Features of Pain Syndrome in Elderly and Senile Patients
DOI: 10.32364/2587-6821-2025-9-11-5
E.V. Vikhareva, E.V. Khozhenko
Academy of Postgraduate Education, Federal Scientific and Clinical Center of the Federal Medical Biological Agency of Russia, Moscow, Russian Federation
Chronic pain syndrome in elderly patients represents a significant medical issue associated with both physiological age-related changes in the nervous system and psychoemotional disorders. Relevance of the paper is determined by high prevalence of chronic pain in elderly patients and a need to develop personalized diagnostic and therapeutic approaches considering age-related physiological and psychoemotional alterations. A comprehensive scientific analysis was conducted on mechanisms underlying development and chronification of pain syndrome in elderly individuals, as well as on approaches to its diagnosis and treatment, with special consideration for age-associated physiological, psychoemotional, and pharmacological features. The paper highlights widespread — up to 87% of cases — occurrence of pain syndrome among patients over the age of 65 with a predominance of musculoskeletal pain (40%), particularly in the lower back and neck (65%), osteoarthritic pain (20%), and neuropathic pain syndromes (40%). Age-related degradation of nociceptive fibers, impaired myelination, and altered function of ion channels lead to hypoalgesia and sensitization. Neurobiological mechanisms of pain syndrome chronification such as NMDA receptor hyperactivity, as well as decreased levels of gamma-aminobutyric acid, serotonin, dopamine, and endogenous opioids, along with chronic systemic inflammation (inflammaging) resulting in peripheral and central sensitization, are described. The role of reduced homeostatic reserve which increases vulnerability and limits adaptive capacity is reported. The importance of a multidisciplinary approach including diagnostic pain assessment scales, physical therapy, cognitive behavioral therapy, therapeutic exercises, manual therapy, and drug therapy, is underlined. The authors emphasize a need for a personalized approach considering the pain pathophysiology, comorbidities, cognitive status, and social factors to reduce pain intensity, to improve psychological resistance, and to enhance quality of life.
Keywords: chronic pain, elderly patients, neuroplasticity, chronic systemic inflammation, sensitization, homeostasis, cognitive behavioral therapy, pain biomarkers, neuromodulation.
For citation: Vikhareva E.V., Khozhenko E.V. Features of Pain Syndrome in Elderly and Senile Patients. Russian Medical Inquiry. 2025;9(11):802–809 (in Russ.). DOI: 10.32364/2587-6821-2025-9-11-5
ABOUT THE AUTHORS:
Elena V. Vikhareva — Postgraduate Student of the Department of Nervous Diseases and Neurorehabilitation at the Academy of Postgraduate Education, Federal Scientific and Clinical Center of the Federal Medical Biological Agency of Russia; 91, Volokolamskoe road, Moscow, 125371, Russian Federation; ORCID iD 000-0003-1977-8886
Elena V. Khozhenko — Dr. Sc. (Med.), Professor of the Department of Nervous Diseases and Neurorehabilitation at the Academy of Postgraduate Education, Federal Scientific and Clinical Center of the Federal Medical Biological Agency of Russia; 91, Volokolamskoe road, Moscow, 125371, Russian Federation; ORCID iD 0000-0003-0313-1754
Contact information: Elena V. Vikhareva, e-mail: vev1996@mail.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 11.08.2025.
Revised 03.09.2025.
Accepted 26.09.2025.
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