline data for several days before beginning treatment.

Recovery and fatigue:

Do you feel rested when you wake up? (0–10 scale.)
At what time of day do you feel most energetic?
Do you rely on stimulants such as coffee or energy drinks?
How long does it take you to recover after exercise or physical effort?

Stress and tolerance:

What is your perceived stress level? (0–10 scale.)
How reactive are you to minor stressful situations?
Do you experience physical symptoms during stress, such as palpitations, sweating or tremor?
How quickly do you recover after stressful situations? >

Autonomic symptoms:

Palpitations: frequency and context, such as rest or stress.
Blood pressure: history of hypertension or hypotension.
Temperature regulation: intolerance to heat or cold.
Digestion: gastric symptoms, IBS or constipation.
Pain: location, distribution and relationship to sleep or stress.

Clinical documentation:

Create a “Baseline Autonomic Profile” within the patient record. These data may help establish a reference point for monitoring response to treatment.

Quick dysautonomia checklist:

Score each area from 0–3 (0 = normal, 3 = severe):

Sleep: __ /3

Sleep: __ /3

Stress tolerance: __ /3

Síntomas vegetativos: __/3

Total: __ /12 >

References: (Vega-Delgado, et al., 2024)

4.9 · How do I define treatment goals with NESA®?

Setting SMART + self-directed goals:

Primary goals (main focus):

Specific: “Improve deep sleep” (not “feel better”)
Measurable: “REM sleep currently 15% → target 25%” (calculable via HRV + patient log)
Achievable: based on baseline data, typical response to NESA® in your patient population
Relevant: aligned with the patient’s main symptom
5. Time-bound: “Within 8 weeks” (typical timeframe to see initial changes)

Examples of Goals by Condition:

Insomnia:

Primary: “Reduce night-time awakenings from 5–6 to 1–2 per night within 8 weeks.”

Secondary: “Improve HRV from 20 ms to 30 ms within 4 weeks.”

Chronic pain:

Primary: “Reduce pain from 7/10 to 4/10 within 8 weeks” (VAS scale).

Secondary: “Improve exercise tolerance progressively over the treatment period.”

Athlete / recovery:

Primary: “Improve HRV from 35 ms to 45 ms within 4 weeks.”

Secondary: “Achieve a 10% improvement in a specific performance test within 8 weeks.”

Older adults / cognition:

Primary: “Improve REM sleep from 12% to 20% within 8 weeks.”

Secondary: “Achieve a 15% improvement in cognitive test score within 8 weeks.”

Practical set-up:

Session 1: define a maximum of 2–3 treatment goals, as too many objectives may become overwhelming for the patient.
Baseline assessment: document current values such as HRV, pain scores and sleep records.
Follow-up: reassess progress every 2–3 sessions.
Adjustment: if no meaningful progress is observed after approximately 4 sessions, review the diagnosis, treatment plan or protocol selection.

Communication with the patient:

“Our goals are X, Y and Z. We will monitor them objectively throughout the treatment process to assess progress. If there are no meaningful changes within approximately four weeks, we will reassess the approach together.”

References: (Contreras-Polo, et al., 2023)

4.10 · How can I measure progress objectively?

Multiparametric measurement system:

HRV (Principal Biomarcador):

Protocol:

Record a baseline ECG at rest: 5 minutes seated, before session 1.

Post-treatment: record ECG after each session for the first 3 sessions, then weekly.

Document HRV in milliseconds and relevant HRV parameters.

Interpretation: an increase in HRV may indicate improved autonomic regulation. A typical target may be a 20–30% improvement, depending on the patient profile.

Sleep — patient log and optional wearables

Protocol:

The patient completes a validated sleep questionnaire, such as the Pittsburgh Sleep Quality Index.

Optional: use a smart wearable such as WHOOP, Oura or Fitbit to record REM sleep, deep sleep and sleep latency.

Documentation: create a trend chart after the first 10 sessions.

Interpretation: perceived sleep quality is usually assessed over 4–6 weeks.

Pain — if applicable

Protocol:

Weekly VAS assessment: 0–10 pain intensity scale.

Record location and context: when does the pain occur?

Medication: document any changes in analgesic use.

Documentation: weekly progress table.

Interpretation: pain reduction is usually assessed over 4–6 weeks.

Function

Protocol:

Timed Up and Go test, if there is a risk of falls in older adults.

Range of motion assessment, using goniometry in musculoskeletal conditions.

Specific functional or stress tests, depending on the speciality.

Documentación: comparativa basal vs. cada 2-3 semanas

Stress and wellbeing — questionnaires

Protocol:

Perceived Stress Scale (PSS-10) every 2 weeks.

Salivary cortisol measurement, where clinically appropriate.

DASS-21 if anxiety or depression is present.

Documentation: track changes over time.

Key point: Objective measurement reduces bias, improves patient motivation and helps justify treatment decisions to institutions.

References: (Bonilla-Eizaguirre, et al., 2024) | (Melián-Ortíz, et al., 2025)

4.11 · How can I explain the ANS to a patient in 60 seconds?4.11 · ¿Cómo explico el SNA al paciente en 60 segundos?

Ultra-brief explanation (for quick reference):

“Your body has two automatic systems that work in balance:

The accelerator — the sympathetic nervous system: it increases heart rate, raises alertness and prepares the body to respond to stress or danger.
The brakes — the parasympathetic nervous system: it helps you rest, digest, recover and sleep.

The problem is that chronic stress, pain or poor sleep can keep the accelerator switched on for too long. When that happens, recovery becomes more difficult: sleep quality drops, fatigue accumulates and the body struggles to regulate itself properly.

NESA® aims to support the body’s regulatory balance by helping the parasympathetic system function more effectively. The goal is not sedation, but improved autonomic regulation.

No lo vas a sentir, pero en una semana verás que duermes mejor y te despiertas menos de noche.”

Recommended duration: 45–60 seconds.
Language: simple, clear and free from technical jargon. Clinical use: useful during patient education and shared decision-making before starting therapy.

Where possible, use a simple visual aid — such as an accelerator/brakes diagram or a basic ANS illustration — to improve understanding.

References: (Paton, et al., 2026)

4.12 · What should I do if the patient does not improve after 4–6 sessions?

Suggested clinical approach when response is limited:

Step 1: Review adherence and protocol consistency

Did the patient attend all scheduled sessions? If not, reassess consistency before modifying the treatment plan.
Were the sessions carried out correctly?
Review notes regarding electrode placement, settings and protocol selection.
Is the patient sleeping adequately between sessions?
Sleep quality may influence autonomic recovery and treatment response.
Have there been changes in stress levels or external factors between sessions?

Major lifestyle or emotional stressors may influence outcomes and should be considered clinically.

Step 2: Reassess the clinical picture

Is autonomic dysregulation genuinely present?

Baseline HRV <and >autonomic markers.

Sleep patterns and night-time awakenings.

Presence of autonomic or stress-related symptoms.

¿Diagnóstico primario es el correcto?

For example, symptoms initially interpreted as primary insomnia may be associated with depression, anxiety or another underlying condition requiring multidisciplinary management.

Referral to an appropriate specialist, such as a neurologist or psychiatrist, may be appropriate where clinically indicated.

Step 3: Optimise the NESA® protocol

Review protocol selection.

Consider changing the protocol.

If only passive therapy has been used, consider introducing active therapy where appropriate.

Increase treatment frequency if clinically justified.
Adjust timing of sessions according to patient response.
Sesiones más largas:De 55 min → 90 min

Step 4: Assess limiting comorbidities

Medication-related factors:

Some medications, such as beta-blockers or chronic benzodiazepine use, may influence HRV and autonomic responsiveness.

Any medication review should be carried out only in coordination with the prescribing physician.

Comunicar con médico prescriptor sobre optimización (no suspensión)

Conditions such as hypothyroidism or anaemia may influence autonomic regulation and recovery capacity.

Undiagnosed medical conditions:

Anemia (limita tolerancia a cualquier intervención)

Further assessment may be appropriate if clinically suspected.

Trauma-related conditions:

NESA® requires integration with trauma-specific therapies (EMDR, SE).

Patients with significant trauma or PTSD may require integrated management alongside trauma-focused therapies such as EMDR or somatic approaches.

Step 5: Clinical decision after 4–6 weeks

Option A — Partial response

If partial improvement is observed, continue the protocol with reassessment over the following weeks.

Expectativa: Consolidación de mejora, posible aceleración

Option B — Minimal or no meaningful response <

Consider temporarily pausing treatment, reassessing the clinical picture and referring for additional specialist evaluation if necessary.

Reason: “Your body needs time. In 4 weeks, we will reassess whether to continue.”

Alternative: Refer to a specialist (neurology, internal medicine) for comprehensive diagnosis.

