Abstract
Background: Chronic pain is a major issue affecting more than 50% of the older population and up to 80% of nursing homes residents. Research on pain in the elderly focuses mainly on the development of clinical tools to assess pain in patients with dementia and cognitive impairment or on the efficacy and tolerability of medications. In this review, we searched for evidence of specific pain mechanisms or modifications in pain signals processing either at the cellular level or in the central nervous system. Methods: Narrative review. Results: Investigation on pain sensitivity led to conflicting results, with some studies indicating a modest decrease in age-related pain sensitivity, while other researchers found a reduced pain threshold for pressure stimuli. Areas of the brain involved in pain perception and analgesia are susceptible to pathological changes such as gliosis and neuronal death and the effectiveness of descending pain inhibitory mechanisms, particularly their endogenous opioid component, also appears to deteriorate with advancing age. Hyperalgesia is more common at older age and recovery from peripheral nerve injury appears to be delayed. In addition, peripheral nociceptors may contribute minimally to pain sensation at either acute or chronic time points in aged populations. Conclusions: Elderly subjects appear to be more susceptible to prolonged pain development, and medications acting on peripheral sensitization are less efficient. Pathologic changes in the central nervous system are responsible for different pain processing and response to treatment. Specific guidelines focusing on specific pathophysiological changes in the elderly are needed to ensure adequate treatment of chronic pain conditions.
Highlights
The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage [1]
Similar trends are observed in C-fiber responsiveness if the stimulus is either mechanical or induced by the interaction of capsaicin with transient receptor potential vanilloid 1 (TRPV1) [25]
The mechanisms of peripheral sensitization through aging do not seem to depend on gene expression of ion channels but rather by the sensitization of the mechanoceptors [25]
Summary
The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage [1]. As the population of developed countries ages, there has been an increase in the prevalence of conditions associated with persistent pain across settings of care [3,4,5]. Survey-based studies in Europe show that chronic pain incidence increases with age, with an estimated prevalence ranging from 38 to 60% in people over 65 years old [4,5]. Despite the high prevalence of painful conditions in the elderly, specific guidelines regarding pain management in this population have not been developed, and only general advice regarding pharmacological treatment and clinical assessment have been proposed. Conclusions: Elderly subjects appear to be more susceptible to prolonged pain development, and medications acting on peripheral sensitization are less efficient
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
