Neuropathic Pain in Aged People: An Unresolved Issue Open to Novel Drug Approaches, Focusing on Painful Diabetic Neuropathy

Abstract

A majority of older patients suffer from neuropathic pain (NP) that significantly alters their daily activities and imposes a significant burden on health care. Multiple comorbidities and the risk ofpolypharmacy in the elderly make it challenging to determine the appropriate drug, dosage, andmaintenance of therapy. Age-dependent processes play a contributing role in neuropathy given that diabetic neuropathy (DN) is the most common form of neuropathy. This narrative review is mainly focused on the drug treatment approach for neuropathy-associated pain in aged people including both drugs and dietary supplements, considering the latter as add-on mechanism-based treatments to increase the effectiveness of usual treatments by implementing their activity or activating other analgesic pathways. On one hand, the limited clinical studies assessing the effectiveness and the adverse effects of existing pain management options in this age segment of the population (> 65), on the other hand, the expanding global demographics of the elderly contribute to building up an unresolved pain management problem that needs the attention of healthcare providers, researchers, and health authorities as well as the expansion of the current therapeutic options.

Characteristics of elderly diabetes patients: focus on clinical manifestation, pathogenic mechanism, and the role of traditional Chinese medicine

“…Clinical treatment focuses on alleviating clinical symptoms, improving blood glucose control and cardiovascular risk factors ( Yang et al, 2022 ). Pain in the elderly need arouse attention from clinicians and patients ( Marchesi et al, 2024 ). In pain management, anticonvulsants such as pregabalin and gabapentin are the first-line treatment of choice, followed by amitriptyline, duloxetine, and venlafaxine ( Cernea and Raz, 2021 ).…”

“…In pain management, anticonvulsants such as pregabalin and gabapentin are the first-line treatment of choice, followed by amitriptyline, duloxetine, and venlafaxine ( Cernea and Raz, 2021 ). Opioids and related medications are recommended for short-term use during acute exacerbations of pain ( Kozma et al, 2012 ; Feldman et al, 2019 ; Marchesi et al, 2024 ). These interventions play an important role in diminishing DPN’s symptoms and complications.…”

“…Basic interventions also include nutritional recommendations (mecobalamin, etc.) and functional exercise ( Didangelos et al, 2020 ; 2021 ; Seyedizadeh et al, 2020 ; Shen et al, 2023b ; Marchesi et al, 2024 ). However, diet and exercise are often neglected in the treatment of elderly patients with diabetes.…”