Option C — Newly identified contraindication or limiting factor

Suspend treatment if clinically appropriate, manage the underlying issue and reassess suitability for NESA® later.

Communication with the patient:

“We are not yet seeing the level of improvement we expected. This may mean that your body needs more time, that the treatment plan requires adjustment or that there may be other contributing factors we should investigate further. We will review the next steps together and adapt the approach according to your clinical response.”

References: (Azevedo, Medina-Ramírez, 2025) | (Molina-Cedrés, et al., 2025)

5.1 · Mental Health (Psychology and Psychiatry) Why does my patient with pharmacologically treated anxiety continue to show hyperarousal even when the medication appears to be working?

Autonomic regulation is fundamental in mood disorders, anxiety and chronic stress. ANS dysfunction can perpetuate cycles of sympathetic hyperarousal, insomnia and reduced parasympathetic vagal tone.

NESA® supports ANS regulation by:

Improving HRV and vagal tone.

Supporting regulation of the sleep–wake cycle.

Reducing chronic allostatic load.

Increasing resilience to stress.

Non-invasive neuromodulation using sub-sensory microcurrents modulates autonomic circuits without the adverse effects typically associated with psychotropic medication. It may therefore complement psychological and pharmacological therapy.

Strength of the ANS↔symptom relationship: Very High | Intervention evidence: Emerging evidence (HRV, ANS-psychiatry)

References: (Azevedo N, et al., 2025)

Q1 References / Systematic Reviews ANS-Specialty: (Schiweck C, et al., 2024) | (Cheng YC, et al., 2025) | (Beauchaine TP, et al., 2024) | (Kemp AH, et al., 2025)

5.2 · Neurology Where does the unexplained fatigue reported by neurological patients come from, when it does not improve with rest and undermines their entire rehabilitation process?

Multiple neurological conditions, including stroke, multiple sclerosis, migraine and neuropathies, involve autonomic dysfunction. Multiple sclerosis, for example, is associated with significant alterations in sleep patterns, neuropathic pain and bladder dysfunction.

NESA® evidence in neurology:

Multiple sclerosis: -38.2% PSQI, with improvements in pain and bladder function (Contreras-Polo M, et al., 2023).

Long COVID with dysautonomia: +62.9% tibial PPT (Melián-Ortíz A, et al., 2025).

Documented relationship between pain and ANS dysfunction (Azevedo N, et al., 2025).

NESA® can be integrated into neurological rehabilitation protocols to support functional recovery and quality of life.

Fortaleza de la relación SNA↔síntoma: Alta | Evidencia intervencionista: Evidencia intervencionista

References: (Contreras-Polo M, et al., 2023) | (Melián-Ortíz A, et al., 2025) | (Azevedo N, et al., 2025)

Q1 References / Systematic Reviews ANS-Speciality: (Fanciulli A, et al., 2024) | (Hilz MJ, et al., 2024) | (Goldstein DS, et al., 2025) | (Jordan J, et al., 2023)

5.3 · Neuropsychology What if the “apathy” observed in your patient is not simply behavioural depression, but a reflection of an ANS that has lost its capacity for activation and sustained attention?

Clinical neuropsychology addresses cognitive deficits associated with neurological and brain-related conditions. Sleep quality is a critical factor influencing cognitive function, memory and attention.

NESA® evidence in cognition:

Dementia: +40% improvement in sleep quality and +35% improvement in cognitive function (Teruel-Hernández E, et al., 2023).

Optimisation of restorative sleep may support memory consolidation and neural plasticity.

NESA® may help support the neurophysiological substrate — particularly REM and NREM sleep architecture — associated with effective neuropsychological assessment and rehabilitation.

Strength of the ANS↔symptom relationship: High | Intervention evidence: Intervention evidence

References: (Teruel-Hernández E, et al., 2023)

Q1 References / Systematic Reviews ANS-Speciality: (Forte G, et al., 2023) | (Mather M, Thayer JF, 2024) | (Williams DP, et al., 2024) | (Holzman JB, Bridgett DJ, et al., 2023)

5.4 · Neurorehabilitation Why does a patient with motor potential fail to engage fully in each session, or become increasingly unable to tolerate the therapeutic workload?

Neurorehabilitation following stroke, traumatic brain injury or spinal cord injury requires optimised sleep and autonomic recovery to support effective neuroplasticity.

NESA® evidence in neurorehabilitation:

Documented improvement in functional recovery through optimisation of REM sleep and ANS regulation.

Integration with physical therapy to support functional gains.

Active trials in ACL injury (NCT05207943) and post-surgical recovery.

As an adjunct within neurorehabilitation protocols, NESA® may support functional recovery and long-term outcomes.

Strength of the ANS↔symptom relationship: High | Interventional evidence: Interventional evidence (active trials)

References: (García F, et al., 2022) | (Medina-Ramírez R, et al., 2024)

Q1 References / Systematic Reviews ANS-Speciality: (Dawson J, et al., 2024) | (Engineer ND, et al., 2025) | (Hilz MJ, et al., 2024) | (Pruvost-Robieux E, et al., 2024)

5.5 · Neurosurgery and Perioperative Neurology How can autonomic stability help identify patients at greater risk of perioperative bleeding, postoperative agitation or slower recovery?

The neurological perioperative period requires optimisation of sleep and autonomic recovery to help reduce complications, support healing and facilitate post-surgical neuroplasticity.

NESA® in the neurological perioperative period:

Pre-quirúrgico: optimización de VFC, sueño y estrés sistémico

Post-surgical: support for recovery through REM sleep and parasympathetic regulation.

Reduction of post-operative neuropathic pain.

Improved tolerance to intensive physical therapy.

The active trial on knee replacement recovery (NCT06134999) supports the relevance of NESA® in post-surgical contexts.

Strength of the ANS↔symptom relationship: High | Interventional evidence: Interventional evidence (active trials)

References: (Bonilla-Eizaguirre M, et al., 2024)

Q1 References / Systematic Reviews ANS-Speciality: (Frasch MG, et al., 2024) | (Reimer P, et al., 2025) | (Sessler DI, et al., 2024) | (Aronson D, et al., 2025)

5.6 · Chronic Pain Why does a patient with a well-defined chronic pain condition continue to amplify their pain experience even after the original condition has been appropriately treated?

Chronic pain may be perpetuated by autonomic dysfunction, including nociceptive hypervigilance, impaired descending inhibitory control and fragmented sleep.

Potential mechanisms of NESA® in chronic pain include:

Support for parasympathetic-sympathetic balance

Improved deep sleep and restoration processes associated with endogenous analgesia.

Reduction of central sensitisation.

Reduction of chronic allostatic load associated with persistent pain.

The relationship between ANS dysfunction and chronic pain persistence has been documented (Azevedo N, et al., 2025). NESA® offers a non-pharmacological approach to autonomic modulation.

Strength of the ANS↔symptom relationship: Very High | Interventional evidence: Interventional evidence

References: (Azevedo N, et al., 2025)

Q1 References / Systematic Reviews on the ANS-Speciality: (Tracy LM, et al., 2024) | (Koenig J, et al., 2023) | (Forte G, et al., 2025) | (Hassett AL, et al., 2024)

5.7 · Physiotherapy Do you recognise the patient who responds well biomechanically to treatment, but whose body simply cannot tolerate it: pain does not subside, fatigue does not improve and recovery fails to consolidate?

Modern physiotherapy requires optimal autonomic recovery to support tissue healing, tolerance to progressive exercise and neuromuscular adaptation.

NESA® applications in physiotherapy:

Pre-treatment optimisation: improved HRV and parasympathetic tone.

Improved joint range of motion: +23.15° in post-treatment cervical rotation (Bonilla-Eizaguirre M, et al., 2024).

Support for muscle recovery: +20% REM sleep in athletes (García F, et al., 2022).

Integration into post-surgical rehabilitation protocols.

NESA® may enhance the therapeutic response by supporting autonomic nervous system regulation.

Strength of the ANS↔symptom relationship: Very High | Intervention evidence: Intervention evidence

References: (García F, et al., 2022) | (Bonilla-Eizaguirre M, et al., 2024) | (Medina-Ramírez R, et al., 2024)

Q1 References / Systematic Reviews on the ANS and Speciality: (Lehrer P, et al., 2024) | (Russo MA, et al., 2025) | (Bordoni B, et al., 2024) | (Schleip R, Stecco C, et al., 2024)

5.8 · Rehabilitation How do you distinguish between a patient with limited recovery potential and one whose body is simply too stressed to make use of it?

Comprehensive rehabilitation — post-traumatic, post-surgical or impairment-related — depends on optimising sleep, HRV and autonomic recovery capacity.

NESA® evidence in rehabilitation:

Basketball recovery: +20% REM sleep, supporting recovery processes (García F, et al., 2022).

