PAIN MANAGEMENT IN CANCER - PHARMACOTHERAPY WITH NON-PHARMACOLOGICAL TREATMENT - DOES IT REALLY MAKE SENSE?

Cancer-related pain remains a major clinical challenge and significantly affects patients’ quality of life despite advances in oncological treatment. It is estimated that adequate pain control is achieved in only a minority of patients, highlighting the need for a broader, multimodal approach. This narrative review aims to evaluate the effectiveness of combining pharmacological pain management with non-pharmacological interventions in patients with cancer. Pharmacotherapy, based primarily on the WHO analgesic ladder, including nonopioid analgesics, weak and strong opioids, and adjuvant medications such as antidepressants and antiepileptic drugs, remains the cornerstone of cancer pain treatment. However, opioid therapy is often limited by insufficient efficacy and adverse effects, particularly in cases of neuropathic or mixed pain. Therefore, alternative and complementary strategies have gained increasing attention. These include radiotherapy, percutaneous vertebroplasty, high-intensity focused ultrasound, transcutaneous electrical nerve stimulation, acupuncture, and the use of intravenous or subcutaneous lidocaine. Evidence suggests that non-pharmacological and interventional methods can significantly enhance pain control, reduce opioid requirements, and improve overall quality of life. Radiotherapy remains a gold standard for pain relief in bone metastases, while minimally invasive and non-invasive techniques show promising results in selected patient populations. Additionally, addressing psychological, social, and spiritual dimensions of pain is essential in the management of total pain.