Treatment of neuropathic pain in cancer survivors: a scoping review of pharmacological, exercise, and psychosocial interventions
DOI:
https://doi.org/10.2340/ao.v65.45347Keywords:
neuropathic pain, exercise, psychological interventions, pharmacological treatment, cancer survivorsAbstract
Background and purpose: Neuropathic pain is a debilitating late effect among cancer survivors. This scoping review aims to provide an overview of pharmacological, psychological, and exercise interventions for neuropathic pain among cancer survivors and to identify further relevant research areas.
Patient/material and methods: PubMed, PsychInfo, and EMBASE were systematically searched for studies published from January 2004 to January 2026 and abstract and full text screening was carried out. The target population was cancer survivors who had completed primary treatment and have no active disease. Neuropathic pain was defined as a) a mean pain intensity the last week/month of ≥ 3 at a numerical rating scale (0 = no pain, 10 = worst pain), and b) symptoms of neuropathy, or c) neuropathic pain diagnosed by an experienced neurologist.
Results: Of the 956 systematic reviews/guidelines and 604 original studies identified, 11 pharmacological, two psychological and three studies on exercise were eligible. Most of the studies included patients with breast cancer.
Duloxetine was effective in reducing neuropathic pain from painful chemotherapy-induced neuropathy and gabapentin + concomitant morphine compared to morphine alone reduced neuropathic pain in cancer survivors with neuropathic pain due to radiation therapy, and surgery. Mindfulness-based cognitive behavioral therapy showed no effect after correction for multiple comparisons. Exercise interventions were useful in both reducing neuropathic pain as well as neuropathic symptoms.
Interpretation: This scoping review found evidence for pharmacological treatment of neuropathic pain in cancer survivors, could not make any conclusion on psychological treatment, and exercise interventions show promising effects. Further research on interdisciplinary treatment of neuropathic pain among cancer survivors is needed.
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References
Tonorezos E, Devasia T, Mariotto AB, Mollica MA, Gallicchio L, Green P, et al. Prevalence of cancer survivors in the United States. J Natl Cancer Inst. 2024;116(11):1784–90.
https://doi.org/10.1093/jnci/djae135 DOI: https://doi.org/10.1093/jnci/djae135
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024 May-Jun;74(3):229-263. doi: https://doi.org/10.3322/caac.21834. Epub 2024 Apr 4. PMID: 38572751 DOI: https://doi.org/10.3322/caac.21834
van den Beuken-van Everdingen MH, de Rijke JM, Kessels AG, Schouten HC, van Kleef M, Patijn J. Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Ann Oncol. 2007;18(9):1437–49.
https://doi.org/10.1093/annonc/mdm056 DOI: https://doi.org/10.1093/annonc/mdm056
Brown MR, Ramirez JD, Farquhar-Smith P. Pain in cancer survivors. Br J Pain. 2014;8(4):139–53.
https://doi.org/10.1177/2049463714542605 DOI: https://doi.org/10.1177/2049463714542605
Mao JJ, Armstrong K, Bowman MA, Xie SX, Kadakia R, Farrar JT. Symptom burden among cancer survivors: impact of age and comorbidity. J Am Board Fam Med. 2007;20(5):434–43.
https://doi.org/10.3122/jabfm.2007.05.060225 DOI: https://doi.org/10.3122/jabfm.2007.05.060225
Soliman N, Moisset X, Ferraro MC, de Andrade DC, Baron R, Belton J, et al. Pharmacotherapy and non-invasive neuromodulation for neuropathic pain: a systematic review and meta-analysis. Lancet Neurol. 2025;24(5):413–28. DOI: https://doi.org/10.1016/S1474-4422(25)00068-7
Leitzelar BN, Koltyn KF. Exercise and neuropathic pain: a general overview of preclinical and clinical research. Sports Med Open. 2021;7(1):21.
