Underlying Mechanisms of Impaired Visceral Pain Perception in Older People

Abstract

There is increasing recognition that aging can have a profound effect on the presentation of illness. Older patients with diseases of visceral organs are much more likely than younger adults to present atypically. Examples are the frequent absence of pain in older patients with conditions such as myocardial infarction, peptic ulcer disease, and pneumothorax. Recent developments have helped elucidate the complex processes involved in signaling information from the effects of noxious stimuli on visceral organs, but understanding of why older patients with visceral disease are more likely to present without pain is still rudimentary. Much of the previous experimental evidence on age-related differences relates to somatic rather than visceral sources of pain. As a result, it may not have direct comparability with transmission of information on visceral damage or noxious stimulation. This article reviews the published pathophysiological data on sensory transmission from visceral organs. Where possible, this is correlated with other published clinical studies on age-related differences in visceral pain perception. Areas in which experimental evidence is absent are also highlighted. Finally suggestions are made as to how newer experimental and neuroimaging techniques may help to increase understanding of this complex subject and its resulting clinical applicability.

Effects of aging on contact heat‐evoked potentials: The physiological assessment of thermal perception

“…22 Aging influences the perception of thermal and noxious stimuli in different dimensions (e.g., pain in the cutaneous tissues, deep tissues, and viscera) and various mechanisms may underlie these differences. 9,27,36 CHEPs are integrated responses to contact heat stimulation at the skin; hence, differences in the pattern of skin innervation may underlie the effect of age. The abundance of skin innervation, particularly of free nerve endings in the epidermis, can be demonstrated with neural markers, 20,24 including protein gene product 9.5, calcitonin generelated peptide, and substance P. 13 Our group and others have previously shown that skin innervation is reduced with age in both upper and lower limbs, and there is a linear decline in epidermal innervation with age.…”

Management of Postoperative Analgesia in Elderly Patients

“…13 Many studies have focused on the age-related pain threshold changes. [18][19][20][21][22][23][24][25] The majority of these studies suggests that there is an increase in pain perception threshold, but most of the work has been methodologically weak. 26 Moreover, age differences in pain may be dependent on the pain sale used.…”

410 Upper Gastrointestinal Mucosal Injury and Symptoms in Elderly Low-Dose Aspirin Users

“…However, in the present study, we found that there was no relationship between LDA and symptoms. In relation to the mechanism of impaired perception of visceral pain in elderly people, Moore and associates [49] pointed out that some age-related differences do in fact exist.…”