Barriers to interventional pain management in patients with cancer: a systematic review

Systemic opioids fail to provide adequate relief in 10-30% of advanced cancer patients due to poor response or debilitating adverse effects. While intrathecal drug delivery and neurolytic blocks offer effective alternatives, these interventions are severely underutilized due to systemic barriers, inadequate provider education, and late referrals, leaving pain undertreated in up to 40% of patients. This review aims to compile barriers to pain management interventions among patients with terminal cancer.

We searched for relevant articles up to February 2026 from PubMed, Scopus, and Web of Science. Two independent reviewers extracted data from the selected studies, including baseline information, outcomes, interventional pain management methods, patient data, physician and facility data, and barriers to different pain management interventions.

We collected 7,614 records after excluding 3,529 duplicates. Thorough screening resulted in the retrieval of 14 entries eligible for inclusion in our review. Our synthesis from 14 studies identified multi-level barriers to interventional pain management, including Intrathecal Drug Delivery Systems (IDDS) and Celiac Plexus Neurolysis (CPN). Patient-related barriers centered on lack of understanding, as well as fear of adverse effects and infection. Clinician-related obstacles were significant; 51% of pain fellows reported unmet training needs, while only 28% of hospice providers felt confident managing IDDS, leading over 80% to prefer systemic analgesics. Systemic issues included fragmented care coordination, a median two-year delay from diagnosis to IDDS implant, and a lack of standardized guidelines. Furthermore, socioeconomic disparities were evident, as racial minorities and residents of lower-income neighborhoods faced significantly lower access to these interventions.

The underutilization of interventional pain management techniques is driven by a complex interplay of patient misconceptions, clinician training gaps, and systemic fragmentation.