Post-traumatic cervical pain: -2.3 points on pain scores and +23.15° in cervical range of motion (Bonilla-Eizaguirre M, et al., 2024).

Active trials: ACL injury (NCT05207943) and knee prosthesis recovery (NCT06134999).

Young athletes: optimisation of sleep and recovery (Medina-Ramírez R, et al., 2024).

NESA® can be integrated as a supportive component within modern rehabilitation protocols.

Strength of the ANS↔symptom relationship: Very High | Intervention evidence: Intervention evidence (active trials)

References: (García F, et al., 2022) | (Medina-Ramírez R, et al., 2024) | (Bonilla-Eizaguirre M, et al., 2024)

Q1 References / Systematic Reviews on the ANS in this Speciality: (Stein PK, Pu Y, et al., 2023) | (Kemp AH, et al., 2025) | (Cipriani G, et al., 2024) | (Sandercock GR, Bromley PD, Brodie DA, 2023)

5.9 · Rheumatology and Immunology Why does a patient with pharmacologically controlled rheumatoid arthritis continue to report severe fatigue, poor sleep and a sensation of inflammation not reflected in laboratory tests?

Autoimmune and rheumatic diseases, including rheumatoid arthritis, lupus and Sjögren’s syndrome, are characterised by immune dysfunction that may be associated with autonomic nervous system imbalance. Chronic stress and sleep deprivation can further amplify inflammatory responses.

Potential mechanisms of NESA® in rheumatology include:

Support for inflammatory-axis regulation through vagal parasympathetic pathways.

Improvement in restorative sleep, supporting protective immune responses.

Reduction of systemic allostatic load.

Complementary support alongside pharmacological treatment.

Autonomic modulation is an emerging component in the holistic management of rheumatic diseases.

Strength of the ANS↔symptom relationship: High | Interventional evidence: Mechanistic evidence (HRV-immunity)

References: (Azevedo N, et al., 2025)

Q1 References / Systematic Reviews on the ANS in this speciality: (Adlan AM, et al., 2024) | (Bonaz B, et al., 2024) | (Koopman FA, et al., 2023) | (Tracey KJ, et al., 2024)

5.10 · Pre- and Post-Surgery Why can a patient who appears “ideal” for elective surgery still develop unpredictable perioperative complications, such as haemodynamic instability, excessive pain or delayed recovery?

The perioperative period requires optimisation of systemic stress, sleep and HRV to help reduce complications, support healing and accelerate functional recovery.

Potential applications of NESA® in perioperative care include:

Pre-surgical support: optimisation of HRV, reduction of pre-operative stress and improvement in sleep quality.

Immediate post-operative support: modulation of surgical stress and support for pain management.

Recovery phase: support for REM sleep and recovery-related physiological processes.

Evidence under investigation in ACL and knee replacement trials (NCT05207943 and NCT06134999).

NESA® may support surgical recovery through autonomic regulation as part of a broader perioperative care strategy.

Strength of the ANS↔symptom relationship: High | Interventional evidence: Interventional evidence (active trials)

References: (Bonilla-Eizaguirre M, et al., 2024)

Q1 References / Systematic Reviews ANS-Speciality: (Reimer P, et al., 2025) | (Hanss R, et al., 2024) | (Ernst G, 2023) | (Aronson D, et al., 2025)

5.11 · Lymphatic Drainage and Oedema Where does persistent fluid retention come from when manual drainage, compression and movement have already been optimised, yet symptoms still fluctuate with the patient’s stress levels?

Lymphatic drainage and oedema management depend on interstitial pressure, muscle contraction and autonomic function, particularly vasomotor tone.

Potential mechanisms of NESA® in lymphatic drainage include:

Modulation of sympathetic influence on vasoconstriction.

Support for microcirculatory flow through ANS regulation.

Improvement in deep sleep, the stage of greatest parasympathetic activity.

Complementary support alongside manual drainage techniques.

NESA® may help create more favourable autonomic conditions for drainage and the management of chronic oedema.

Strength of the ANS↔symptom relationship: Moderate | Intervention evidence: Mechanistic evidence (VFC-circulation)

References: (García F, et al., 2022)

Q1 References / Systematic Reviews ANS-Speciality: (Scallan JP, et al., 2024) | (Gashev AA, et al., 2023) | (Bridenbaugh EA, et al., 2024) | (Mortimer PS, Rockson SG, 2024)

5.12 · Podiatry and the lower limb Why do some patients with foot pain or diabetic ulcers respond better when the autonomic nervous system is also addressed?

Podiatric and lower-limb conditions, including diabetic neuropathy, ulcers and claudication, often involve vascular and autonomic dysfunction.

Potential applications of NESA® in podiatry include:

Support for distal perfusion through optimisation of autonomic vasomotor tone.

Support for recovery processes in diabetic ulcers through improved sleep and autonomic regulation.

Reduction of neuropathic pain through improved parasympathetic balance.

Complementary support alongside conventional vascular therapy.

NESA® may help optimise the autonomic component underlying many podiatric conditions.

Strength of the ANS ↔ symptom relationship: Moderate | Interventional evidence: Mechanistic evidence

References: (Azevedo N, et al., 2025)

Q1 References / Systematic Reviews ANS-Speciality: (Pop-Busui R, et al., 2024) | (Spallone V, et al., 2023) | (Vinik AI, Casellini C, et al., 2024) | (Tesfaye S, et al., 2025)

5.13 · Sports medicine What distinguishes an athlete who recovers well from one who becomes overtrained despite following the same training plan?

Sports medicine aims to optimise recovery, performance and injury prevention through neuromuscular and cardiovascular adaptation.

NESA® evidence in sports medicine:

Basketball recovery: +20% REM sleep, supporting post-training recovery (García F, et al., 2022).

Young athletes: optimisation of sleep and recovery in elite athletes (Medina-Ramírez R, et al., 2024).

Support for muscle recovery through improved sleep quality.

Active trials in ACL injury (NCT05207943).

NESA® can be used as a supportive tool for recovery and injury-prevention strategies within modern sports medicine protocols.

Strength of the ANS↔symptom relationship: Very High | Intervention evidence: Intervention evidence

References: (García F, et al., 2022) | (Medina-Ramírez R, et al., 2024)

Q1 References / Systematic Reviews ANS-Speciality: (Plews DJ, Laursen PB, et al., 2024) | (Buchheit M, 2024) | (Bellenger CR, et al., 2023) | (Manresa-Rocamora A, et al., 2024)

5.14 · Internal medicine Why does a patient with all biochemical markers “under control” still report fatigue, exercise intolerance and poor quality of life?

Internal medicine involves the management of systemic comorbidities. Autonomic dysfunction is a common underlying factor in hypertension, metabolic disorders, metabolic syndrome and frailty.

Aplicación NESA en medicina interna:

Improvement in HRV, a marker associated with morbidity and mortality risk in complex patients.

Support for sleep optimisation in patients with polypharmacy.

Reduction of systemic allostatic load.

Complementary support without known pharmacological interactions.

NESA® may serve as a tool for systemic autonomic regulation in internal medicine.

Strength of the ANS ↔ symptom relationship: High | Interventional evidence: Mechanistic evidence (HRV-general health)

References: (Mínguez-Esteban I, et al., 2024)

Q1 References / Systematic Reviews on the ANS-Speciality: (Thayer JF, Lane RD, 2024) | (Williams DP, et al., 2025) | (Kemp AH, et al., 2025) | (Jarczok MN, et al., 2024)

5.15 · Preventive Medicine How can a non-invasive biomarker help identify patients with an “apparently healthy” lifestyle who may be silently developing chronic disease?

Preventive medicine aims to optimise autonomic regulation, HRV and sleep in order to reduce risk factors associated with chronic disease.

The value of NESA® in preventive medicine includes:

Assessment and improvement of HRV in asymptomatic populations.

Sleep optimisation as a cardiovascular protective factor.

Reduction of chronic stress and allostatic load.

Improvement of autonomic recovery capacity.

NESA® may be used as a preventive intervention to support autonomic resilience and healthy ageing.

Strength of the ANS↔symptom relationship: High | Intervention evidence: Mechanistic evidence

References: (Mínguez-Esteban I, et al., 2024)

References Q1 / Systematic Reviews ANS-Speciality: (Jandackova VK, et al., 2024) | (Nunan D, Sandercock GRH, Brodie DA, 2023) | (Kemp AH, et al., 2025) | (Hillebrand S, et al., 2024)

5.16 · Endocrinology and Obesity Why do some patients develop insulin resistance and weight gain even in a calorie deficit, while others with a similar intake remain metabolically flexible?

Endocrinology and obesity involve dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and autonomic dysfunction. Fragmented sleep can worsen insulin sensitivity and metabolic control.

