Cancer-Related Neuropathic Pain: A Review of Contemporary Diagnostic and Therapeutic Approaches

Abstract

Aim: The aim of this review article is to summarize current knowledge on the etiology, pathophysiology, diagnosis, clinical characteristics, and treatment options for cancer-related neuropathic pain (CRNP), with an emphasis on recent advances in pharmacological and non-pharmacological management strategies.

Methods: A narrative review of contemporary literature and clinical recommendations on cancer-related neuropathic pain was conducted. Relevant evidence addressing the etiology, pathophysiology, diagnosis, clinical characteristics, and pharmacological and non-pharmacological management of CRNP was examined. Particular attention was given to diagnostic criteria recommended by the International Association for the Study of Pain (IASP), validated assessment tools such as the DN4 questionnaire, neuroimmune mechanisms underlying neuropathic pain, and contemporary therapeutic approaches.

Results: The reviewed evidence indicates that cancer-related neuropathic pain is a complex, multifactorial condition associated with tumor invasion, nerve compression, chemotherapy- and radiotherapy-induced nerve injury, neuroinflammation, and central sensitization. Diagnosis relies on recognizing characteristic sensory symptoms and demonstrating nervous system involvement, with validated tools such as the DN4 questionnaire supporting clinical assessment. Current evidence supports multimodal pharmacological management, including opioids combined with adjuvant agents such as gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors. Emerging approaches, including monoclonal antibodies, cannabinoids, intrathecal analgesics, and targeted molecular therapies, show promising but still limited evidence. Non-pharmacological interventions, including acupuncture, cognitive-behavioral therapies

Conclusion: Cancer-related neuropathic pain remains underrecognized and difficult to treat, significantly impairing patients’ quality of life and treatment outcomes. Early diagnosis, individualized multimodal therapy, and integration of pharmacological and supportive interventions are essential for effective management. Future advances in molecular biology, immunology, and pharmacogenomics may enable more targeted and personalized therapeutic strategies for patients with cancer-related neuropathic pain.