Cancer pain: current practice and emerging targets

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