Neuroimmunology and Behavior Laboratory, Department of Neuroscience, Center for Advanced Pain Studies (CAPS), School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA.
Garrison Institute on Aging and Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
Mol Pain. 2023 Jan-Dec;19:17448069231203090. doi: 10.1177/17448069231203090.
Chronic pain is one of the most common, costly, and potentially debilitating health issues facing older adults, with attributable costs exceeding $600 billion annually. The prevalence of pain in humans increases with advancing age. Yet, the contributions of sex differences, age-related chronic inflammation, and changes in neuroplasticity to the overall experience of pain are less clear, given that opposing processes in aging interact. This review article examines and summarizes pre-clinical research and clinical data on chronic pain among older adults to identify knowledge gaps and provide the base for future research and clinical practice. We provide evidence to suggest that neurodegenerative conditions engender a loss of neural plasticity involved in pain response, whereas low-grade inflammation in aging increases CNS sensitization but decreases PNS sensitivity. Insights from preclinical studies are needed to answer mechanistic questions. However, the selection of appropriate aging models presents a challenge that has resulted in conflicting data regarding pain processing and behavioral outcomes that are difficult to translate to humans.
慢性疼痛是老年人面临的最常见、最昂贵且潜在致残的健康问题之一，其可归因成本每年超过 6000 亿美元。疼痛在人类中的发生率随着年龄的增长而增加。然而，鉴于衰老过程中的相反过程相互作用，性别差异、与年龄相关的慢性炎症和神经可塑性变化对整体疼痛体验的贡献尚不清楚。本文综述了老年人群慢性疼痛的临床前研究和临床数据，以确定知识空白，并为未来的研究和临床实践提供基础。我们提供的证据表明，神经退行性疾病导致参与疼痛反应的神经可塑性丧失，而衰老过程中的低水平炎症增加中枢神经系统敏化，但降低周围神经系统敏感性。需要从临床前研究中获得见解来回答机制问题。然而，合适的衰老模型的选择是一个挑战，这导致了关于疼痛处理和行为结果的相互矛盾的数据，这些数据很难转化为人类。
