The sarcopenia-pain connection: why mechanisms matter for patient care?

Sarcopenia and pain are two highly prevalent conditions in aging populations, each exerting profound effects on mobility, independence, and quality of life. Emerging evidence demonstrates that these conditions are not merely coincidental but are closely interconnected through shared biological, mechanical, and neurophysiological pathways. Pain reduces physical activity, accelerates muscle wasting, and fosters functional decline, while sarcopenia increases vulnerability to painful syndromes such as osteoarthritis, fragility fractures, and low back pain. This bidirectional relationship is further amplified by chronic low-grade inflammation ("inflammaging"), mitochondrial dysfunction, and central sensitization, creating a vicious cycle of musculoskeletal fragility and disability. Despite robust epidemiological data, current diagnostic frameworks for sarcopenia fail to integrate pain dimensions, risking misclassification and underestimation of disease burden. Novel screening approaches that combine anthropometric measures with validated pain assessments may improve case finding and clinical management. This narrative review synthesizes epidemiological insights, mechanistic links, and diagnostic challenges, and advocates for integrated strategies that simultaneously target muscle health and pain management. Recognizing pain as both a determinant and consequence of sarcopenia is essential to advancing prevention, rehabilitation, and multidisciplinary care in older adults.