Potential mechanisms of NESA® in endocrinology include:

Optimisation of the sleep–wake cycle, supporting insulin sensitivity.

Regulation of hyperactive sympathetic tone in obesity.

Improved satiety and appetite control through deeper, more restorative sleep.

Complementary support alongside nutritional and pharmacological therapy.

NESA® may support autonomic function in metabolic disorders.

Strength of the ANS↔symptom relationship: High | Interventional evidence: Mechanistic evidence (ANS-metabolism)

References: (Báez-Suárez A, et al., 2023)

Q1 References / Systematic Reviews on the ANS and Speciality: (Carnagarin R, et al., 2024) | (Esler M, et al., 2023) | (Thorp AA, Schlaich MP, 2023) | (Spallone V, 2023)

5.17 · Clinical Nutrition How can your patient’s autonomic state influence whether they absorb and metabolise the nutrients you carefully prescribe?

Clinical nutrition requires optimal sleep, digestive function and autonomic regulation to support metabolism, nutrient absorption and healing.

Potential applications of NESA® in nutrition include:

Improvement of gastrointestinal motility through ANS regulation.

Optimisation of sleep to support nutrient absorption and metabolism.

Support for microbiota balance.

Complementary support alongside supplementation and dietary therapy.

Improved digestive function in critically ill or rehabilitating patients.

NESA® may help optimise the autonomic physiology that underpins clinical nutrition.

Strength of the ANS ↔ symptom relationship: Moderate | Interventional evidence: Mechanistic evidence

References: (Báez-Suárez A, et al., 2023)

Q1 References / Systematic Reviews ANS-Speciality: (Mayer EA, et al., 2024) | (Cryan JF, et al., 2024) | (Bonaz B, Sinniger V, Pellissier S, 2024) | (Tan VPS, Chu DT, et al., 2024)

5.18 · Cardiology Why is heart rate variability such an important prognostic marker after myocardial infarction?

Modern cardiology recognises HRV as a relevant marker of cardiovascular morbidity and mortality. NESA® modulates the ANS, which plays a central role in cardiac regulation.

Evidence and potential applications of NESA® in cardiology include:

HRV modulation, a marker associated with cardiovascular prognosis.

Documented vascular changes: increased carotid diameter and reduced intima-media thickness (Mínguez-Esteban I, et al., 2024).

Support for post-infarction recovery through autonomic optimisation.

Support for parasympathetic balance in patients with autonomic dysregulation.

NESA® is an emerging complementary modality within integrated cardiological management.

Strength of the ANS↔symptom relationship: Very High | Interventional evidence: Interventional evidence

References: (Mínguez-Esteban I, et al., 2024)

Q1 References / Systematic Reviews on the ANS-Speciality: (Sessa F, et al., 2024) | (Vinik AI, Casellini C, et al., 2024) | (Goldberger JJ, et al., 2024) | (Paton JFR, Żera T, et al., 2026)

5.19 · Vascular Health How can autonomic dysfunction undermine arterial health, even when lipids and blood pressure appear to be under control?

Vascular health depends on adequate vasomotor tone, endothelial function and optimal ANS regulation.

Potential mechanisms of NESA® in vascular health include:

Modulation of sympathetic tone in arterioles.

Improved arterial diameter, with increased carotid artery diameter reported by Mínguez-Esteban I, et al. (2024).

Reduction in intima-media thickness.

Optimisation of sleep to support endothelial recovery.

NESA® may support vascular function through autonomic regulation.

Strength of the ANS ↔ symptom relationship: High | Interventional evidence: Interventional evidence

Referencias: (Mínguez-Esteban I, et al., 2024)

Q1 References / Systematic Reviews on ANS-Speciality: (Joyner MJ, Charkoudian N, et al., 2024) | (Charkoudian N, et al., 2024) | (Carnagarin R, et al., 2025) | (Esler M, Schlaich MP, et al., 2025)

5.20 · Respiratory medicine Why can “difficult-to-control” asthma improve when patients learn to regulate both their breathing and autonomic nervous system, without adding more medication?

Respiratory conditions such as COPD, asthma and sleep apnoea are often associated with autonomic dysfunction and fragmented sleep.

Potential applications of NESA® in respiratory medicine include:

Improved sleep quality in patients with respiratory disorders (PSQI -4 points; Vega-Delgado N, et al., 2024).

Modulation of sympathetic tone associated with bronchoconstriction.

Optimisation of REM sleep in COPD.

Complementary support alongside inhalation therapy and non-invasive ventilation.

NESA® may help support the autonomic component underlying respiratory physiology.

Strength of the ANS ↔ symptom relationship: High | Interventional evidence: Interventional evidence

References: (Vega-Delgado N, et al., 2024)

Q1 References / Systematic Reviews ANS-Speciality: (Tobaldini E, et al., 2024) | (Borchers AT, et al., 2023) | (Chien JH, Lin SH, et al., 2024) | (Russo MA, Santarelli DM, O’Rourke D, 2025)

5.21 · Gastroenterology How can two patients with identical endoscopic findings have completely different symptoms and respond very differently to the same treatment?

Gastrointestinal conditions, including IBS, inflammatory bowel disease and motility disorders, are closely linked to autonomic and enteric nervous system dysfunction.

NESA® evidence and potential applications in gastroenterology include:

Normalisation of bowel-movement frequency: from 87% of patients < fewer than 3 bowel movements per week to 60.9% with 3–6 bowel movements per week (Báez-Suárez A, et al., 2023).

Improved intestinal motility through parasympathetic regulation.

Support for gut–brain axis regulation.

Reduction in functional digestive symptoms.

NESA® may help modulate the autonomic and enteric components involved in gastrointestinal function.

Strength of the ANS ↔ symptom relationship: High | Interventional evidence: Interventional evidence

References: (Báez-Suárez A, et al., 2023)

Q1 References / Systematic Reviews ANS-Speciality: (Browning KN, Travagli RA, 2024) | (Bonaz B, Sinniger V, Pellissier S, 2024) | (Mayer EA, et al., 2024) | (Black CJ, et al., 2024)

5.22 · Intimate Health and Pelvic Floor Why can sexual and pelvic floor dysfunction persist after mechanical treatment when autonomic dysregulation remains unaddressed?

Intimate and pelvic floor health depends on appropriate autonomic function, including muscle tone, perfusion and sleep quality.

NESA® evidence and potential applications in pelvic health include:

Overactive bladder: documented improvement in urinary control (Blasco-Bonora PM, et al., 2025).

Urinary incontinence: significant reduction in episodes (Conde-Santos G, et al., 2025).

Support for sexual function through autonomic optimisation.

Complementary support alongside pelvic floor therapy.

NESA® may help optimise the autonomic regulation required for normal pelvic function.

Strength of the ANS↔symptom relationship: High | Interventional evidence: Interventional evidence

References: (Blasco-Bonora PM, et al., 2025) | (Conde-Santos G, et al., 2025)

Q1 References / Systematic Reviews ANS-Speciality: (Yamanishi T, et al., 2024) | (Padilla-Fernández B, et al., 2024) | (Peters KM, et al., 2023) | (de Groat WC, Yoshimura N, 2024)

5.23 · Andrology How does the autonomic nervous system influence male sexual function and prostate health?

Andrology includes conditions such as erectile dysfunction, infertility and hypogonadism, which may be associated with autonomic dysfunction and sleep disturbance.

Potential mechanisms of NESA® in andrology include:

Improved deep sleep, which supports hormonal regulation.

Support for blood flow and vascular function.

Modulation of sympathetic tone involved in erectile function.

Optimisation of HRV as a marker of autonomic regulation.

Complementary support alongside pharmacological and behavioural therapy.

NESA® may help modulate the autonomic substrate underlying male sexual function.

Strength of the ANS↔symptom relationship: Moderate | Interventional evidence: Mechanistic evidence (ANS-sexuality)

References: (Blasco-Bonora PM, et al., 2025) (Mínguez-Esteban I, et al., 2024)

Q1 References / Systematic Reviews on the ANS and Speciality: (Maiorino MI, Bellastella G, Esposito K, 2024) | (Corona G, et al., 2024) | (Dimitriadis F, et al., 2024) | (Mulhall JP, et al., 2024)

5.24 · Dentistry: orofacial pain, bruxism and TMJ What role does the autonomic nervous system play in nocturnal bruxism, TMJ pain and post-extraction recovery?

Dental conditions such as orofacial pain, bruxism and TMJ dysfunction are often associated with chronic stress, fragmented sleep and autonomic dysfunction.

Potential applications of NESA® in dentistry include:

Reduction of orofacial muscle tension through parasympathetic regulation.

Reduction of anxiety during dental treatment.

Improved sleep quality, which may help reduce nocturnal bruxism.

