Treatment-related pain in refractory cancer pain: prevalence, mechanisms, and clinical implications in a tertiary referral cohort

The long-term effects of cancer treatment are increasingly driving persistent pain in cancer survivors; however, the contribution and clinical profile of cancer treatment–related pain (CTRP) in refractory pain populations remain poorly defined.

We conducted a retrospective cohort study of consecutive patients (N = 622) referred to a tertiary multidisciplinary cancer pain clinic for initial evaluation of refractory pain (January 2021-June 2025). Pain etiology was classified using ICD-11 criteria as treatment-related pain (TRP; MG30.11), tumor-related pain (MG30.10), or non–cancer-related pain. The multivariate logistic regression analysis identified factors associated with TRP attribution.

TRP was identified in 42.1% of patients (n = 262). Patients with TRP were younger than those with tumor-related pain (mean 58.1 ± 14.8 vs 64.2 ± 12.8 years, p < 0.001). Peripheral neuropathy was strongly associated with TRP attribution (adjusted odds ratio 9.18; 95% CI 2.56–32.83). Neuropathic (46.2%) and mixed (35.9%) mechanisms predominated in TRP, whereas nociceptive mechanisms were more common in tumor-related pain.

Treatment-related pain constitutes a major component of refractory cancer pain and demonstrates a distinct clinical and mechanistic profiles. Its predominance among younger survivors supports its characterization as a survivorship-associated morbidity rather than an end-of-life phenomenon. These findings support the earlier recognition and integration of mechanism-informed, multidisciplinary supportive care strategies to improve outcomes in patients with persistent treatment-related pain.