Dagnino Ana P A, Campos Maria M
Programa de Pós-graduação em Medicina e Ciências da Saúde, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
Centro de Pesquisa em Toxicologia e Farmacologia, Escola de Ciências da Saúde e da Vida, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
Front Hum Neurosci. 2022 Mar 3;16:736688. doi: 10.3389/fnhum.2022.736688. eCollection 2022.
Chronic pain affects a large part of the population causing functional disability, being often associated with coexisting psychological disorders, such as depression and anxiety, besides cognitive deficits, and sleep disturbance. The world elderly population has been growing over the last decades and the negative consequences of chronic pain for these individuals represent a current clinical challenge. The main painful complaints in the elderly are related to neurodegenerative and musculoskeletal conditions, peripheral vascular diseases, arthritis, and osteoarthritis, contributing toward poorly life quality, social isolation, impaired physical activity, and dependence to carry out daily activities. Organ dysfunction and other existing diseases can significantly affect the perception and responses to chronic pain in this group. It has been proposed that elderly people have an altered pain experience, with changes in pain processing mechanisms, which might be associated with the degeneration of circuits that modulate the descending inhibitory pathways of pain. Aging has also been linked to an increase in the pain threshold, a decline of painful sensations, and a decrease in pain tolerance. Still, elderly patients with chronic pain show an increased risk for dementia and cognitive impairment. The present review article is aimed to provide the state-of-art of pre-clinical and clinical research about chronic pain in elderly, emphasizing the altered mechanisms, comorbidities, challenges, and potential therapeutic alternatives.
慢性疼痛影响着很大一部分人群，导致功能残疾，除了认知缺陷和睡眠障碍外，还常常与并存的心理障碍（如抑郁和焦虑）相关。在过去几十年中，世界老年人口一直在增长，慢性疼痛对这些人的负面影响是当前的一项临床挑战。老年人主要的疼痛主诉与神经退行性疾病、肌肉骨骼疾病、外周血管疾病、关节炎和骨关节炎有关，这些导致生活质量低下、社会隔离、身体活动受损以及日常生活依赖。器官功能障碍和其他现存疾病会显著影响该群体对慢性疼痛的感知和反应。有人提出，老年人的疼痛体验发生了改变，疼痛处理机制也有所变化，这可能与调节疼痛下行抑制通路的神经回路退化有关。衰老还与疼痛阈值升高、痛觉下降和疼痛耐受性降低有关。尽管如此，患有慢性疼痛的老年患者患痴呆症和认知障碍的风险增加。本综述文章旨在提供关于老年人慢性疼痛的临床前和临床研究的最新进展，强调其改变的机制、合并症、挑战以及潜在的治疗选择。