Reduction of orofacial pain through ANS regulation.

Pre-treatment optimisation before dental procedures, particularly in anxious patients.

NESA® may be used as a non-pharmacological adjunct in functional dental conditions.

Strength of the ANS↔symptom relationship: High | Interventional evidence: Mechanistic evidence

References: (Azevedo N, et al., 2025)

Q1 References / Systematic Reviews on the ANS in this speciality: (Manfredini D, et al., 2024) | (Lavigne GJ, et al., 2024) | (Fischer L, et al., 2024) | (De La Torre Canales G, et al., 2024)

5.25 · Dentistry and stomatology: oral perioperative care How should anticipatory anxiety and patient reactivity be managed during complex oral procedures?

The oral perioperative period requires management of surgical stress, sleep optimisation and pain control to support healing of oral tissues.

Potential applications of NESA® in oral perioperative care include:

Pre-operative support: reduction of dental anxiety through autonomic optimisation.

Post-operative support: support for bone and soft-tissue healing through improved sleep.

Post-operative pain management through ANS regulation.

Improved patient adherence and tolerance.

NESA® may help support dental outcomes through autonomic regulation.

Strength of the ANS↔symptom relationship: High | Interventional evidence: Mechanistic evidence

References: (Bonilla-Eizaguirre M, et al., 2024)

Q1 References / Systematic Reviews on ANS-Speciality: (Appukuttan DP, et al., 2024) | (Boyer JM, et al., 2024) | (Aminoshariae A, et al., 2023) | (Fischer L, et al., 2024)

5.26 · ENT and audiology What is the connection between tinnitus, vertigo and autonomic regulation in patients with hearing loss?

ENT conditions such as rhinitis, sleep apnoea and vertigo may involve autonomic dysfunction and sleep fragmentation, including nocturnal hypoxia in relevant cases.

Potential applications of NESA® in ENT include:

Improved sleep quality in patients with sleep apnoea (PSQI -4 points; Vega-Delgado N, et al., 2024).

Modulation of nasal tone through parasympathetic regulation.

Support for vestibular function through ANS regulation.

Complementary support alongside CPAP and ENT surgery.

NESA® may help improve sleep quality and autonomic regulation in ENT-related conditions.

Strength of the ANS↔symptom relationship: High | Interventional evidence: Interventional evidence

References: (Vega-Delgado N, et al., 2024)

Q1 References / Systematic Reviews ANS-Speciality: (Bertora P, et al., 2024) | (Andersson G, McKenna L, Baguley DM, 2024) | (Pothier DD, et al., 2023) | (De Stefano A, et al., 2024)

5.27 · Ophthalmology How can ophthalmologists interpret dry eye, visual fatigue and accommodative dysfunction from an ANS perspective?

Ophthalmological conditions such as dry eye, intraocular pressure changes and photophobia may be linked to autonomic dysfunction and fragmented sleep.

Potential mechanisms of NESA® in ophthalmology include:

Sleep optimisation to support ocular recovery, tear production and epithelial healing.

Modulation of sympathetic tone involved in tear production.

Improved sleep quality (PSQI -4 points; Vega-Delgado N, et al., 2024).

Complementary support alongside topical ophthalmic therapy.

NESA® may help optimise autonomic conditions that support eye health.

Strength of the ANS ↔ symptom relationship: Moderate | Interventional evidence: Mechanistic evidence

References: (Vega-Delgado N, et al., 2024)

Q1 References / Systematic Reviews on the ANS and Speciality: (Galor A, et al., 2024) | (McMonnies CW, 2023) | (Dieterich M, Brandt T, 2024) | (Lalor SJH, et al., 2024)

5.28 · Dermatology Why are flare-ups of psoriasis, atopic dermatitis and urticaria exacerbated by stress, and what role does the autonomic nervous system play?

Dermatological conditions such as atopic dermatitis, psoriasis and alopecia are often linked to chronic stress, fragmented sleep and autonomic dysfunction.

Potential applications of NESA® in dermatology include:

Optimisation of deep sleep to support epidermal tissue recovery.

Stress reduction through parasympathetic regulation.

Support for skin healing through improved HRV and autonomic balance.

Complementary support alongside conventional dermatological therapy.

NESA® may help modulate the neuroregulatory substrate involved in dermatological conditions.

Strength of the ANS ↔ symptom relationship: Moderate | Interventional evidence: Mechanistic evidence

References: (Vega-Delgado N, et al., 2024)

Q1 References / Systematic Reviews on the ANS and Speciality: (Suárez AL, Feramisco JD, et al., 2024) | (Theoharides TC, et al., 2024) | (Slominski AT, et al., 2024) | (Misery L, et al., 2024)

5.29 · Aesthetic medicine and wellness How can post-procedure recovery, oedema and sensitivity be optimised by modulating the autonomic nervous system?

Modern aesthetic medicine increasingly integrates sleep optimisation, stress management and autonomic regulation to support treatment outcomes and healthy ageing.

Potential value of NESA® in aesthetics and wellness includes:

Improved sleep quality (PSQI -4 points) to support skin recovery and healing (Vega-Delgado N, et al., 2024).

Optimisation of HRV as a biomarker associated with biological ageing.

Reduction of chronic stress, which may contribute to accelerated ageing.

Complementary support alongside aesthetic treatments.

NESA® may be used as a wellness-oriented modality to support healthy ageing through autonomic regulation.

Fortaleza de la relación SNA↔síntoma: Media | Evidencia intervencionista: Evidencia mecanística

Referencias: (Vega-Delgado N, et al., 2024)

Q1 References / Systematic Reviews ANS-Speciality: (Slominski AT, et al., 2024) | (Kemp AH, Koenig J, Thayer JF, 2025) | (Choi K, et al., 2024) | (Russo MA, Santarelli DM, O’Rourke D, 2025)

5.30 · Geriatrics How does dysautonomia contribute to frailty, falls, insomnia and functional decline in older adults?

Modern geriatrics recognises that pathological ageing is often associated with autonomic dysfunction, fragmented sleep and reduced neural plasticity.

NESA® evidence and potential applications in geriatrics include:

Dementia: +40% improvement in sleep quality and +35% improvement in cognitive function (Teruel-Hernández E, et al., 2023).

Institutionalised older adults: -64.4% night-time awakenings (Báez-Suárez A, et al., 2025).

Support for fall-risk reduction through optimisation of sleep and HRV.

Support for autonomic recovery capacity.

NESA® may be used as a supportive intervention for healthy ageing and frailty prevention.

Strength of the ANS↔symptom relationship: Very High | Intervention evidence: Intervention evidence

References: (Teruel-Hernández E, et al., 2023) | (Báez-Suárez A, et al., 2025)

Q1 References / Systematic Reviews ANS-Speciality: (Cremer A, et al., 2024) | (Fanciulli A, et al., 2024) | (Forte G, Casagrande M, 2025) | (Parvaneh S, et al., 2024)

5.31 · Paediatrics and neurodevelopment What role does the autonomic nervous system play in neurodevelopment, behavioural regulation and functional gastrointestinal symptoms in children?

Child neurodevelopment depends on deep sleep, autonomic regulation and neural plasticity. Neurodevelopmental disorders, including ASD and ADHD, are often associated with fragmented sleep and ANS dysfunction.

NESA® evidence and potential applications in paediatrics include:

Children with neurodevelopmental disorders: +1.74 hours of sleep and -69.5% night-time interruptions (Báez-Suárez A, et al., 2023).

Autism spectrum disorder: improvements in sleep, behaviour and sensory profile (Molina-Cedrés F, et al., 2025).

Autism clinical case: -44% disruptive behaviour and +22% sensory profile improvement (Hernández Pérez A, et al., 2025).

Support for attention and learning through sleep optimisation.

NESA® may help optimise the autonomic substrate required for healthy neurodevelopment.

Strength of the ANS↔symptom relationship: Very High | Interventional evidence: Interventional evidence

References: (Báez-Suárez A, et al., 2023) | (Molina-Cedrés F, et al., 2025) | (Hernández Pérez A, et al., 2025)

Q1 References / Systematic Reviews ANS-Speciality: (Patriquin MA, et al., 2024) | (Porges SW, Lewis GF, et al., 2024) | (Beauchaine TP, Thayer JF, 2024) | (Frasch MG, et al., 2024)

5.32 · Speech and Language Therapy How does autonomic regulation influence stuttering, orofacial control, respiratory coordination and communication?

Speech and language therapy depends on adequate sleep, neural plasticity and attentional regulation to support verbal motor learning and communication.

Potential applications of NESA® in speech and language therapy include:

Improvement of deep sleep to support consolidation of verbal motor patterns.

Optimisation of attention and auditory processing through improved HRV.

