Chronic Pain in Older Adults: Risk Factors and Prevention

Chronic pain is highly prevalent among older adults and represents a major health challenge due to its multifactorial aetiology, association with multimorbidity and frailty, and impact on quality of life. This narrative review synthesises evidence from the last few decades addressing chronic pain in older adults, with emphasis on risk factors, underlying mechanisms, and preventive strategies. Risk factors were organised according to the Dahlgren and Whitehead "Rainbow model" into individual, environmental, and social determinants. Individual-level factors-particularly physical inactivity, abnormal body weight, poor nutrition, mental health disorders, maladaptive pain beliefs, sleep disturbance, previous surgical and postoperative pain, multimorbidity, frailty, smoking, and alcohol use-were associated with pain persistence. Emerging evidence related to environmental and social determinants, including reduced nature and sunlight exposure, low socio-economic status, occupational factors, and social isolation, suggests further increased pain vulnerability. Mechanistic evidence indicates that ageing is associated with impaired descending pain modulation and increased susceptibility to peripheral and central sensitisation. Although randomised preventive trials in older adults remain scarce, converging evidence suggests that targeted lifestyle modification, early pain management, and multimodal non-pharmacological strategies may reduce progression to chronic pain. A prevention-oriented, risk-stratified approach integrating clinical care with broader public health strategies may help mitigate the growing burden of chronic pain in ageing societies.