Evolving Paradigms in Cancer Pain Management: From Opioid-Centric Care to Multimodal and Personalized Strategies

Cancer-related pain remains one of the most prevalent and distressing symptoms across the disease trajectory, significantly impairing function and quality of life. Although opioids are central to managing moderate to severe pain, their limitations, including adverse effects, dependence risk, and societal concerns, highlight the need for more individualized and comprehensive strategies. This review aims to synthesize current approaches to cancer pain management within a palliative care framework, emphasizing multimodal, mechanism-based, and patient-centered care.

A narrative review was conducted using literature searches of PubMed, Scopus, and Google Scholar. Articles published between 2010 and 2026, with emphasis on recent literature (2020-2026), were included. Search terms included combinations of "cancer pain," "palliative care," "multimodal analgesia," "opioids," "adjuvant analgesics," and "neuropathic pain." Peer-reviewed studies, clinical guidelines, systematic reviews, and meta-analyses relevant to cancer pain mechanisms and management were considered.

Cancer pain is heterogeneous, arising from tumor progression and treatment-related injury, and includes neuropathic, visceral, and somatic components. Effective management requires mechanism-based assessment and multimodal strategies. Adjuvant analgesics, such as antidepressants, anticonvulsants, corticosteroids, and topical agents, enhance pain control and reduce opioid reliance. Non-pharmacological interventions and early integration of palliative care further improve symptom management and quality of life. Emerging therapies, including cannabinoid-based treatments and gene-targeted approaches, show promise but require further clinical validation.

A multidisciplinary, patient-centered approach that integrates pharmacologic and non-pharmacologic strategies is essential for optimizing cancer pain management. Advancing toward personalized and multimodal care models may improve outcomes, reduce opioid-related risks, and enhance quality of life for patients with cancer.