{"entity":{"id":"pain-management","kind":"technology","name":"Cancer pain management","aka":[],"tldr":"Systematic treatment of cancer pain with opioids, adjuvant drugs, radiation and procedures such as nerve blocks and intrathecal pumps. Most pain can be controlled, yet under-treatment remains common, especially where opioids are unavailable.","summary":"Pain affects ~55% of patients during treatment and ~66% with advanced disease. The WHO analgesic ladder (1986) established oral morphine as the core; modern practice adds mechanism-based adjuvants (dexamethasone, gabapentinoids, duloxetine for chemotherapy-induced neuropathy per CALGB 170601, ketamine, cannabinoids with weak evidence), bone-directed therapy (single-fraction radiotherapy, bisphosphonates/denosumab, radiopharmaceuticals), interventional procedures (coeliac plexus neurolysis for pancreatic cancer, vertebroplasty, intrathecal drug delivery, cordotomy), and non-pharmacologic approaches. Opioid stewardship balances the US overdose epidemic (which reduced cancer patients' access) against the ~80% of the world's population with essentially no morphine access. Cancer survivors with chronic pain need distinct guidance (ASCO 2016).","status":"standard-of-care","asOf":"2026-09-08","wikipedia":"https://en.wikipedia.org/wiki/Cancer_pain","links":[{"label":"WHO cancer pain guidelines 2018","url":"https://www.who.int/publications/i/item/9789241550390"},{"label":"ASCO chronic pain in survivors 2016","url":"https://doi.org/10.1200/JCO.2016.68.5206"},{"label":"Pancreatic Cancer UK: managing pancreatic cancer pain","url":"https://www.pancreaticcancer.org.uk/information-and-support/managing-symptoms-and-side-effects/managing-pancreatic-cancer-pain/"},{"label":"Cancer Research UK: controlling symptoms of advanced pancreatic cancer","url":"https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/treatment/controlling-symptoms"},{"label":"Macmillan: managing symptoms of pancreatic cancer","url":"https://www.macmillan.org.uk/cancer-information-and-support/pancreatic-cancer/controlling-symptoms-of-pancreatic-cancer"},{"label":"NICE NG85: pancreatic cancer in adults, diagnosis and management, recommendations","url":"https://www.nice.org.uk/guidance/ng85/chapter/Recommendations"},{"label":"Wyse et al., randomised double-blind trial of early EUS-guided coeliac plexus neurolysis to prevent pain progression in pancreatic cancer (JCO 2011)","url":"https://doi.org/10.1200/JCO.2010.32.2750"},{"label":"NICE NG122: lung cancer, palliative interventions and supportive and palliative care","url":"https://www.nice.org.uk/guidance/ng122/chapter/Palliative-interventions-and-supportive-and-palliative-care"},{"label":"Cancer Research UK: coping and support when you have lung cancer","url":"https://www.cancerresearchuk.org/about-cancer/lung-cancer/living-with/coping"}],"tags":["gap-fill","supportive"],"related":[],"cancers":["pancreatic","lung-cancer","nsclc","sclc"],"sections":["supportive-care"],"technologies":["palliative-radiotherapy","palliative-care","bone-modifying-agents"],"targets":[],"drugs":["radium-223","methylnaltrexone"],"companies":["insys-therapeutics","mundipharma"],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-paice-j-clin-oncol"],"journals":[],"dependsOn":[],"notes":["Pancreatic cancer pain is often nerve pain from pressure on the coeliac plexus behind the pancreas. Cancer Research UK lists the steps: paracetamol, then weak and strong opioids with regular laxatives, anti-inflammatories, and amitriptyline or gabapentin for burning or shooting pain; cancer treatment and palliative radiotherapy can also shrink what is pressing on the nerves.","NICE NG85 says consider an EUS-guided or image-guided coeliac plexus block for uncontrolled pain, unacceptable opioid side effects or escalating doses; a randomised double-blind trial (Wyse 2011) found early EUS-guided neurolysis reduced pain at three months compared with pain medicines alone.","Lung cancer: NICE NG122 (1.17.1) says to offer single-fraction radiotherapy to people with bone metastasis who need palliation and for whom standard pain relief is inadequate, and (1.15.5) to consider opioids such as codeine or morphine to reduce cough. Cancer Research UK says surgery can cause scarring or pain afterwards, that there is a great deal a team can do including changing