Chronic Pain in Older Adults Is a Multidimensional Process That Should be Dealt Accordingly

Dear Editor,

We have read with outmost interest the intriguing article by Sakai et al. (2023) entitled “Skeletal Muscle and Fat Mass Reflect Chronic Pain in Older Adult” which explores the implication of accumulated chronic inflammation with age on the development of geriatric chronic pain. These findings shed light on “one of the most common, costly and potentially debilitation health issue with which older adults are faced” (Singh et al., 2023). Interestingly, the authors have suggested the lower extremity skeletal muscle fat mass ratio to be used as an index related to chronic pain. Notwithstanding the potential this novel suggested pathway might bring, however, we fear that there might just be one other side to this coin. It is also possible that the chronic pain itself might easily occur due to completely other reasons but skeletal muscle decline and fat increase deriving from of the age-related chronic inflammation (at least in a fair number of cases). In that scenario, we strongly believe it is the lack of engagement in physical activity resulting due to the chronic pain the real reason why there are lower skeletal muscle mass and higher fat deposing on the same body parts which in such cases are significantly less used (lower extremities). Something similar has already been pointed out by Naugle et al. (2023) suggesting that the combination of sedentary lifestyle and decreased physical activity might as well be the contributors to the aging-associated decline of endogenous pain modulation (Naugle et al., 2023).

When dealing with non-specific chronic pain, we should be aware about the vast possibility of causes behind, together with the limitless interactions in between. When this pain occurs in older adults, the cause becomes even more vague and complex. Yes, the accumulated age-related chronic inflammation on the development of geriatric chronic pain is probably a major stakeholder on the matter and should be further investigated. However, until this hypothesis is established, it is important to tackle the problem multidimensionally from physiological toward psychological levels. Whichever the cause/effect might be, we believe the primary goal should be going toward the pain neuroscience education (PNE) as the first step to managing the situation. It is only then the possibility to go further toward establishing a care-provider–patient coherent program to further facilitate the process (Shala et al., 2021). Finally, physical activity has been shown to have a significant impact on healthy aging (Moreno-Agostino et al., 2020) and pain modulation (Naugle et al., 2023), and thus should be an important target to tackle from the very moment a young human learns to walk.