Support for ASD and language disorders through sleep optimisation (+1.74 hours; Báez-Suárez A, et al., 2023).

Complementary support alongside conventional speech and language therapy.

NESA® may help optimise autonomic conditions associated with effective speech and language rehabilitation.

Strength of the ANS ↔ symptom relationship: High | Intervention evidence: Intervention evidence

References: (Báez-Suárez A, et al., 2023) | (Molina-Cedrés F, et al., 2025)

Q1 References / Systematic Reviews on ANS-Speciality: (Jones RM, et al., 2024) | (Choi D, et al., 2024) | (Beauchaine TP, Thayer JF, 2024) | (Maguire GA, et al., 2024)

6.1 · What does the ecosystem include when I purchase NESA®?

6.1 · What does the ecosystem include when I purchase NESA®?
The core element, the NESA XSIGNAL® neuromodulator, remains the same. What changes between purchasing structures is the level of implementation, the material included, the support provided, and the speed at which the centre can start using it consistently.

That difference matters because many healthcare professionals are not so much unsure about the technology itself as about the path to integrating it. A well-chosen package reduces friction, shortens the adoption curve, and helps the team feel capable from the very first month.

The ecosystem can usually include: the XSIGNAL® device, GDCN cable, glove and ankle strap kits, power supply and adapters, transport case/backpack, manuals, specialty-specific protocols, adapted furniture, and support tools for physiological objectification, depending on the configuration.
Purchasing structures are usually organised around a Basic / Advanced / Premium logic, or an equivalent model: the same technological foundation, with different levels of deployment, support, and resources.
The highest-value complements for implementation are usually initial training, the campus/clinical guides, start-up mentoring, and presence within the clinic ecosystem.

6.2 · What is an ANS Rehabilitation Unit, and do I need to set one up?

An ANS Rehabilitation Unit is a clinical space dedicated to non-invasive neuromodulation, designed to optimise therapeutic efficacy and the patient experience. It includes a specially equipped treatment area in which all stimuli that may influence the patient’s ANS are considered from a 360° perspective: light, sound, visual and olfactory stimuli, as well as comfort.

Creating a separate unit is not mandatory if your practice is small or multidisciplinary. NESA® can be implemented in existing consultation rooms. However, centres that dedicate a specific space often report:

Greater consistency in protocol application
Better patient adherence
Easier promotion of the technology within the local area
A clearer per-session billing model

NESA CLINICS represents the gold-standard configuration: a proven spatial set-up designed to accelerate time to value and support standardisation. Treatment becomes a structured clinical experience.

6.3 · What is NESA Clinics?

NESA Clinics is a network of partner clinics that implement NESA® in accordance with proven international standards. It is designed as a lower-risk business model because it provides:

Documented operational standards for installation, protocols and biosafety
Remote and on-site support from the NESA team
Priority access to innovations, including new protocols and software updates
Integration into a global network of clinics, supporting visibility and referral opportunities
NESA certification, which can enhance credibility with patients and partner organisations

It is particularly suitable for multidisciplinary clinics, private hospitals and private centres looking to differentiate their clinical offering. It requires a commitment to a minimum number of sessions and is designed to support a more predictable return.

6.4 · What should I do with amputee patients or very young children?

NESA® offers specific adapters for special populations:

Amputees: silicone/foam adapters that secure the gloves and ankle straps to residual limbs, supporting effective signal delivery without requiring all four limbs.
Young children (<<6 years): XS glove and ankle strap sizes, ergonomically designed for paediatric hands and feet.
Severe oedema or deformity: flexible configuration kits that adapt to non-standard anatomy.

Each adaptation requires technical validation to ensure adequate electrode–skin contact and should be documented in the patient’s protocol.

6.5 · What warranty and technical support are provided?

NESA® warranty and technical support include:

Manufacturer’s warranty: 24 months from the date of purchase, including parts and labour. This covers manufacturing defects, but not damage caused by misuse.
Global technical support: available in more than 20 countries through local technical teams.
Repairs: most repairs are carried out in Spain or in the customer’s country of origin. Remote diagnostics and troubleshooting are available via TeamViewer or telephone.
Spare parts: available at list price, with delivery typically within 2–7 days in Europe. Outside Europe, stock availability depends on each distributor.
Extended warranty: optional cover extending protection to 60 months, including accidental damage and battery ageing.

Response times: critical issues are addressed within <<24 hours; non-critical issues are usually managed within 48–72 hours.

6.6 · How long does the device last?

The XSIGNAL® neuromodulator is designed for long-term clinical use:

Designed service life: a minimum of 8–10 years of intensive clinical use (10+ sessions/day), without functional degradation under normal operating conditions.
Battery: 1,000+ charge cycles before degradation exceeds <10%. Battery replacement is available at an accessible cost.
Housing and connectors: durable materials selected for clinical use and long-term performance.

Investment in an XSIGNAL® neuromodulator typically pays for itself within 7 to 9 months on average, depending on session volume and pricing per session or per package of 10–20 sessions.

6.7 · Does it have certifications and regulatory approval?

NESA® complies with demanding international regulatory standards:

MDR 2017: classified as a Class II medical device under the EU Medical Device Regulation, with assessment by an independent Notified Body.
ISO 13485: quality management certification; manufactured in accordance with medical device quality standards.
MDSAP: Canada.
CE marking: displayed on the device, confirming conformity with applicable safety and performance requirements.
Additional approvals: health registrations in more than 20 countries; accepted by public health systems in Spain, Italy, Portugal, Poland, Bulgaria, Malaysia, Ghana and others.

This regulatory framework helps protect patients, supports clinicians’ legal responsibilities and may facilitate reimbursement by public and private insurers.

6.8 · What are the guidelines for use and care?

Essential guidelines for safe use:

Pre-use inspection: visually inspect the gloves and ankle straps before each use (no tears, electrodes intact).
Hygiene: use single-patient kits; each patient should use their own glove and ankle strap kit throughout the full treatment cycle.
Storage: store in a dry environment at 15–25°C, away from direct sunlight.
Care of the neuromodulator: do not immerse in water. Clean the casing with a dry cloth and store it in the protective case provided.
Cable handling: avoid forcing connections; insert and remove with gentle pressure. Avoid repeated bending of cables.
Power supply: always use the original adapter. Do not modify the voltage specifications.

Failure to follow these guidelines may void the warranty. A full reference manual is included and is also available via the online campus.

6.9 · How often should maintenance be carried out?

Preventive maintenance schedule:

Monthly: inspect the condition of cables and connectors and ensure all connections remain secure.
Annually: optional on-site technical inspection, included with Advanced and Premium packages.

This maintenance schedule is designed to support system reliability and help identify potential issues before they affect clinical sessions.

6.10 · Are the glove and ankle strap kits assigned to individual patients?

Yes. For biosafety and patient comfort:

Individual kit: each patient receives a personalised set of gloves and ankle straps identified with their patient ID and stored in a labelled bag.
Lifespan: each kit typically lasts for approximately 40–50 clinical uses before the electrodes or silicone components begin to degrade.
Replacement: replacement kits can be ordered individually or in packs of five for hospitals and larger clinics.
Improved hygiene: individual storage helps reduce the risk of cross-contamination, particularly in relation to skin conditions or infections.
Patient comfort: appropriately fitted gloves improve comfort, treatment experience and adherence.

Kit replacement represents a predictable consumables cycle that clinics may incorporate into the pricing structure of the initial treatment package.

6.11 · Can cables be disconnected during a session?

No. Maintaining connection integrity is essential:

GDCN cable: this cable supports targeted signal routing; disconnecting it interrupts therapeutic delivery.
Glove and ankle strap cables: disconnection results in loss of electrode–skin contact and interrupts treatment.
Safety design: NESA® connectors are designed to minimise accidental disconnection during normal clinical use.
Treatment continuity: if any connection needs to be adjusted, the session should be paused before reconnecting and restarting the protocol.

As part of standard protocol, cables should not be disconnected during an active session. If there is any technical concern, the session should be stopped and technical support contacted.

6.12 · What happens if I connect the cables incorrectly?

NESA® includes multiple safety protections to reduce the risk of incorrect connection:

Connector design: circular DIN-type connectors with a unique orientation system, designed to prevent incorrect insertion.

These protection mechanisms are intended to help prevent use under unsafe conditions. Initial training includes cable installation and connection procedures, which typically require less than <five minutes to learn.

6.13 · What happens if I do not connect the GDCN cable?

The GDCN cable is essential for the intended clinical operation of the system:

Function: it enables targeted neuromodulation according to the selected protocol (for example, protocols focused on parasympathetic or sympathetic modulation).
Without the GDCN cable: signal delivery is not properly directed, and the system will not initiate the session if the cable is not connected.

