Global perspectives on pain management in ENT cancers; a narrative review study

Abstract

Pain in ear, nose, and throat (ENT) cancers is common and highly debilitating, resulting from tumor invasion, treatment toxicity, and complex neurophysiological mechanisms, making effective management essential for maintaining quality of life (QoL) and treatment adherence. This narrative review synthesizes global evidence on pain mechanisms, assessment methods, and management strategies, covering pharmacological, interventional, and non‑pharmacological approaches while highlighting major regional disparities in access to care. Pain in these cancers arises from nociceptive, neuropathic, and inflammatory pathways, with opioids as the primary therapy supported by adjuvant medications and complementary non‑pharmacological interventions. However, low‑ and middle‑income countries face significant barriers, including limited opioid availability, inadequate training, and cultural obstacles, that hinder effective pain control. Emerging options such as targeted therapies, immunotherapy‑related pain management, neuromodulation, and personalized analgesic strategies show promise but remain unevenly accessible. Overall, improving pain outcomes in ENT cancers requires a multidisciplinary, culturally sensitive, and equity‑focused approach supported by strengthened palliative care systems and coordinated global efforts.

Keywords: Head and neck cancer, Otorhinolaryngologic neoplasms, Pain management, Analgesics, Opioid analgesics, Adjuvant analgesics, Palliative care