237: Cancer Treatment-Related Pain in Patients with Refractory Pain: A Registry Study

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic postsurgical pain, Epidemiology, Pain in Special Populations , Treatment/management

Background and Aims: Cancer treatment–related pain (CTRP) is an often-under-recognized contributor to chronic pain in cancer survivors, yet its prevalence and clinical characteristics in refractory pain populations remain poorly defined. The objective of this study was to quantify the prevalence and characterize the demographic and clinical presentation of CTRP relative to tumor-related pain in a tertiary refractory pain cohort.

Methods: We conducted a retrospective cohort study of consecutive patients (N=622) referred for first evaluation of refractory pain to a tertiary multidisciplinary cancer pain clinic between January 2021 and June 2025. Pain etiology was classified using ICD-11 criteria as Treatment-Related Pain (TRP; MG30.11), Tumor-related pain (MG30.10), or Non-cancer-related pain. Multivariable logistic regression identified factors associated with TRP attribution, comparing TRP versus tumor-related pain.

Results: Among 622 patients, 42.1% (n = 262) were classified as having TRP. Patients with TRP were significantly younger than those with tumor-related pain (mean 58.1 ± 14.8 vs 64.2 ± 12.8 years, p < 0.001). Peripheral neuropathy was the strongest factor associated with TRP attribution (adjusted odds ratio 9.18; 95% confidence interval 2.56–32.83). Neuropathic (46.2%) and mixed (35.9%) pain mechanisms predominated in the TRP group, whereas nociceptive mechanisms were more common in the tumor-related group.

Conclusions: Treatment-related pain (TRP) is highly prevalent in tertiary refractory pain settings and demonstrates a distinct clinical and mechanistic profile. TRP clustered among younger survivors, supporting its role as a major survivorship morbidity rather than an end-of-life phenomenon. These findings support mechanism-informed assessment pathways and prospective studies to define escalation strategies for reducing persistent treatment-related pain.

References: Evenepoel M, Haenen V, De Baerdemaecker T, Meeus M, Devoogdt N, Dams L, et al. Pain Prevalence During Cancer Treatment: A Systematic Review and Meta-Analysis. J Pain Symptom Manage. 2022 Mar;63(3):e317–35.

Snijders RAH, Brom L, Theunissen M, van den Beuken-van Everdingen MHJ. Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis. Cancers (Basel). 2023 Jan 18;15(3):591.

Bennett MI, Kaasa S, Barke A, Korwisi B, Rief W, Treede RD, et al. The IASP classification of chronic pain for ICD-11: chronic cancer-related pain. Pain. 2019 Jan;160(1):38–44.

Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain. 2019 Jan;160(1):19–27.

Freynhagen R, Parada HA, Calderon-Ospina CA, Chen J, Rakhmawati Emril D, Fernández-Villacorta FJ, et al. Current understanding of the mixed pain concept: a brief narrative review. Curr Med Res Opin. 2019 June;35(6):1011–8.

Camps Herrero C, Reina Zoilo JJ, Monge Martín D, Caballero Martínez F, Guillem Porta V, Aranda Aguilar E, et al. Active study: undetected prevalence and clinical inertia in the treatment of breakthrough cancer pain (BTcP). Clin Transl Oncol. 2019 Mar;21(3):380–90.

Ferrero VT, Oset MM, Masferrer JP, Pardo EH, Sorolla EJ, Largo SC, et al. Prevalence and characterization of breakthrough pain in cancer patients with proctalgia treated with 3D pelvic radiotherapy. Clin Transl Oncol. 2019 Dec;21(12):1707–11.

Loprinzi CL, Lacchetti C, Bleeker J, Cavaletti G, Chauhan C, Hertz DL, et al. Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update. J Clin Oncol. 2020 Oct 1;38(28):3325–48.

Epstein JB, Hong C, Logan RM, Barasch A, Gordon SM, Oberle-Edwards L, et al. A systematic review of orofacial pain in patients receiving cancer therapy. Support Care Cancer. 2010 Aug;18(8):1023–31.

Kostine M, Finckh A, Bingham CO, Visser K, Leipe J, Schulze-Koops H, et al. EULAR points to consider for the diagnosis and management of rheumatic immune-related adverse events due to cancer immunotherapy with checkpoint inhibitors. Ann Rheum Dis. 2021 Jan;80(1):36–48.

Gallaway MS, Townsend JS, Shelby D, Puckett MC. Pain Among Cancer Survivors. Prev Chronic Dis. 2020 July 9;17:E54.

Haenen V, Evenepoel M, De Baerdemaecker T, Meeus M, Devoogdt N, Morlion B, et al. Pain prevalence and characteristics in survivors of solid cancers: a systematic review and meta-analysis. Support Care Cancer. 2022 Dec 27;31(1):85.

Presenting Author: Uri Hochberg
Submitting Author: Uri Hochberg

Senior Author: Uri Hochberg

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Rotem Agur: m.d - Tel Aviv sourasky medical center, Tel- Aviv, Israel
• Barak Cohen: M.D - Tel Aviv sourasky medical center, Tel- Aviv, Israel
• Silviu Brill: M.D - Tel Aviv sourasky medical center, Tel- Aviv, Israel
• Morsi Khashan: M.D - Tel Aviv sourasky medical center, Tel- Aviv, Israel