Nonsurgical oncological management of cancer pain

Pain is the most common symptom in patients with advanced cancer and often persists despite treatment. Recent advances in oncological therapy and the molecular basis of cancer and pain will help to improve patient outcomes.

Chemotherapy, targeted therapy and radiotherapy are important components of the multidisciplinary management of cancer pain, which also includes early referral to specialist pain services. Cancer pain is complex and an understanding of the type of pain, the biology of the particular cancer as well as patient factors must be considered. Conventional palliative radiotherapy provides effective pain relief from cancer metastases, and recently radiopharmaceuticals have been shown to be beneficial for bone metastasis. Systemic cancer therapy can provide pain relief as a result of tumour shrinkage but recent studies suggest that benefit may also be as a consequence of modulation of pain signalling pathways.

In advanced cancers, oncological therapies must be considered as anti-pain treatments. Identifying molecular targets that have a role in both pain and cancer is an interesting strategy for future drug development.