Frontal lobe function and pain in the elderly

We review the literature on pain and aging and conclude that evidence suppo rts 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, neuroc ognitive, and neuroimaging studies, which implicate right inferior and orbi tofrontal cortex in (1) the persistent pain experience, (2) negative emotio nal states, (3) retrieval of negative emotional and autobiographical memori es, (4) regulation of autonomic arousal, and (5) regulation of attentional and pain functions of the anterior cingulate region. Right frontal dysfunct ion 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 ex perience of chronic pain, then cognitively impaired elderly with right fron tal dysfunction should be protected to some extent from persistent pain syn dromes. Available evidence supports this proposition.