Assessment of nociceptive versus neuropathic pain in older adults.

WHY: Many older adults have severe or ongoing pain. Distinguishing whether the pain is nociceptive or neuropathic has important implications for diagnostic, lifestyle and treatment decisions. Nociceptive pain is caused by an active illness, injury and/or inflammatory process associated with actual or potential tissue damage. Recognition of nociceptive pain can help identify an acute condition (e.g. angina, temporal arteritis, thrombosis, torn ligament) demanding prompt treatment, or a chronic condition (e.g. arthritis, osteoporosis) guiding treatment to halt tissue damage. Neuropathic pain results from a lesion or a malfunction within the nervous system. High intensity neuropathic pain interferes with daily living and has been linked to a loss of muscle, bone and brain mass. Older adults are at greater risk for developing neuropathic pain because of fewer inhibitory nerves, lower endorphin levels and a slowed capacity to reverse processes that sensitize nerves. For example, postherpetic neuralgia develops in half of those over age 70, compared to 3% under 60 years old.