Department of Medicine-Geriatrics, Center for the Study of Aging, Duke University Medical Center and Geriatric Research, Durham, NC, USA.
Mayo Clin Proc. 2010 Mar;85(3 Suppl):S26-32. doi: 10.4065/mcp.2009.0646.
Currently, an estimated 38 million individuals 65 years or older live in the United States, and more than 11 million of these individuals are 80 years or older. Older people are at high risk of neuropathic pain because many diseases that cause neuropathic pain increase in incidence with age. Depending on their underlying health, older adults with neuropathic pain may have to cope with multiple coexisting diseases, polypharmacy, and impaired functional ability. The objective of this article is to review how aging and frailty affect the treatment of older adults with neuropathic pain. Specific topics reviewed include the complexity of treatment decisions in older patients due to aged heterogeneity, multimorbidity, and polypharmacy; selection of treatment in an effort to maximize patients' functional abilities in addition to relieving their pain; more careful dosing (usually lower) and monitoring of pharmacotherapy relative to younger patients due to age-related changes in pharmacokinetics and pharmacodynamics; and underrepresentation of older adults in clinical trials of neuropathic pain treatments, which further compromises physicians' ability to make informed treatment decisions.
目前，美国有大约 3800 万 65 岁及以上的老年人，其中超过 1100 万人年龄在 80 岁及以上。老年人患神经性疼痛的风险很高，因为许多导致神经性疼痛的疾病随着年龄的增长发病率会增加。患有神经性疼痛的老年人可能会根据其潜在的健康状况，同时应对多种共存疾病、多种药物治疗和功能能力受损的问题。本文的目的是回顾衰老和虚弱如何影响老年神经性疼痛患者的治疗。综述的具体内容包括：由于年龄异质性、多种合并症和多种药物治疗，老年患者的治疗决策变得更加复杂；选择治疗方法以尽量提高患者的功能能力，同时缓解疼痛；与年轻患者相比，由于与年龄相关的药代动力学和药效学变化，药物治疗的剂量（通常较低）和监测更加谨慎；以及神经性疼痛治疗的临床试验中老年人代表性不足，这进一步影响了医生做出明智治疗决策的能力。
