Pancreatic Cancer-Associated Pain Management Beyond Opioids: Integrating Oncological Treatment, Palliative Care, and Interventional Pain Medicine

Pain is one of the most frequent and burdensome symptoms of pancreatic cancer and may substantially impair quality of life throughout the disease trajectory. Its complex and evolving etiology, involving visceral, neuropathic, somatic, and treatment-related mechanisms, frequently makes adequate pain control challenging. This critical narrative review provides a multidisciplinary overview of pancreatic cancer-associated pain management, integrating oncological treatment, palliative and pharmacological care, and interventional pain management into a practical clinical framework. Anticancer therapies, including chemotherapy and radiotherapy, may provide clinically meaningful analgesia in addition to their disease-controlling effect. Early integration of palliative care enables repeated symptom assessment, individualized pharmacological treatment, and management of the psychological, social, and spiritual dimensions of total pain. When conventional analgesic strategies provide insufficient relief or cause intolerable adverse effects, interventional techniques such as coeliac plexus neurolysis, splanchnic neurolysis, or intrathecal drug delivery can complement ongoing oncological and palliative treatment. Rather than following a rigid stepwise analgesic approach, pancreatic cancer-associated pain management should be individualized according to pain mechanism, disease stage and anatomy, previous treatments, functional status, expected survival, and patient preferences. Based on the available evidence and multidisciplinary clinical considerations, we propose a practical patient-centered pathway that dynamically integrates disease-directed, pharmacological, supportive, and interventional strategies throughout the disease course. Early multidisciplinary collaboration and continuous reassessment may facilitate timely treatment escalation and improve pain control while minimizing treatment burden.