https://doi.org/10.1186/s40798-021-00307-9 DOI: https://doi.org/10.1186/s40798-021-00307-9
Finnerup NB, Haroutounian S, Kamerman P, Baron R, Bennett DL, Bouhassira D, et al. Neuropathic pain: an updated grading system for research and clinical practice. Pain. 2016;157(8):1599–606.
https://doi.org/10.1097/j.pain.0000000000000492 DOI: https://doi.org/10.1097/j.pain.0000000000000492
Attal N, Fermanian C, Fermanian J, Lanteri-Minet M, Alchaar H, Bouhassira D. Neuropathic pain: are there distinct subtypes depending on the aetiology or anatomical lesion? Pain. 2008;138(2):343–53.
https://doi.org/10.1016/j.pain.2008.01.006 DOI: https://doi.org/10.1016/j.pain.2008.01.006
Bennett MI, Rayment C, Hjermstad M, Aass N, Caraceni A, Kaasa S. Prevalence and aetiology of neuropathic pain in cancer patients: a systematic review. Pain. 2012;153(2):359–65.
https://doi.org/10.1016/j.pain.2011.10.028 DOI: https://doi.org/10.1016/j.pain.2011.10.028
Loprinzi CL, Lacchetti C, Bleeker J, Cavaletti G, Chauhan C, Hertz DL, et al. Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: ASCO guideline update. J Clin Oncol. 2020;38(28):3325–48.
https://doi.org/10.1200/JCO.20.01399 DOI: https://doi.org/10.1200/JCO.20.01399
Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2018;29(Suppl 4):iv166–91.
https://doi.org/10.1093/annonc/mdy152 DOI: https://doi.org/10.1093/annonc/mdy152
Bennett MI, Laird B, van Litsenburg C, Nimour M. Pregabalin for the management of neuropathic pain in adults with cancer: a systematic review of the literature. Pain Med. 2013;14(11):1681–8.
https://doi.org/10.1111/pme.12212 DOI: https://doi.org/10.1111/pme.12212
Paice JA, Portenoy R, Lacchetti C, Campbell T, Cheville A, Citron M, et al. Management of chronic pain in survivors of adult cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2016;34(27):3325–45.
https://doi.org/10.1200/JCO.2016.68.5206 DOI: https://doi.org/10.1200/JCO.2016.68.5206
Lise Ventzel. DMCG. Neuropatiske smerter – Farmakologiske, psykologiske og træningsinterventioner til kræftoverlevere. Vejle. 2025. p. 1.
Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73.
https://doi.org/10.7326/M18-0850 DOI: https://doi.org/10.7326/M18-0850
Bennett MI, Eisenberg E, Ahmedzai SH, Bhaskar A, O’Brien T, Mercadante S, et al. Standards for the management of cancer-related pain across Europe-A position paper from the EFIC Task Force on Cancer Pain. Eur J Pain. 2019;23(4):660–8.
https://doi.org/10.1002/ejp.1346 DOI: https://doi.org/10.1002/ejp.1346
Filipczak-Bryniarska I, Krzyzewski RM, Kucharz J, Michalowska-Kaczmarczyk A, Kleja J, Woron J, et al. High-dose 8% capsaicin patch in treatment of chemotherapy-induced peripheral neuropathy: single-center experience. Med Oncol. 2017;34(9):162.
https://doi.org/10.1007/s12032-017-1015-1 DOI: https://doi.org/10.1007/s12032-017-1015-1
Velasco R, Besora S, Argyriou AA, Santos C, Sala R, Izquierdo C, et al. Duloxetine against symptomatic chemotherapy-induced peripheral neurotoxicity in cancer survivors: a real world, open-label experience. Anticancer Drugs. 2021;32(1):88–94.
https://doi.org/10.1097/CAD.0000000000001005 DOI: https://doi.org/10.1097/CAD.0000000000001005
Hincker A, Frey K, Rao L, Wagner-Johnston N, Ben Abdallah A, Tan B, et al. Somatosensory predictors of response to pregabalin in painful chemotherapy-induced peripheral neuropathy: a randomized, placebo-controlled, crossover study. Pain. 2019;160(8):1835–46.
