Myofascial pain in older adults: a geroscience-informed framework integrating precision geriatrics and digital therapeutics

Myofascial pain syndrome (MPS) in the elderly is a significant contributor to chronic pain and functional decline, driven by a unique set of age-related pathophysiological challenges. Core geroscience principles-including sarcopenia, inflammaging, and cellular senescence-converge to create a state of heightened central sensitization that amplifies pain. Traditional pharmacotherapy is fraught with risks in this population due to polypharmacy and vulnerability to adverse effects, with many common analgesics discouraged by geriatric guidelines. This review proposes an innovative biopsychosocial framework integrating precision geriatrics and digital therapeutics to address these challenges. Precision geriatrics employs multidimensional assessment tools (e.g., ultrasonography, frailty indices) to phenotype patients and tailor interventions, while digital therapeutics deliver evidence-based non-pharmacological interventions like cognitive behavioral therapy and therapeutic exercise, overcoming access barriers. The proposed framework prioritizes non-pharmacological strategies, advocates for structured deprescribing, and emphasizes geriatrically-adapted interventions delivered through multidisciplinary teams. By synthesizing recent evidence, this review provides a comprehensive roadmap for clinicians to move beyond a one-size-fits-all approach, offering safer, more effective care that improves function, independence, and quality of life for older adults with MPS.