pain medicines and teaching relaxation techniques, and that pain should be raised rather than tolerated."],"principle":"Assess pain type (nociceptive, neuropathic, bone, visceral) and intensity; treat cause (radiation, surgery, systemic therapy) and symptom in parallel with a stepped, mechanism-based regimen and regular reassessment.","strengths":["Oral morphine is cheap, effective and on the WHO essential list","Single-fraction radiotherapy relieves bone pain in ~60%","Interventional options for refractory pain"],"limitations":["Global opioid access inequity","Opioid-related stigma and regulation","Chemotherapy-induced neuropathy has one moderately effective drug (duloxetine)"],"since":1986},"route":"/technologies/pain-management/","neighbours":{"cancer":[{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"},{"id":"gallbladder","kind":"cancer","name":"Gallbladder cancer","route":"/cancers/gallbladder/"},{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"}],"section":[{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"acupuncture-aromatase-inhibitor-arthralgia","kind":"technology","name":"Acupuncture for aromatase-inhibitor joint pain","route":"/technologies/acupuncture-aromatase-inhibitor-arthralgia/"},{"id":"acupuncture-chemotherapy-neuropathy","kind":"technology","name":"Acupuncture for chemotherapy-induced neuropathy","route":"/technologies/acupuncture-chemotherapy-neuropathy/"},{"id":"bone-modifying-agents","kind":"technology","name":"Bone-modifying agents (bisphosphonates, denosumab)","route":"/technologies/bone-modifying-agents/"},{"id":"cannabinoids-pain-appetite","kind":"technology","name":"Cannabis and cannabinoids for pain, appetite and cancer control","route":"/technologies/cannabinoids-pain-appetite/"},{"id":"hypnosis-cancer-care","kind":"technology","name":"Clinical hypnosis for procedures, pain and hot flushes","route":"/technologies/hypnosis-cancer-care/"},{"id":"palliative-care","kind":"technology","name":"Early integrated palliative care","route":"/technologies/palliative-care/"},{"id":"integrative-oncology","kind":"technology","name":"Evidence-based integrative oncology","route":"/technologies/integrative-oncology/"},{"id":"hospice-end-of-life","kind":"technology","name":"Hospice and end-of-life care","route":"/technologies/hospice-end-of-life/"},{"id":"massage-therapy-cancer","kind":"technology","name":"Massage therapy in cancer care","route":"/technologies/massage-therapy-cancer/"},{"id":"palliative-radiotherapy","kind":"technology","name":"Palliative radiotherapy","route":"/technologies/palliative-radiotherapy/"},{"id":"scrambler-therapy","kind":"technology","name":"Scrambler therapy (Calmare) for chemotherapy nerve pain","route":"/technologies/scrambler-therapy/"}],"drug":[{"id":"fentanyl","kind":"drug","name":"Fentanyl (transmucosal, for breakthrough cancer pain)","route":"/drugs/fentanyl/"},{"id":"methylnaltrexone","kind":"drug","name":"Methylnaltrexone","route":"/drugs/methylnaltrexone/"},{"id":"radium-223","kind":"drug","name":"Radium-223 dichloride","route":"/drugs/radium-223/"}],"company":[{"id":"gruenenthal","kind":"company","name":"Grünenthal","route":"/companies/gruenenthal/"},{"id":"insys-therapeutics","kind":"company","name":"Insys Therapeutics","route":"/companies/insys-therapeutics/"},{"id":"mundipharma","kind":"company","name":"Mundipharma","route":"/companies/mundipharma/"},{"id":"sorrento-therapeutics","kind":"company","name":"Sorrento Therapeutics","route":"/companies/sorrento-therapeutics/"}],"paper":[{"id":"paper-paice-j-clin-oncol","kind":"paper","name":"Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline","route":"/key-papers/paper-paice-j-clin-oncol/"}],"term":[{"id":"coeliac-plexus-block","kind":"term","name":"Coeliac plexus block for pancreatic cancer pain","route":"/terms/coeliac-plexus-block/"},{"id":"pain-with-biliary-cancer","kind":"term","name":"Pain with gallbladder and bile duct cancer","route":"/terms/pain-with-biliary-cancer/"}],"person":[{"id":"cicely-saunders","kind":"person","name":"Dame Cicely Saunders","route":"/people/cicely-saunders/"}],"roadmap":[{"id":"survivorship-roadmap","kind":"roadmap","name":"Supportive care and survivorship roadmap: making treatment bearable → proving it extends life → caring for tens of millions afterwards","route":"/roadmaps/survivorship-roadmap/"}]}}