Anaes · Chronic & cancer pain
Chronic & cancer pain
Also known as Chronic pain · Cancer pain · Neuropathic pain · Nociplastic pain · WHO analgesic ladder · Pregabalin · Spinal cord stimulation · Intrathecal drug delivery
The chronic and the cancer pain is the persistent pain (over 3 months) that differs from the acute pain in the mechanisms and the management. The framework rests on the pain types (the nociceptive, the neuropathic, the nociplastic), the neuropathic pharmacotherapy (the gabapentinoids, the SNRIs, the TCAs), the cancer pain and the WHO analgesic ladder, the chronic opioid therapy and its risks, the interventional techniques (the neuraxial, the neurolytic blocks, the neuromodulation — the spinal cord stimulation and the intrathecal drug delivery), and the multidisciplinary biopsychosocial management. The FFPM (the Faculty of Pain Medicine) is the link to the specialty.
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- The chronic pain is not the acute pain that persists — it is a different condition with the central sensitisation, the psychological comorbidity, and the complex biopsychosocial drivers. The pure biomedical approach (the escalating opioids) fails and harms. The chronic opioid therapy risks the dependence, the hyperalgesia, the endocrine and the immune effects, and the overdose — the multidisciplinary, the opioid-sparing, the biopsychosocial approach is the standard.
Meet the patient
A 64-year-old with metastatic pancreatic cancer has burning, shooting epigastric pain that three rounds of morphine escalation have barely touched. She is drowsy, constipated, and still in agony. The oncology registrar wants to push the opioid higher. The pain physician asks the question that changes everything: is this nociceptive, neuropathic, or mixed — and is an interventional approach overdue? Pain affects 70 to 80 percent of pancreatic adenocarcinoma patients and remains inadequately controlled in more than half — and is now recognised as an independent prognostic factor, reflecting perineural invasion driving a bidirectional cancer-nerve dialogue (review-exact).[2]
The trap the oncology team fell into is the one every trainee meets: treating a neuropathic-visceral pain with escalating opioids. The answer is not more morphine — it is mechanism-matched analgesia and, for pancreatic cancer, an early celiac plexus block: recent evidence favours early neurolysis over the reactive approach, with celiac plexus radiosurgery among the advances arguing for a proactive multimodal strategy from diagnosis rather than reserved for refractory disease (review-exact).[2]
References6ShowHide
- [1]Lu H, et al. Consensus on the Clinical Use of Pregabalin in Peripheral Neuropathic Pain CNS Neurosci Ther, 2026.PMID 42310848
- [2]Blero D, et al. Pain management in pancreatic cancer: time to change our strategy! Curr Opin Oncol, 2026.PMID 42240215
- [3]Johnson T, et al. Peripheral Nerve Stimulation for Perioperative Care in Oncologic Surgical Cases: A Narrative Review Healthcare (Basel), 2026.PMID 42354627
- [4]Hagen KMR, et al. PaSo paracetamol with strong opioids trial: paracetamol versus placebo in conjunction with strong opioids for cancer pain-a pilot randomised placebo-controlled withdrawal trial BMJ Support Palliat Care, 2026.PMID 42309698
- [5]Cordero-Tous N, et al. Intrathecal Drug Delivery as a Rescue Strategy in Patients with Spinal Cord Stimulation: A Single-Center Case Series J Clin Med, 2026.PMID 42355686
- [6]Sperandio G, et al. Somatic and psychological predictors of chronic postsurgical pain in cancer patients: a machine learning approach in a longitudinal two-centre study Br J Anaesth, 2026.PMID 41506969