Modern pharmacological approaches to pain management in oncology patients. Part II (narrative review)

Introduction. The second part of this review focuses on clinical scenarios, in which standard analgesic regimens in cancer patients show limited efficacy or unacceptable tolerability, including mixed pain phenotypes, a pronounced neuropathic component, and chemotherapy-induced peripheral neuropathy (CIPN). We address pharmacological approaches that may be feasible for implementation with adequate clinical workflow organization, as well as experimental targets shaping the «next wave» of mechanism-based, targeted analgesia.

The objective was to critically synthesize the available evidence on implementable and theoretically promising pharmacological analgesic strategies in patients with malignant disease.

 Materials and methods. In the second part, a narrative review was performed using the methodology for searching and critically evaluating sources described in detail in the first part of the series; the literature search was additionally updated as of 10.23.2025 with an emphasis on implemented and experimental pharmacological approaches.

Sections. The following approaches are presented as promising methods suitable for routine implementation: xenon–O₂ in subanesthetic regimens as an option for rapid reduction of pain/anxiety with opioid-sparing potential; intrathecal analgesia using ziconotide as an effective strategy for generalized refractory pain with a prominent neuropathic component; and the 8% capsaicin patch as a local treatment for selected subtypes of painful focal CIPN/peripheral neuropathy. Experimental approaches with theoretically justified potential include anti-NGF antibodies, TrkA antagonists, selective NaV1.7 blockers, P2X3 (and P2X2/3) antagonists, as well as σ1 antagonists, KCC2 modulators, CSF1R inhibitors, and tetrahydrobiopterin.

Conclusions. Xenon at subanesthetic concentrations appears to be the most promising approach. Intrathecal therapy remains a powerful option for the control of refractory pain but is associated with technical complexity and potential complications. The 8% capsaicin patch occupies a narrow yet clinically useful niche in focal painful neuropathy/CIPN. Experimental targets support the concept of phenotype-oriented analgesia; however, they are not yet ready for routine clinical use without further accumulation of robust clinical evidence.

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