ArticleFrontiers in pain research (Lausanne, Switzerland)2026
Therapeutic scarification, shadow pain, and integrative geriatric rehabilitation for chronic musculoskeletal pain in older adults in Cameroon: a prospective mixed-methods observational study.
Article in Frontiers in pain research (Lausanne, Switzerland), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: In sub-Saharan Africa, the coexistence of conventional medicine and traditional healing practices creates a complex therapeutic landscape that disproportionately affects older adults. Therapeutic scarification-cutaneous incisions performed on painful body areas-remains one of the most widespread traditional approaches to chronic pain management. Its geriatric-specific complications and functional consequences remain poorly documented. With a projected 67% increase in the population aged over 60 in Cameroon by 2030 and fewer than 15% of older adults benefiting from effective social coverage, this represents a major public health priority. Objective: To analyze the prevalence, typology, and geriatric-specific complications of therapeutic scarification among older adults with chronic musculoskeletal pain in Cameroon, and to evaluate the preliminary effectiveness of a culturally integrative physiotherapy approach bridging traditional and conventional medicine. Methods: A prospective single-center mixed-methods observational study was conducted from February 2023 to May 2025 at Bafoussam Regional Hospital. Patients aged ≥65 years with chronic articular pain (≥6 months) and documented history of therapeutic scarification were included. The quantitative component involved standardized clinical assessment and statistical analysis; the qualitative component comprised semi-structured interviews ( Results: Ninety-two patients were enrolled (mean age 73.1 ± 8.4 years; 60 women, 65.2%). Four scarification modalities were identified: parallel linear (63.0%), punctiform (20.7%), deep cruciform (12.0%), micro-scarification with cupping (4.3%). Knee osteoarthritis predominated (44.6%). Complications included infections (15.2%), keloids (34.8%), and proprioceptive impairment (35.9%) associated with a 29% increase in relative fall risk ( Conclusion: Therapeutic scarification exposes older adults to preventable geriatric complications, including a previously unrecognized fall risk from proprioceptive disruption. The "shadow pain" mechanism-transient nociceptive inhibition by iatrogenic pain-offers a novel neurophysiological explanation for treatment adherence. The culturally integrative rehabilitation model achieved preliminary effectiveness supporting development of context-sensitive geriatric care strategies in low-resource settings. Randomized controlled trials are needed to confirm these findings.
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