TY - JOUR
AU - M. G. Carbone
AU - I. Maremmani
AU - L. Mazzetto
AU - A. Bellini
AU - R. Miccichè
AU - R. Rizzato
AU - G. Gastaldello
AU - C. Tagliarini
AU - Della Rocca
AU - A. G. I. Maremmani
A1 - 
AB - BACKGROUND: Chronic pain, opioid use, and mental health disorders frequently co-occur in older adults, forming a complex and mutually reinforcing triad. Neurobiological ageing processes-such as neuroinflammation, dopaminergic decline, and impaired top-down regulation-may increase vulnerability to maladaptive coping strategies, including opioid misuse. This review aims to integrate neurobiological, affective, and clinical evidence to propose a unified neuropsychiatric framework for understanding the intersection between chronic pain, emotional distress, and opioid vulnerability in later life, while highlighting implications for integrated treatment and opioid stewardship. METHODS: This structured narrative review synthesised interdisciplinary evidence from neuroscience, geriatric psychiatry, and pain medicine. The literature was thematically organised to examine shared neurobiological and psychosocial mechanisms underlying chronic pain, affective disorders, and opioid use disorder (OUD) in older adults, with attention to treatment strategies and stewardship principles. RESULTS: Converging evidence suggests a neuroprogressive continuum linking chronic pain, emotional distress, opioid misuse, and cognitive decline. Key mechanisms include frontolimbic dysfunction, impaired reward processing, and chronic allostatic load. Therapeutic approaches that integrate analgesia with emotional regulation-such as buprenorphine, serotonin-noradrenaline reuptake inhibitors (SNRIs), and multimodal tapering strategies-may offer neuroprotective benefits. Effective opioid stewardship appears to require integrated functional, cognitive, and affective monitoring. CONCLUSIONS: Pain management in older adults may benefit from moving beyond symptom-focused approaches toward a neuropsychiatric model of care aimed at preserving homeostatic balance across sensory, emotional, and motivational domains. Within this framework, opioid therapy can be conceptualised as a potential means of functional and neuroaffective restoration, rather than solely as a strategy for risk reduction.
AD - Division of Psychiatry, Department of Medicine and Surgery, University of Insubria, Viale Luigi Borri 57, 21100 Varese, Italy.; VP Dole Research Group, G. De Lisio Institute of Behavioural Sciences, Via di Pratale, 3, 56121 Pisa, Italy.; Saint Camillus International University of Health Sciences, Via di Sant'Alessandro 8, 00131 Rome, Italy.; Department of Mental Health, Psychiatric Diagnosis and Treatment Service, Sant'Elia Hospital, ASP 2, 93100 Caltanissetta, Italy.; Addiction Unit, Department of Mental Health and Addictions, ASL5 Liguria NHS, Via Dalmazia 1, 19124 La Spezia, Italy.
AN - 41899662
BT - Int J Environ Res Public Health
C5 - Opioids & Substance Use; Healthcare Disparities
CP - 3
DA - Feb 25
DO - 10.3390/ijerph23030285
DP - NLM
ET - 20260225
IS - 3
JF - Int J Environ Res Public Health
LA - eng
N2 - BACKGROUND: Chronic pain, opioid use, and mental health disorders frequently co-occur in older adults, forming a complex and mutually reinforcing triad. Neurobiological ageing processes-such as neuroinflammation, dopaminergic decline, and impaired top-down regulation-may increase vulnerability to maladaptive coping strategies, including opioid misuse. This review aims to integrate neurobiological, affective, and clinical evidence to propose a unified neuropsychiatric framework for understanding the intersection between chronic pain, emotional distress, and opioid vulnerability in later life, while highlighting implications for integrated treatment and opioid stewardship. METHODS: This structured narrative review synthesised interdisciplinary evidence from neuroscience, geriatric psychiatry, and pain medicine. The literature was thematically organised to examine shared neurobiological and psychosocial mechanisms underlying chronic pain, affective disorders, and opioid use disorder (OUD) in older adults, with attention to treatment strategies and stewardship principles. RESULTS: Converging evidence suggests a neuroprogressive continuum linking chronic pain, emotional distress, opioid misuse, and cognitive decline. Key mechanisms include frontolimbic dysfunction, impaired reward processing, and chronic allostatic load. Therapeutic approaches that integrate analgesia with emotional regulation-such as buprenorphine, serotonin-noradrenaline reuptake inhibitors (SNRIs), and multimodal tapering strategies-may offer neuroprotective benefits. Effective opioid stewardship appears to require integrated functional, cognitive, and affective monitoring. CONCLUSIONS: Pain management in older adults may benefit from moving beyond symptom-focused approaches toward a neuropsychiatric model of care aimed at preserving homeostatic balance across sensory, emotional, and motivational domains. Within this framework, opioid therapy can be conceptualised as a potential means of functional and neuroaffective restoration, rather than solely as a strategy for risk reduction.
PY - 2026
SN - 1661-7827 (Print); 1660-4601
ST - Chronic Pain and Opioids in the Elderly: Treating the Brain, Not Just the Body
T1 - Chronic Pain and Opioids in the Elderly: Treating the Brain, Not Just the Body
T2 - Int J Environ Res Public Health
TI - Chronic Pain and Opioids in the Elderly: Treating the Brain, Not Just the Body
U1 - Opioids & Substance Use; Healthcare Disparities
U3 - 10.3390/ijerph23030285
VL - 23
VO - 1661-7827 (Print); 1660-4601
Y1 - 2026
ER -