Chronic Pain and Opioids in the Elderly: Treating the Brain, Not Just the Body - PubMed

7 hours ago

Chronic pain, opioid use, and mental health disorders often co-occur in older adults, creating a complex triad.
Neurobiological aging processes like neuroinflammation and dopaminergic decline may increase vulnerability to opioid misuse.
A unified neuropsychiatric framework integrates neurobiological, affective, and clinical evidence to understand this intersection.
Key mechanisms include frontolimbic dysfunction, impaired reward processing, and chronic allostatic load.
Integrated therapeutic approaches, such as buprenorphine and SNRIs, may offer neuroprotective benefits.
Effective opioid stewardship requires integrated functional, cognitive, and affective monitoring.
Pain management should shift toward a neuropsychiatric model focusing on homeostatic balance across sensory, emotional, and motivational domains.
Opioid therapy can be viewed as a means of functional and neuroaffective restoration, not just risk reduction.

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