NESA® cannot be used functionally without the GDCN cable. If the cable is damaged, replacement units are available, with standard delivery times of approximately 2–7 days within Europe.

6.14 · How do I know where to place the directional electrode?

Accurate placement of the GDCN cable is important for protocol consistency:

Protocol-specific positioning: each speciality area (sleep, insomnia, incontinence, sexual dysfunction, attention deficit and others) includes documented positioning guidance.
Placement manual: supplied in print format and available online, with step-by-step photographs and demonstration videos.
Anatomical landmarks: positioning is based on reproducible anatomical reference points (for example, iliac crest or malleolar landmarks).
Clinical references: positioning approaches used in published studies are documented for specific clinical applications.
Support resources: the online campus includes a visual validation checklist.
Support app: an augmented reality positioning support app is currently in development.

Initial training generally requires 30–45 minutes to become familiar with positioning for the five main indications.

6.15 · What if the patient is allergic to the electrodes?

Allergic reactions to NESA® electrodes are uncommon:

The electrodes are manufactured using biocompatible silver chloride (Ag/Cl) materials.

Los pacientes alérgicos pueden usar NESA® con adaptación mínima. Documentación de alergias en historia clínica mejora seguridad.

6.16 · Can I use a different power supply?

No. Only the original NESA® power supply should be used:

Specifications: voltage, amperage and connector configuration are calibrated specifically for XSIGNAL®. Use of an incompatible power supply may damage the system or affect battery performance.
Safety: the original power supply includes CE/UL-certified protection against overload and short circuits. Generic alternatives may not provide equivalent protection.
Warranty: use of a non-original power supply voids the warranty and releases NESA® from associated liability.
Warranty: use of a non-original power supply voids the warranty and releases NESA® from associated liability.

The original power supply forms part of the overall clinical safety system. Replacement units are available if the original adapter is damaged.

6.17 · Can I order additional materials (leaflets, vinyl graphics, etc.)?

Yes. NESA® offers a range of branded support materials for clinics:

Leaflets and brochures: available in Spanish, English and other languages. These explain NESA®, clinical indications, session protocols and clinic contact details.
Vinyl graphics and posters: suitable for waiting rooms and treatment areas, featuring NESA® branding and educational information related to the ANS.
Digital templates: for email marketing, Instagram and websites, customisable with clinic branding and contact details.
PowerPoint presentations: designed for conferences, meetings with hospitals or professional associations, including clinical and operational information.
Short videos: 30–60 second explanatory reels for social media use.
Certificates: academic certificates issued upon completion of the NESA non-invasive neuromodulation expert course.

Requests for materials are managed through the sales team.

7.1 · What training will I receive when I purchase NESA®?

Training is phased and personalised to build clinical confidence:

Account Manager: you are assigned a dedicated contact from day one to support implementation and adoption.
Initial training: 4–6 hours, delivered online or in person depending on your preference, covering basic safety, installation, session protocols and real clinical cases.
Online campus: 200+ educational videos, each lasting 3–10 minutes, covering:

ANS neurophysiology

150+ treatment protocols by speciality

Resolved clinical cases

Technical troubleshooting

Up-to-date scientific evidence, including NESA papers and wider literature

Start-up mentoring: priority access to the clinical team for consultations during the first 30 days.
Month 1 objective: your team becomes confident in applying the standard protocol for 3–5 main indications and managing initial cases.

Training is included with all packages. Campus access is valid for five years.

7.2 · What does the basic training include?

Basic training is intensive but accessible:

Module 1: ANS neurophysiology (1 hour). Key concepts, parasympathetic and sympathetic systems, and their role in health and disease.
Module 2: NESA® technology (1 hour). How neuromodulation works, GDCN cable routing and session parameters.
Module 3: Installation and safety (1 hour). Unit assembly, cable connection, fault checks and biosafety measures.
Module 4: Standard clinical protocol (1 hour). Session structure, including pre-assessment, medical history, application, post-assessment, duration and recommended frequency.
Module 5: Clinical indications (1 hour). Concise review of six main indications — chronic pain, insomnia, incontinence, sexual dysfunction, attention deficit and migraine — with standard protocols and variations.
Module 6: Clinical case review (1 hour).

Total time: 4–6 contact hours + independent practice. We recommend 30 minutes per day for one week. Certificate of competence issued upon completion.

7.3 · Is online or in-person training better?

Both formats have advantages; the best option depends on your learning style and clinical context.

In-person training:

Advantages: live hands-on demonstration, practice with a real patient, role play, immediate questions, on-site support from the NESA® team and integration with the local clinical team.

Ideal for: teams that value experiential learning and feel more confident after supervised practical training.

Duration: 4 hours.

Online training:

Advantages: access from anywhere, ability to pause and revisit videos at your own pace, flexible review at any time and lower travel costs.

Ideal for: clinics with geographically dispersed staff, irregular working hours or teams that prefer autonomous learning.

Duration: 4–6 hours.

Best practice: a hybrid approach. In-person training for the core clinical team (4 hours), followed by online platform access for in-depth study during months 1–3. We offer flexibility so you can choose the format that best fits your setting.

7.4 · ¿Puedo formarme antes de comprar?

Yes. NESA® supports an informed decision-making process:

Free campus access: limited three-week access to 10–15 introductory videos, with no obligation to purchase. Topics include basic neurophysiology, clinical cases and ROI.
Demo presencial:Demostración de 40–60 minutos en tu clínica. Incluye uso del dispositivo, visualización de sesión, y conversación sobre aplicabilidad a tus pacientes.
Online demo: a shorter 25–40-minute session via Zoom, with interactive slides and Q&A.
Webinars: regular webinars on specific topics within each speciality, such as neuromodulation in rehabilitation or urology. These are free of charge and do not require registration of sensitive personal data.
Clinical references: contact with centres in your region that have implemented the system and can share their experience regarding clinical use, ROI and outcomes.

Purpose: when you decide to purchase, you should have clear information about clinical applicability, required investment and expected return. No surprises.

7.5 · What is the online campus?

The NESA® online campus is your gateway to continuing clinical education:

Structure: 200+ videos organised by topic:

ANS neurophysiology fundamentals

150+ treatment protocols by medical and surgical speciality

Real clinical cases, including baseline, progression and follow-up

NESA papers and clinical interpretation, including 15+ indexed publications

Technical troubleshooting, common issues and practical solutions

Interviews with 12+ international experts, including researchers and clinicians

Format: 3–10-minute videos, designed to be easy to watch between clinical appointments. Subtitles are available in 10+ languages.
Updates: new content every six months, including new protocols, recent papers and testimonials.
Access: via the NESA app for iOS and Android, or through a web browser. Offline download is available.
Certification: modules include quizzes. After completing five modules, users can generate a digital “NESA Trained Professional” certificate for CVs and professional profiles.
Community: a moderated forum where clinicians share cases, questions and best practice. The NESA team responds within <48 hours.

Campus access is valid indefinitely from the date of purchase, with unlimited access for you and your clinical team.

7.6 · What is the Expert in Non-Invasive Neuromodulation programme?

It is a six-month advanced clinical certification programme:

Content: in-depth study of non-invasive neuromodulation, neuroplasticity, advanced protocols, clinical research and case publication.
Structure:

Modules 1–2 (weeks 2–3): advanced neurophysiology and NESA® mechanisms of action.

Modules 3–4 (weeks 4–12): in-depth protocols across 12 specialities.

Modules 5–6 (weeks 12–24): clinical research, trial design, data collection and HRV analysis.

Final project: final examination.

Format: asynchronous flexible learning + monthly live synchronous sessions with NESA mentors.
Duration: 100–120 hours of self-study + 8 hours of live sessions.
Certification: “Expert in Non-Invasive Neuromodulation” diploma recognised by NESA and academic partners, including universities in Spain, Italy and Portugal.
Cost: €950. Optional and not required to use NESA®.

Ideal for clinicians seeking to deepen their expertise, develop innovation or differentiate themselves professionally.

7.7 · What is 4SleepDrive®?

4SleepDrive® is a specialised blended learning programme for clinicians treating sleep disorders:

Focus: in-depth study of NESA® protocols for insomnia, obstructive sleep apnoea, restless legs syndrome and circadian rhythm disorders.
Content:

Theoretical modules: sleep neurophysiology, classification of sleep disorders and global epidemiology.

Practical protocols: 8+ protocol variants according to insomnia subtype, including sleep onset insomnia, sleep maintenance insomnia, early awakening and comorbidities.

Management of complex patients: patients with apnoea and insomnia, and patients receiving psychotropic medication.

Assessment tools: validated questionnaires, including PSQI, ISI and ESS, with interpretation and follow-up guidance.