https://doi.org/10.1097/j.pain.0000000000001577 DOI: https://doi.org/10.1097/j.pain.0000000000001577
Smith EM, Pang H, Cirrincione C, Fleishman S, Paskett ED, Ahles T, et al. Effect of duloxetine on pain, function, and quality of life among patients with chemotherapy-induced painful peripheral neuropathy: a randomized clinical trial. JAMA. 2013;309(13):1359–67.
https://doi.org/10.1001/jama.2013.2813 DOI: https://doi.org/10.1001/jama.2013.2813
Mohamadi M, Molla A, Sadeghi E, Orakifar N, Bahari M, Yekta ZM, et al. Management of neuropathic pain and paresthesia in patients with multiple sclerosis: a systematic review and network meta-analysis. Mult Scler Relat Disord. 2025;104:106815. DOI: https://doi.org/10.1016/j.msard.2025.106815
Amarelo A, Magalhães B, Araújo N, Capela Marques AF, Fernandes CS. Effects of exercise programs on chemotherapy-induced peripheral neuropathy in cancer survivors: an umbrella systematic review. J Bodyw Mov Ther. 2025;44:655–64.
https://doi.org/10.1016/j.jbmt.2025.06.037 DOI: https://doi.org/10.1016/j.jbmt.2025.06.037
Seth NH, Qureshi I. Effectiveness of physiotherapy interventions on improving quality of life, total neuropathy score, strength and reducing pain in cancer survivors suffering from chemotherapy-induced peripheral neuropathy – a systematic review. Acta Oncol. 2023;62(9):1143–51. DOI: https://doi.org/10.1080/0284186X.2023.2238890
Li C, Hou W, Ding D, Yang Y, Gu S, Zhu Y. Evidence mapping based on systematic reviews of cognitive behavioral therapy for neuropathic pain. Neural Plast. 2023;2023:2680620.
https://doi.org/10.1155/2023/2680620 DOI: https://doi.org/10.1155/2023/2680620
Sheinfeld Gorin S, Krebs P, Badr H, Janke EA, Jim HS, Spring B, et al. Meta-analysis of psychosocial interventions to reduce pain in patients with cancer. J Clin Oncol. 2012;30(5):539–47. DOI: https://doi.org/10.1200/JCO.2011.37.0437
Johannsen M, Farver I, Beck N, Zachariae R. The efficacy of psychosocial intervention for pain in breast cancer patients and survivors: a systematic review and meta-analysis. Breast Cancer Res Treat. 2013;138(3):675–90.
https://doi.org/10.1007/s10549-013-2503-4 DOI: https://doi.org/10.1007/s10549-013-2503-4
Singhal Y, Pingoliya S, Mathur A, Atal P. A comparative study of the effectiveness and safety of pregabalin and duloxetine in the treatment of chemotherapy-induced neuropathic pain. Palliat Med Pract. 2025;19(2):93–100. DOI: https://doi.org/10.5603/pmp.100998
Keskinbora K, Pekel AF, Aydinli I. Gabapentin and an opioid combination versus opioid alone for the management of neuropathic cancer pain: a randomized open trial. J Pain Symptom Manage. 2007;34(2):183–9.
https://doi.org/10.1016/j.jpainsymman.2006.11.013 DOI: https://doi.org/10.1016/j.jpainsymman.2006.11.013
Caraceni A, Zecca E, Bonezzi C, Arcuri E, Yaya Tur R, Maltoni M, et al. Gabapentin for neuropathic cancer pain: a randomized controlled trial from the Gabapentin Cancer Pain Study Group. J Clin Oncol. 2004;22(14):2909–17.
https://doi.org/10.1200/JCO.2004.08.141 DOI: https://doi.org/10.1200/JCO.2004.08.141
Cheville AL, Sloan JA, Northfelt DW, Jillella AP, Wong GY, Bearden Iii JD, et al. Use of a lidocaine patch in the management of postsurgical neuropathic pain in patients with cancer: a phase III double-blind crossover study (N01CB). Support Care Cancer. 2009;17(4):451–60.
