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, highlighting its public health significance.

Key Findings:

• Ninety-two patients enrolled with a mean age of 73.1 years; 60% were women.
• Four scarification modalities identified: parallel linear (63.0%), punctiform (20.7%), deep cruciform (12.0%), micro-scarification with cupping (4.3%).
• Knee osteoarthritis was the most common condition (44.6%).
• Complications included infections (15.2%), keloids (34.8%), and proprioceptive impairment (35.9%), with a 29% increase in relative fall risk (p < 0.01).
• A significant age-complication gradient was observed (OR = 4.9 for >75 vs. 65–70 years; p = 0.032).
• Education level inversely correlated with scarification frequency (r = −0.67; p < 0.001).
• Among 68 patients receiving the integrative approach, 73.5% reduced scarification use (p < 0.001) with significant functional improvements and 89.7% patient satisfaction.

Interpretation:

Therapeutic scarification exposes older adults to preventable geriatric complications, including a previously unrecognized fall risk from proprioceptive disruption. The 'shadow pain' mechanism offers a novel neurophysiological explanation for treatment adherence, emphasizing the need for awareness in geriatric care.

Limitations:

• The study is observational and lacks a control group.
• Findings are based on a single-center experience, limiting generalizability.
• Potential biases in qualitative data collection should be considered.

Conclusion:

The culturally integrative rehabilitation model achieved preliminary effectiveness supporting the development of context-sensitive geriatric care strategies in low-resource settings. Randomized controlled trials are needed to confirm these findings and further explore the implications for geriatric care.