Current structure: in-person training in two cities: Madrid and Lisbon. Asynchronous online training will be available soon.
Duration: 16 in-person hours across four modules of four hours each, delivered on Friday afternoon, Saturday and Sunday morning.
Certification: “Specialist in Sleep Neuromodulation” diploma.
Cost: €500.

Ideal if sleep medicine is a core part of your practice or if you want to stand out in this clinical area.

7.8 · Are there sleep patients in my city?

Yes. There is significant and growing demand for the management of sleep disorders:

Global epidemiology: chronic insomnia affects a substantial proportion of the global population. In Europe, approximately 25–30% of adults report symptoms of insomnia.
Obstructive sleep apnoea: estimated global prevalence is high, with cases ranging from mild to severe. Prevalence increases notably in men> over 40.
Current treatments have limitations: hypnotics may be associated with dependence and adverse effects; CPAP may be limited by intolerance or low adherence; CBT-I is not widely accessible in many countries.
Growing market: patient interest in non-pharmacological and “natural” approaches to insomnia has increased in recent years.
Your clinic: in a city with more than >100,000 inhabitants, there is likely to be a substantial population of patients with clinically relevant insomnia symptoms. NESA® is already used in public hospital settings in Spain, Italy and Portugal.

Training in 4SleepDrive® and the Sleep Campus can help position your clinic within this high-value clinical segment.

References: Benjafield et al., 2019.

7.9 · What are the ICNIN international conferences?

ICNIN, the International Congress on Non-Invasive Neuromodulation, is NESA’s annual global scientific conference:

Event: a 2–3-day conference featuring scientific presentations, clinical workshops and international networking.
Location: Madrid.
Programme:

Oral presentations of clinical research, including NESA papers and studies by independent researchers.

Practical workshops: advanced protocols, troubleshooting and complex clinical cases, with parallel training across up to six tracks.

Round tables: expert discussions on trends, regulatory barriers and innovation.

Networking: access to clinicians from 40+ countries, researchers and thought leaders.

Access: open to clinicians, researchers and students. Online registration is available.
Streaming: full conference available via multilingual streaming in ES, EN, FR, DE and IT for those unable to attend in person.
Certification: attendance certificates available.

An ideal platform to stay up to date and connect with a global community of innovators in neuromodulation.

7.10 · In which languages is the training available?

Training is available in multiple languages, depending on region:

Online campus: currently available primarily in Spanish (ES) and English (EN), with additional content available in PT, IT, NL, RO, LT, FR and DE.
In-person training: available in ES, EN, IT and PT, depending on country and demand.
Webinars and ICNIN: streaming with simultaneous interpretation in ES, EN, FR, DE and IT.
Clinical materials: protocols and reference manuals available in 10 languages.
Technical support: available in ES, EN, IT and PT. Other languages may be available through local partners.

If your main language is not listed, please contact the sales team. We may be able to arrange translation of key materials or connect you with a mentor in your language, where available.

8.1 · How do I request an in-person demonstration?

An in-person demonstration is the first practical step towards understanding how NESA® could fit into your clinical setting. The session is designed to be tailored, informative and clinically relevant.

Typical content (40–60 minutes):

Review of your clinical context: specialities, patient volume and current equipment

Technical overview of XSIGNAL®: assembly, GDCN cable, parameters and contact integrity.

Live session demonstration: carried out with a volunteer (patient or staff member), including pre-assessment, application and post-assessment. Portable ECG-based monitoring may be included if available.

Clinical discussion: review of one or two representative patient profiles from your practice, including possible protocols, variations and expected clinical objectives.

Operational considerations: discussion of workflow integration, space requirements and staff training.

Application: complete the form on the NESA WORLD website, indicating your speciality, city and preferred availability.
Confirmation: the sales team will usually contact you within 24 hours to arrange a suitable date. Flexible scheduling options are available where possible.
Logistics: demonstrations can be delivered either in person at your clinic or online.

Following the demonstration, you will have time to ask any additional questions. The aim is to support an informed evaluation process without pressure.

8.2 · ¿Hay demostración online?

Yes. A 25–40-minute online demonstration is available and can be an efficient first introduction to the system.

Content:

Visual presentation of the device, including a 360° overview, contact points and the GDCN cable.

Interactive slides covering neurophysiology, mechanism of action and key protocols.

Recorded clinical session demonstrating treatment workflow and, where available, HRV-related monitoring.

Live Q&A tailored to your clinical setting.

Supporting resources, including a PDF summary of key protocols, estimated ROI and contact details.

Ideal for:

Initial evaluation with minimal time commitment.

Geographically remote clinics.

Teams working across multiple locations.

Limitation: online demonstrations do not provide hands-on interaction with the device. If you wish to explore further afterwards, an in-person follow-up demonstration can be arranged.
Request: appointments can be booked directly through the website in approximately 30 seconds.

An online demo can be a practical first step towards evaluating whether NESA® is appropriate for your clinic.

8.3 · Where can I buy NESA®?

NESA® is distributed through two main channels, depending on the region:

Direct sales through NESA WORLD: available in countries without an official distributor. Contact can be made through the website contact form.
Local distributors: available in more than 40 countries, including:

Middle East: Saudi Arabia, Bahrain, Iraq, Jordan, Kuwait and Qatar

Asia-Pacific: Brunei, India, Malaysia, Nepal and Taiwan.

Europe: Andorra, Bulgaria, Greece, Italy, Kosovo, Latvia, Moldova, the Netherlands, Poland, the United Kingdom, the Czech Republic and Slovakia.

Americas: Brazil, Canada, Chile, Colombia, Costa Rica, Guatemala, Mexico and Peru.

Africa: Cameroon, Egypt, Ghana and Morocco.

Benefits of local distribution:

After-sales support in the local language.

Local technical service.

Market-adapted pricing structures where applicable.

Knowledge of regional regulations and reimbursement systems.

Verification: always purchase through an authorised distributor listed on the official NESA® website. Purchases from unauthorised sellers may void the warranty.

An updated distributor list is available online. If your region is not listed, please contact NESA® directly.

8.4 · Are financing options available?

Yes. Financing options may be available depending on the country, distributor and type of institution.

8.5 · How do I introduce NESA® into a public hospital?

Introducing NESA® into a public hospital usually requires an institutional and evidence-based approach:

Existing adoption: by 2026, NESA® has been implemented in hospitals across Spain, Poland, Portugal, Bulgaria, Malaysia and Ghana. Clinical references and case examples are available.
Typical documentation required:

Technical documentation: regulatory compliance, CE marking, MDR classification, ISO 13485 certification and installation requirements.

Clinical dossier: indexed publications, ongoing trials and comparative efficacy data where available.

Operational proposal: cost-benefit analysis and implementation planning.

Training and support plan: onboarding, technical support and continuity arrangements.

Typical hospital procurement pathway (2–6 months):

Step 1: demonstration to the relevant clinical department and medical management.

Step 2: technical evaluation by the biomedical engineering department.

Step 3: review by the procurement committee.

Step 4: contract negotiation.

Step 5: approval and purchase.

Recommendation: identify a clinical “champion” within the hospital, such as the head of department, to help support internal evaluation and adoption.
Support: the NESA® sales team works directly with hospitals and can provide references from existing centres where appropriate.

8.6 · How do I present the treatment to patients without sounding like I’m selling?

Professional, clinically focused communication helps maintain trust and minimise any perception of aggressive marketing.

Separate the treatment plan from the technology:

First explain the diagnosis and evidence-based treatment strategy.

Then introduce NESA® as the tool used to deliver the neuromodulation protocol safely and non-invasively.

Educate patients about the mechanism:

Explain the role of the ANS in the context of their condition.

Describe how NESA® is designed to modulate autonomic function non-invasively.

Use simple analogies where appropriate, such as “a form of training or regulation for the nervous system”.

Set realistic expectations:

Discuss clinical objectives.

Explain session frequency and duration.

Outline expected timelines for reassessment and possible response.

Describe how progress will be monitored, including symptom scales or physiological measurements where relevant.

Obtain informed consent:

Provide written information covering the procedure, expected benefits, known limitations, potential risks and available alternatives.

Document consent appropriately in the medical record.

Ensure cost transparency:

Clearly communicate pricing, packages and any available payment options.

If there are payment options, they are all clearly stated

Explain reimbursement options where applicable.

Build patient confidence:

Provide anonymised testimonials or educational resources where appropriate.

Offer access to educational webinars or patient information events

When communication is transparent, evidence-based and patient-centred, the interaction is perceived as professional clinical guidance rather than sales activity.

8.7 · Does NESA® participate in conferences?

Yes. NESA® has participated in more than 30 international conferences and scientific events.

Congresos científicos principales:

ICS (International Continence Society),
ISPRM (International Society of Physical and Rehabilitation Medicine), ESPRM (European Society of Physical and Rehabilitation Medicine)