Evolving Paradigms in Cancer Pain Management: From Opioid-Centric Care to Multimodal and Personalized Strategies

Cancer-related pain remains one of the most prevalent and distressing symptoms across the disease trajectory, significantly impairing function and quality of life. This narrative review examines contemporary approaches to cancer pain management within a palliative care framework, emphasizing the transition from opioid-centric strategies toward multimodal, patient-centered care. Although opioids remain essential for moderate to severe pain, their use is limited by adverse effects, dependence risk, and increasing regulatory and societal concerns. Cancer pain is heterogeneous, arising from tumor progression and treatment-related injury, underscoring the need for mechanism-based assessment to guide therapy. This review highlights the expanding role of adjuvant analgesics, including antidepressants, anticonvulsants, corticosteroids, bisphosphonates, and topical agents, within multimodal regimens designed to optimize analgesia while minimizing opioid exposure. Non-pharmacological and interdisciplinary interventions are emphasized as integral components of supportive and palliative care, addressing both physical and psychosocial suffering. Emerging therapies, including cannabinoids and gene-targeted approaches, are discussed in the context of evolving evidence and personalized medicine. A multidisciplinary, patient-centered framework that integrates pharmacologic and non-pharmacologic strategies is essential for improving symptom control, functional outcomes, and quality of life in patients with cancer.