https://doi.org/10.1007/s00520-008-0542-x DOI: https://doi.org/10.1007/s00520-008-0542-x
Guo S, Han W, Wang P, Wang X, Fang X. Effects of exercise on chemotherapy-induced peripheral neuropathy in cancer patients: a systematic review and meta-analysis. J Cancer Surviv. 2023;17(2):318–31. DOI: https://doi.org/10.1007/s11764-022-01182-3
Gewandter JS, Mohile SG, Heckler CE, Ryan JL, Kirshner JJ, Flynn PJ, et al. A phase III randomized, placebo-controlled study of topical amitriptyline and ketamine for chemotherapy-induced peripheral neuropathy (CIPN): a University of Rochester CCOP study of 462 cancer survivors. Support Care Cancer. 2014;22(7):1807–14. DOI: https://doi.org/10.1007/s00520-014-2158-7
Hirayama Y, Ishitani K, Sato Y, Iyama S, Takada K, Murase K, et al. Effect of duloxetine in Japanese patients with chemotherapy-induced peripheral neuropathy: a pilot randomized trial. Int J Clin Oncol. 2015;20(5):866–71.
https://doi.org/10.1007/s10147-015-0810-y DOI: https://doi.org/10.1007/s10147-015-0810-y
Vilholm OJ, Cold S, Rasmussen L, Sindrup SH. Effect of levetiracetam on the postmastectomy pain syndrome. Eur J Neurol. 2008;15(8):851–7. DOI: https://doi.org/10.1111/j.1468-1331.2008.02206.x
Johannsen M, O’Connor M, O’Toole MS, Jensen AB, Højris I, Zachariae R. Efficacy of mindfulness-based cognitive therapy on late post-treatment pain in women treated for primary breast cancer: a randomized controlled trial. J Clin Oncol. 2016;34(28):3390–9.
https://doi.org/10.1200/JCO.2015.65.0770 DOI: https://doi.org/10.1200/JCO.2015.65.0770
Shergill Y, Rice DB, Khoo EL, Jarvis V, Zhang T, Taljaard M, et al. Mindfulness-based stress reduction in breast cancer survivors with chronic neuropathic pain: a randomized controlled trial. Pain Res Manag. 2022;2022:4020550.
https://doi.org/10.1155/2022/4020550 DOI: https://doi.org/10.1155/2022/4020550
Knoerl R, Grandinetti K, Smener L, Doll E, Fecher LA, Henry NL, et al. Exploring adolescent and young adult cancer survivors’ experience with cancer treatment-related symptoms: a qualitative analysis of semi-structured interviews. J Adolesc Young Adult Oncol. 2024;13(4):665–73. DOI: https://doi.org/10.1089/jayao.2024.0053
Wong P, Muanza T, Hijal T, Masse L, Pillay S, Chasen M, et al. Effect of exercise in reducing breast and chest-wall pain in patients with breast cancer: a pilot study. Curr Oncol. 2012;19(3):e129–35.
https://doi.org/10.3747/co.19.905 DOI: https://doi.org/10.3747/co.19.905
Lores-Peniche JA, Uicab Pool G, Aguiñaga-Malanco S. Pain neuroscience education and therapeutic exercise for the treatment of sequelae in breast cancer survivors living with chronic pain: a pilot study. J Bodyw Mov Ther. 2024;40:1744–51.
https://doi.org/10.1016/j.jbmt.2024.10.025 DOI: https://doi.org/10.1016/j.jbmt.2024.10.025
Huang Y, Tan T, Liu L, Yan Z, Deng Y, Li G, et al. Exercise for reducing chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis of randomized controlled trials. Front Neurol. 2023;14:1252259.
https://doi.org/10.3389/fneur.2023.1252259 DOI: https://doi.org/10.3389/fneur.2023.1252259
Lin KY, Cheng HC, