Cancer pain: current practice and emerging targets

Cancer pain (CP) arises from a complex interplay between the tumour and its microenvironment. Many patients experience a mixed pain phenotype that encompasses nociceptive, neuropathic and neuroinflammatory mechanisms, and vary across tumour type and disease stage. Despite decades of intensive research, the mainstay of cancer pain treatment is still non-steroidal anti-inflammatory drugs (NSAIDs) and opioids. Recent advances in cancer neuroscience have provided novel insights into the neurobiology of cancer pain. The emerging picture of cancer pain is a disorder of aberrant crosstalk between the tumour, the sensory innervation that the tumour creates and the immune cells that these nerves attract. Precision approaches to disrupt this aberrant pain signalling cascade are guided by newly recognized molecular mechanisms. Here, we review the current practice of cancer pain management and the emerging future of personalized, mechanism-driven pain therapy in oncology.