Targeting molecular pathways in neuropathic cancer pain: from mechanisms to novel therapeutics

Neuropathic cancer pain (NCP) remains a formidable clinical adversary, severely compromising the quality of life for cancer survivors. Its pathogenesis is highly complex and multifactorial, bifurcated into tumor-induced and chemotherapy-induced neuropathic pain. This review dissects the intricate molecular mechanism of NCP, highlighting how the tumor microenvironment orchestrates neuro-tumor interaction. Bridging the gap between pathogenesis and treatment, we evaluate the vanguard of therapeutic strategies designed to breach the current therapeutic impasse. We specifically explore the potential of antisense oligonucleotides in silencing pathological gene expression, the deployment of nanotechnology for bespoke drug delivery, the targets of neuro-tumor interactions, and the modulation of the endocannabinoid system as a novel analgesic target. In summary, by integrating pathogenic insights with therapeutic innovations, this review aims to catalyze a paradigm shift, from symptomatic management to mechanism-based precision intervention, paving the way for a new epoch in NCP management.