Background/Objectives:Cancer pain affects 55–95% of patients with advanced malignancy, representing a complex syndrome involving nociceptive, neuropathic and nociplastic mechanisms. Despite therapeutic advances, two-thirds of patients with metastatic cancer experience inadequate pain control. This scoping review synthesizes recent advances in cancer pain pathophysiology and management, focusing on molecular and cellular mechanisms, emerging pharmacological, interventional and technological therapies and key evidence gaps to inform future precision-based pain management strategies.Methods:Following PRISMA-ScR methodology, we searched PubMed, Embase, Scopus, and Web of Science for studies published between January 2022 and September 2025. After screening 3412 records, 278 studies were included and analyzed across different domains: biological mechanisms, pharmacological management, interventional and neuromodulatory approaches, radiotherapy developments, and digital health innovations.Results:Recent mechanistic research reveals cancer pain arises from tumor–neuron–immune crosstalk, with malignant cells secreting neurotrophic factors that promote axonal sprouting and nociceptor sensitization. Genetic polymorphisms and epigenetic modifications contribute to inter-individual pain variability. Management strategies are evolving toward multimodal precision medicine: NSAIDs and opioids remain foundational, complemented by adjuvant agents and interventional procedures including nerve blocks, intrathecal delivery, and neuromodulation (spinal cord and dorsal root ganglion stimulation). Stereotactic body radiotherapy demonstrates superior analgesic durability versus conventional approaches. Digital health innovations, such as mobile applications, remote monitoring, wearables, and AI-enabled predictive models, enable continuous assessment and personalized treatment optimization.Conclusions:Cancer pain management is transitioning toward mechanism-based precision medicine integrating biological insights, advanced interventional techniques, and digital technologies. However, implementation challenges persist, including limited randomized trials for interventional approaches, the incomplete external validation of AI tools, and digital health equity concerns. Future research must prioritize prospective controlled studies and equitable integration into routine care.
背景/目标： 癌症疼痛影响55%–95%的晚期恶性肿瘤患者，是一种涉及伤害性、神经病理性和伤害可塑性机制的复杂综合征。尽管治疗手段有所进步，仍有三分之二的转移性癌症患者疼痛控制不足。本次范围综述整合了癌症疼痛病理生理学与管理的最新进展，重点关注分子与细胞机制、新兴的药物、介入及技术疗法，以及关键的证据缺口，旨在为未来基于精准医学的疼痛管理策略提供信息。
方法： 遵循PRISMA-ScR方法，我们检索了PubMed、Embase、Scopus和Web of Science中2022年1月至2025年9月发表的研究。经过对3412条记录的筛选，最终纳入并分析了278项研究，涵盖以下领域：生物学机制、药物管理、介入与神经调节方法、放射治疗进展以及数字健康创新。
结果： 近期机制研究表明，癌症疼痛源于肿瘤-神经元-免疫互作，恶性细胞分泌神经营养因子，促进轴突发芽和伤害感受器敏化。基因多态性和表观遗传修饰导致了个体间的疼痛差异。管理策略正朝着多模式精准医学方向发展：非甾体抗炎药和阿片类药物仍是基础，并辅以辅助药物以及包括神经阻滞、鞘内给药和神经调节（脊髓和背根神经节刺激）在内的介入治疗。相较于传统方法，立体定向体部放疗显示出更优的镇痛持久性。数字健康创新，如移动应用程序、远程监测、可穿戴设备及人工智能驱动的预测模型，能够实现持续评估和个性化治疗优化。
结论： 癌症疼痛管理正在向整合生物学见解、先进介入技术和数字技术的、基于机制的精准医学过渡。然而，实施挑战依然存在，包括介入疗法的随机对照试验有限、人工智能工具的外部验证不完全，以及数字健康的公平性问题。未来研究必须优先开展前瞻性对照研究，并推动其在常规护理中的公平整合。
Advances in the Pathophysiology and Management of Cancer Pain: A Scoping Review
肿瘤(癌症)患者之家