Gibson S J, Katz B, Corran T M, Farrell M J, Helme R D
National Research Institute for Gerontology and Geriatric Medicine, North West Hospital, Parkville, Victoria, Australia.
Disabil Rehabil. 1994 Jul-Sep;16(3):127-39. doi: 10.3109/09638289409166289.
Chronic pain is more prevalent in older persons than in young adults. In this review the physiological, pathological, and psychological reasons for altered pain sensibility in older persons are explored and strategies for the management of pain in older persons described. The evidence suggests that altered physiology of peripheral and central pain mechanisms combine with psychological attitudes, such as stoicism and reluctance to confirm the presence of pain, to raise pain threshold. However, once pain is experienced, older persons describe the same severity, quality, and psychological disturbance as younger persons. There is some evidence to suggest that the complaint of pain in the presence of pathology is reported less often in older persons. On the other hand, the presence of persistent or recurrent clinical pain may have a greater impact on the psychological, social, and physical function of older adults. It is also clear, however, that further empirical studies are required in order to delineate the age-related differences and similarities in the chronic pain experience. Management of chronic pain in the elderly requires meticulous diagnosis of the causal pain mechanisms as well as a holistic approach which gives due regard to psychological and social consequences of pain.
慢性疼痛在老年人中比在年轻人中更为普遍。在这篇综述中，探讨了老年人疼痛敏感性改变的生理、病理和心理原因，并描述了老年人疼痛管理的策略。证据表明，外周和中枢疼痛机制的生理改变与诸如坚忍和不愿确认疼痛存在等心理态度相结合，提高了疼痛阈值。然而，一旦经历疼痛，老年人所描述的疼痛严重程度、性质和心理困扰与年轻人相同。有一些证据表明，在存在病理状况时，老年人较少报告疼痛主诉。另一方面，持续性或复发性临床疼痛的存在可能对老年人的心理、社会和身体功能产生更大影响。然而，同样清楚的是，需要进一步的实证研究来阐明慢性疼痛体验中与年龄相关的差异和相似之处。老年人慢性疼痛的管理需要对引起疼痛的机制进行细致诊断，以及采取一种全面的方法，充分考虑疼痛的心理和社会后果。
