Cancer pain in the emergency department: A narrative review

Background: Cancer-related pain accounts for up to 62 % of emergency department (ED) visits among patients with malignancy, yet one in three receives inadequate analgesia. Persistent disparities in cancer pain management based on race, age, and insurance status, further exacerbate this issue. To date, there are no reviews evaluating the existing literature on cancer pain management in the emergency department, or strategies to optimize care for this prevalent condition. Objective: To review and synthesize recent evidence (2015–2025) on the burden of cancer-related pain in the ED, focusing on incidence, clinical features, treatment shortcomings, and emerging strategies to improve care. Discussion: Twenty-seven studies were included in the review. Pain recurred or persisted in 40–62 % of encounters, with musculoskeletal and abdominal pain responding poorly. Median time to opioid administration exceeded 1 h; while escalation occurred in only 11 % of undertreated cases. Black patients were nearly twice as likely as White patients to present in severe pain but were less likely to receive opioids. Younger adults, Medicaid/Medicare recipients, and patients with chronic pain or bone metastases also faced higher pain scores and admission rates. Promising interventions, including electronic best-practice advisories, alternative-to-opioid protocols, nerve blocks, and oncology-specific observation units were linked to lower pain scores, reduced opioid use, and fewer revisits or admissions. These strategies are based on single-center studies, with limited validation and sparse data on long-term, patient-centered outcomes. Although there are novel modalities explored, the primary pain management intervention for patients with cancer is opioids. Conclusion: Cancer pain remains a leading, inequitable driver of ED use, highlighting the need for scalable, validated interventions that integrate timely analgesia and address structural disparities.