The Vicious Cycle of Chronic Pain in Aging Requires Multidisciplinary Non-pharmacological Approach to Treatment

Abstract

This review summarizes how aging contributes to pain chronification and how recent developments in neuroscience can inform management of chronic pain in the elderly. Normal aging can boost pain chronification through neurodegeneration, alterations in circadian rhythms, inflammaging, as well as musculoskeletal deterioration and metabolic dysregulation. These processes are interconnected and bidirectional. There is accumulating evidence for the central role of inflammaging in chronic pain, and novel therapies are in development to address inflammaging. Social support and relapse prevention are particularly important aspects of interventions in the elderly. The confluence of multiple neurobiological mechanisms in the course of aging and pain chronification calls for an integrative health approach to management. In addition to pharmacotherapy, a comprehensive approach should include nutritional, psychological, and physical interventions.