Cancer
pain is a significant symptom that affects the majority of patients with
cancer. 44% of cancer patients reported having pain overall, according to a
recent systematic analysis that included research from 2014 to 2021. In a
recent systematic review, 31% of individuals experienced moderate to severe
pain and 55% of patients with advanced metastatic and terminal cancer reported
experiencing pain1. Pain associated
with cancer is complex, as it may result from tumor progression,
treatment-related complications or damage to the nervous system. Nociceptive
pain, caused by tissue damage or inflammation, is more common, while
neuropathic pain arises from injury to the nerves and is often more difficult
to treat. According to reports, up to 40% of cancer patients experience
neuropathic cancer pain (NCP). Cancer itself was responsible for 64% of NCP,
with therapies such as chemotherapy, radiation therapy and cancer surgery
contributing to 20%2. The cornerstone
of cancer pain management remains pharmacological treatment, primarily guided
by the World Health Organization's (WHO) pain ladder. This approach recommends
a stepwise escalation from non-opioid medications like NSAIDs and acetaminophen
for mild pain to stronger opioids such as morphine and fentanyl for severe pain3. Importantly, the pain ladder emphasizes the
combination of opioids with adjuvant therapies, such as antidepressants or
anticonvulsants, especially for managing neuropathic pain. Despite the
effectiveness of opioids, their use is not without challenges. Issues such as
fear of dependence, regulatory barriers and side effects like constipation and
sedation complicate their broader application. In addition to medications,
non-pharmacological strategies play a vital role in managing cancer pain. These
interventions often address the multidimensional nature of pain, which includes
physical, emotional and psychological aspects. Techniques such as acupuncture,
physical therapy and TENS (transcutaneous electrical nerve stimulation) have
gained traction for their ability to provide relief with minimal side effects.
Pain not only has a physical dimension but is also influenced by fear, anxiety
and depression, which Cognitive Behavioral Therapy (CBT) can help alleviate.
Recent advances in cancer pain management have focused on personalized medicine
and emerging technologies. Neuromodulation techniques, such as spinal cord
stimulation and intrathecal drug delivery systems, are being used to manage
refractory cancer pain in advanced cases4.
Research into molecular targets for pain management is advancing, focusing on
pathways such as TRPV1 receptors, sodium channels and inflammatory cytokines5. These novel approaches aim to address pain at
its source, offering hope for safer and more effective therapies in the future.
Machine learning and artificial intelligence are also emerging as powerful
tools to predict and personalize pain management strategies based on individual
patient profiles. Healthcare systems must focus on:
1.
Improving Access to Medications: Particularly in resource-limited
settings by reducing regulatory barriers and training providers in appropriate
opioid prescribing.
2.
Expanding Multidisciplinary Care Models: Integrating oncologists,
palliative care specialists, physical therapists and mental health
professionals to provide holistic care.
3.
Advancing Research: Supporting studies on innovative therapies,
especially those addressing refractory pain or offering alternatives to
opioid-based treatments.
Keywords:
Cancer Pain; Cancer Pain Management; Transcutaneous
electrical nerve stimulation
References
1. Mestdagh F, Steyaert A, Lavand’homme P. Cancer
Pain Management: A Narrative Review of Current Concepts, Strategies and
Techniques. Curr Oncol 2023;30:6838-6858.