Cancer Pain Is Not One-Size-Fits-All: Evolving from Tradition to Precision

Cancer pain remains a significant challenge in oncology, profoundly affecting patients' quality of life, function, and prognosis. Historically under-recognized and managed with a uniform, opioid-centric approach, cancer pain was often inadequately treated. Advances in pain assessment, multimodal analgesia, and supportive care have improved outcomes, yet traditional algorithms frequently fail to address the complex, heterogeneous nature of cancer pain. Contemporary management is shifting toward precision and personalized medicine, integrating genetic, molecular, and biomarker data with individual patient characteristics to inform treatment decisions. To address this complexity, we propose a five-domain framework encompassing biological, pharmacologic, psychological, sociocultural, and functional domains. This multidimensional approach enables clinicians to tailor pain management strategies to each patient's unique profile, aiming for equitable and individualized care. However, challenges remain, including tumor and patient heterogeneity, limited biomarker validation, data integration, disparities in access, and the need for multidisciplinary coordination. This review traces the evolution of cancer pain management, highlights the promise of precision and personalized strategies, and presents a comprehensive framework for optimizing pain control in oncology.