{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T05:59:39Z","timestamp":1780898379833,"version":"3.54.1"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pain Res."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2014cutaneous incisions performed on painful body areas\u2014remains 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A prospective single-center mixed-methods observational study was conducted from February 2023 to May 2025 at Bafoussam Regional Hospital. Patients aged \u226565 years with chronic articular pain (\u22656 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 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200992, 30\u201345\u2005min) analyzed thematically following Braun and Clarke's framework (kappa\u2009=\u20090.78). A culturally adapted integrative physiotherapy protocol over 16 sessions was implemented, with follow-up of 6\u201318 months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Ninety-two patients were enrolled (mean age 73.1\u2009\u00b1\u20098.4 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 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.01). A significant age-complication gradient was observed (OR\u2009=\u20094.9 for &amp;gt;75 vs. 65\u201370 years;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.032). Education level was inversely correlated with scarification frequency (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.67;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Among 68 patients receiving the integrative approach, 73.5% reduced scarification use (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), with significant functional improvements and 89.7% patient satisfaction. Five qualitative themes of adherence drivers were identified.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Therapeutic scarification exposes older adults to preventable geriatric complications, including a previously unrecognized fall risk from proprioceptive disruption. The \u201cshadow pain\u201d mechanism\u2014transient nociceptive inhibition by iatrogenic pain\u2014offers 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpain.2026.1826721","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T05:33:04Z","timestamp":1780896784000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Therapeutic scarification, shadow pain, and integrative geriatric rehabilitation for chronic musculoskeletal pain in older adults in Cameroon: a prospective mixed-methods observational study"],"prefix":"10.3389","volume":"7","author":[{"given":"Ibrahim","family":"Npochinto Moumeni","sequence":"first","affiliation":[{"name":"Department of Physiotherapy & Physical Medicine, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang","place":["Dschang, West Region, Cameroon"]},{"name":"Department of Physical Medicine & Osteopathy, Regional Hospital of Bafoussam","place":["Bafoussam, West 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