Toward function-oriented, neuroscience-based spine care in older adults: a structured narrative review and...

Chronic spinal pain remains the leading cause of disability worldwide, disproportionately affecting aging populations. Traditional pharmacological and surgical approaches offer limited long-term efficacy and carry significant risks. This structured narrative review examines recent evidence (2020-2025) on function-oriented, neuroscience-based approaches to spine care in older adults, with a focus on non-pharmacological and regenerative strategies such as Pain Neuroscience Education (PNE), structured exercise, psychological therapies, and manual therapy, which have been shown to improve pain and functional outcomes across multiple studies. Adjunctive modalities, including extracorporeal shockwave therapy (ESWT), high-intensity laser therapy (HILT), and thermotherapy, may provide additional benefits through modulation of neuroimmune and vascular pathways. Regenerative interventions, particularly ultrasound-guided mechanical needling with sterile water injection, have shown promising findings in observational studies for addressing fibrosis and calcification. Biologic injectables (e.g., PRP, HA, and MSCs) and neuromodulation techniques (rTMS and tDCS) also demonstrate potential but require protocol standardization and robust randomized trials. This review synthesizes contemporary evidence of varying methodological quality and proposes a tiered, function-oriented model that integrates these modalities into accessible, cost-effective, and globally relevant pain care systems.