Chronic pain, pain that lasts beyond three months, is a common finding in the elderly. It is often due to musculoskeletal conditions but can be precipitated by other factors as well. While physiological systems decline with aging, chronic pain is influenced by changes in hormone profiles as men and women enter into andropause and menopause, respectively. Research on gonadal hormones is limited, especially when it comes to their relationship with chronic pain. Women tend to experience less pain with aging compared to their premenopausal years, and this is partially explained by the fact that estrogen enhances pain sensitivity and its decline during menopause decreases it. However, hormone replacement therapy (HRT) seems to increase pain tolerance post-menopause. There is some evidence that testosterone plays a protective factor in pain perception. Men on the other hand, have higher pain tolerance as testosterone is considered to be a protective factor. With aging and decreasing testosterone, older men tend to be less tolerant to pain. This paper explores how hormonal changes with aging impact pain perception in both men and women, highlighting several pain conditions influenced by hormones. Although research remains limited, the potential of HRT as a treatment for common pain conditions is examined.

Background/Objectives: To determine the incidence of and risk factors for uncomfortable paresthesia and/or dysesthesia after tonic percutaneous spinal cord stimulator implantation. Methods: A retrospective analysis was conducted on the prospectively collected data of patients that had permanent percutaneous tonic spinal cord stimulators implanted. Our primary objective was to assess the prevalence of complications over a period of 24 months after the implantation of this device. Results: The mean post-implantation follow-up time was 27.3 months. The mean pain score before spinal cord stimulator implantation was 8.05, which was reduced to 3.6 after 24 months. The most common complications in our study sample were the need for revision and the development of unpleasant paresthesia, which were reported by 34.95% and 27.86% of patients, respectively. There was no association between paresthesia and age, sex, or body mass index (BMI). The only risk factor of statistical significance was current tobacco use (p = 0.001). Conclusions: The development of uncomfortable paresthesia after SCS is associated with considerable morbidity, particularly the explantation of SCS, despite adequate pain relief. Focusing on strategies, such as appropriate waveform selection, might reduce the incidence of uncomfortable paresthesia requiring revision or explantation. Current tobacco use appears to be a significant risk factor for the development of unpleasant paresthesia/dysesthesia when compared with non-tobacco and former tobacco users after tonic percutaneous spinal cord stimulator implantation.

Purpose of review: Neurologic disorders and complications during pregnancy are common, but guidelines and data are sparse. This review aims to give an overview of recent developments in neuroanesthesia and management of neuropathology during pregnancy, with the hope that these may fill the gaps in current guidelines and recommendations, as well as their implications for an anesthetic approach. Recent findings: Neuraxial and general anesthesia are safe in multiple sclerosis and myasthenia gravis, though neuromuscular blockade response is unpredictable and risk for exacerbation exists. Cerebral vascular pathology is common and carries a significant morbidity and mortality burden, but thrombolytic and endovascular therapies are often appropriate and safe. Instrumental vaginal delivery can minimize intracranial pressure shifts and is a viable option. Tumors and cerebral malformations require a complex multidisciplinary and anesthetic approach. Summary: While clinical trials remain sparse, larger population-based studies offer insight into the optimal approach to the parturient with neurologic disease.