Depression and chronic pain in the elderly: links and management challenges

Figures & data

Table 1 Pain syndromes, major causes and types of pain

Pain syndrome	Etiology	Type of pain
Chronic primary pain	Unknown	Difficult to distinguish the type (ie, fibromyalgia, irritable bowel syndrome)
Chronic cancer pain	Directly caused by the tumor (ie, bone metastases)	Visceral, musculoskeletal and neuropathic
	Related to treatment (ie, postsurgical, chemotherapy related, radiotherapy related)	Usually neuropathic
Chronic postsurgical and post-traumatic pain	Definition of exclusion; other causes (ie, infections) and pre-existing pain need to be excluded	Usually purely neuropathic or with a neuropathic component
Chronic neuropathic pain	Stroke, peripheral neuropathy, radiculopathy and cranial neuralgias	Neuropathic
Chronic visceral pain	Inflammation, ischemia and obstruction	Nociceptive
Chronic orofacial pain	Cranial neuropathies (ie, trigeminal neuralgia)	Neuropathic
	Temporomandibular disorders	Nociceptive
Chronic musculoskeletal pain	Arthritis, fractures and myositis	Nociceptive

Figure 1 The differences between normal and “primed” microglia consist of an increased sensibility of the latter to any kind of stimulation. The consequence is an increased production of cytokines.

Note: Copyright, with permission from Pain Nursing Magazine, Fusco M, Paladini A, Skaper SD, Varrassi G. Chronic and neuropathic pain syndrome in the elderly: Pathophysiological basis and perspectives for a rational therapy. Pain Nursing Magazine. 2014;3:94–104.¹⁵⁶

Figure 2 Relationship between chronic pain and depression, and the vicious cycle existing between the two pathologies.

FuscoMPaladiniASkaperSDVarrassiGChronic and neuropathic pain syndrome in the elderly: Pathophysiological basis and perspectives for a rational therapyPain Nursing Magazine2014394104

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