Nonpharmacologic Therapies for Neuropathic Pain in Older Adults
A recent review analyzed the effectiveness of nonpharmacologic therapies for neuropathic pain in older adults. Results in our new slide show.
Neuropathic pain is considered one of the most difficult forms of chronic pain to manage. Medications are usually the first line therapies for neuropathic pain, most notably anticonvulsants and serotonin-norepinephrine reuptake inhibitors (SNRIs) and, to a lesser extent, opioids.
Many common neuropathic pain conditions are associated with disorders such as diabetes, postherpetic neuralgia, and stroke which all are more likely to occur in older adults. In treating neuropathic pain in older adults, practitioners often run into the challenge of balancing the potential for relief with potential adverse events associated with the medications used for neuropathic pain, comorbid conditions, and potential drug-drug interactions with current medications.
Authors of a recent literature review published in the January issue of Pain Medicine sought to determine whether there is evidence for the use of nonpharmacologic therapies for neuropathic pain in adults aged ≥65 years that might help avoid these issues. In the slides below, find key results and conclusions for clinicians.
Many common neuropathic pain conditions are associated with disorders such as diabetes, postherpetic neuralgia, and stroke which all are more likely to occur in older adults. In treating neuropathic pain in this cohort, practitioners often run into the challenge of balancing the potential for relief with:
- Potential adverse events associated with the medications used
for neuropathic pain - Comorbid conditions
- Potential drug-drug interactions with current medications
A recent literature review sought to determine whether there is evidence for the use of nonpharmacologic therapies for neuropathic pain in adults aged ≥65 years that might help avoid these issues.
The review found studies on:
- Peripheral electric therapies including external muscle stimulation, transcutaneous electrical nerve stimulation (TENS), and
pulsed electrical field therapy. Studies found that they provided statistically significant improvements in pain severity. - Repetitive transcranial magnet stimulation (rTMS), a centrally applied treatment. Studies reported significant improvement in pain severity and reduction in opioid use.
- Acupuncture, which appeared to provide significant improvement in pain.
The review also found studies on:
- Meditation, exercise, and light therapy. Fewer studies than on the electrical therapies and acupuncture. Results were more mixed, although there were indications that they might be beneficial in certain patients.
- Some studies examined outcomes in addition to pain and found that these nondrug therapiescan potentially affect sleep quality and strength and balance, which can also have a positive effect on functioning.
Conclusions:
- Although there were a limited number of studies and they were of varying quality, nonpharmacologic therapies, especially electrical ones and acupuncture, appear to be promising for the treatment of neuropathic pain in older adults without the negative effects of medications.
- Even if these therapies just allow for a reduction in medication dosages, this would be a positive step as it would reduce the risk for adverse events associated with the medications.
Conclusions:
- Although several of the nonpharmacologic therapies (eg, acupuncture) require administration by trained practitioners, others such as TENS are easily administered, including by patients themselves.
- There is a need for more studies that would help determine which patients are most likely to benefit from each of the therapies.
Conclusions:
- It would be interesting to have studies combining the various nonpharmacologic therapies as they appear to exert their effects by different mechanisms and are not associated with adverse effects.
- In current practice, therapies such as TENS, acupuncture, and exercise often are combined.
Source: Holmes A, Chang YP. Non-pharmacological management of neuropathic pain in older adults: a systematic review. Pain Med. 2024;25:47-56. doi:10.1093/pm/pnad112
