Frontal Lobe Function and Pain in the Elderly

We review the literature on pain and aging and conclude that evidence supports a hypothesis that right frontal cortex contributes to the mediation of the chronic pain experience in elderly persons with chronic pain syndromes. Evidence for the right frontal pain hypothesis comes from clinical, neurocognitive, and neuroimaging studies, which implicate right inferior and orbitofrontal cortex in (1) the persistent pain experience, (2) negative emotional states, (3) retrieval of negative emotional and autobiographical memories, (4) regulation of autonomic arousal, and (5) regulation of attentional and pain functions of the anterior cingulate region. Right frontal dysfunction is also implicated in the effects of cognitive aging. If right frontal neurocognitive systems are affected in cognitively impaired elderly, and if (by hypothesis) the right frontal cortex also plays a major role in the experience of chronic pain, then cognitively impaired elderly with right frontal dysfunction should be protected to some extent from persistent pain syndromes. Available evidence supports this proposition.