Unpacking Cancer Pain: Mechanisms, Phenotypes, and the Modern Oncology Patient

Cancer-related pain is increasingly heterogeneous, reflecting a complex interplay of tumor burden, treatment-related injury, neuropathic mechanisms, and the growing population of cancer survivors living with chronic pain. Despite this complexity, intrathecal drug delivery strategies have traditionally relied on relatively uniform medication algorithms that may not fully address the diverse etiologies and mechanisms underlying cancer pain. In contrast, the management of non-malignant pain has increasingly embraced diagnosis-driven and mechanism-based approaches that tailor therapy to the underlying pathology and pain phenotype. A similar evolution may be needed in cancer pain care. This panel will explore the emerging concept of precision-oriented intrathecal therapy, emphasizing the importance of aligning medication selection, combination therapy, and dosing strategies with specific pain mechanisms, disease trajectories, and patient goals. Through case-based discussion and multidisciplinary perspectives, panelists will examine how intrathecal therapies can be individualized for complex cancer pain syndromes-including neuropathic injury, treatment-related toxicity, and mixed pain states-while addressing practical considerations such as titration strategies, survivorship care, and long-term device management. The discussion will also highlight current gaps in evidence and the need for focused research to better define mechanism-based intrathecal strategies in oncology populations. By reframing cancer pain management through a more etiology-driven and precision-based lens, this session aims to advance a more individualized and evidence-informed approach to intrathecal therapy in patients with cancer.