Chronic Pain in Elderly Patients: Pathophysiology, Pharmacologic and Non-Pharmacologic Therapies, and Interventional Management

Ankur Jain, Eliot Sadik, Alejandra Cardenas-Rojas, Krithika Mahesh, Preston Ooi, Vahid Grami, Paul Christo Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USACorrespondence: Ankur Jain, Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA, Tel +1 703 853 2980, Email [email protected]: Chronic pain is a debilitating condition faced among the geriatric population, contributing to reduced mobility, impaired daily function, and increased dependence on healthcare services. This review explores the current landscape of chronic pain in the elderly, providing a comprehensive overview of treatment options, with the goal of exploring more effective, individualized care.Patients and Methods: This narrative review draws on a range of studies and clinical publications accessible through the National Center for Biotechnology Information (NCBI) database. The literature reviewed includes research on the underlying mechanisms, diagnostic challenges, and treatment strategies for chronic pain in older adults. Clinical relevance and practical approaches were explored, where risks and benefits of pharmacologic, non-pharmacologic, and interventional therapies were explored.Results: Chronic pain in the elderly is often undertreated, likely due to unaccounted comorbidities and age-related changes in drug metabolism. While acetaminophen remains the recommended first-line agent, the use of NSAIDs and opioids in this population carries significant risks and demands careful consideration. Adjuvant medications such as SNRIs and gabapentinoids offer additional options for neuropathic pain, but may require dose adjustments or close adverse effect monitoring. Non-pharmacologic interventions—such as physical therapy and cognitive behavioral therapy— often are underutilized despite a strong safety profile and evidence of benefit. In cases refractory to conservative measures, interventional procedures including epidural steroid injections, radiofrequency ablation, and spinal cord stimulation may offer meaningful relief for select patients.Conclusion: Managing chronic pain in older adults requires a thoughtful, individualized approach that balances effectiveness with safety. As the population ages, there is a growing need for more inclusive research, better integration of non-drug therapies, and greater access to interdisciplinary care. Tailoring treatment to individual goals can help improve outcomes and preserve independence and function in this vulnerable group.Keywords: multimodal pain management, opioids, non-pharmacologic therapy, interventional procedures, functional outcomes, geriatric care