Cancer Pain Management: A Narrative Review of Current Concepts, Strategies, and Techniques

Abstract

Pain is frequently reported during cancer disease, and it still remains poorly controlled in 40% of patients. Recent developments in oncology have helped to better control pain. Targeted treatments may cure cancer disease and significantly increase survival. Therefore, a novel population of patients (cancer survivors) has emerged, also enduring chronic pain (27.6% moderate to severe pain). The present review discusses the different options currently available to manage pain in (former) cancer patients in light of progress made in the last decade. Major progress in the field includes the recent development of a chronic cancer pain taxonomy now included in the International Classification of Diseases (ICD-11) and the update of the WHO analgesic ladder. Until recently, cancer pain management has mostly relied on pharmacotherapy, with opioids being considered as the mainstay. The opioids crisis has prompted the reassessment of opioids use in cancer patients and survivors. This review focuses on the current utilization of opioids, the neuropathic pain component often neglected, and the techniques and non-pharmacological strategies available which help to personalize patient treatment. Cancer pain management is now closer to the management of chronic non-cancer pain, i.e., "an integrative and supportive pain care" aiming to improve patient's quality of life.

Keywords: WHO analgesic ladder; cancer pain; cancer survivors; integrative pain care; neuropathic pain; non-pharmacological treatments; opioid analgesics.

Figure 1

The WHO analgesic ladder for treating cancer pain. Adapted from the World Health Organisation.

Figure 2

New adaptation of the analgesic ladder. This adapted version of the ladder includes interventional treatments and provides a bidirectional approach, depending on the pain and its response to treatments.