Targeting neuroimmune pathways in chronic pain: clinical insights and immunotherapeutic prospects

evidence of glial activation, although signals remain heterogeneous across syndromes and point toward immune endotypes. Early clinical signals from repurposed immunomodulators, including anti-TNF agents, colony-stimulating factor 1 receptor (CSF-1R) inhibitors, and pro-resolving mediators, suggest that immune-targeted interventions can modify pain-related outcomes. However, effects are variable, and substantial safety and translational barriers remain. Here we synthesize mechanistic and human evidence, highlight key translational bottlenecks, and propose a roadmap toward precision immunotherapy in chronic pain. This approach emphasizes biomarker-guided stratification, mechanism-aligned endpoints, and pragmatic integration into multimodal care.