Cancer pain

Cancer pain is a persistent and multifaceted global health problem that profoundly impairs quality of life, function and prognosis. Cancer pain occurs across all cancer types and stages, including in long-term survivors, with prevalence and severity influenced by tumour location, treatment modality, metastatic burden, sex, age and comorbidities. Mechanistically, cancer pain is not a single entity but arises from diverse processes including peripheral nociception, central sensitization and maladaptive neuroplasticity. Growing evidence highlights a key contribution of non-neuronal cells, such as immune cells, Schwann cells and central glia, in regulating cancer-related nociceptive signalling. Sex differences and effects of sex hormones further modulate pain perception, susceptibility to treatment-related toxicities and response to analgesic therapies. Comprehensive assessment integrates quantitative sensory testing with psychosocial screening to capture biological and psychosocial determinants of pain. Effective management requires individualized, multimodal strategies combining non-opioid and opioid analgesics, adjuvant agents and emerging targeted therapies with non-pharmacological approaches such as interventional and neuromodulatory procedures, psychological therapies and palliative care. Improving patient-reported outcomes remains central, particularly in cancer survivors with chronic pain. Precision medicine approaches, including mechanistic phenotyping and biomarker-driven and pharmacogenomic strategies, hold promise for tailoring cancer pain management to individual clinical, psychosocial and molecular profiles, ultimately enhancing treatment efficacy and long-term outcomes.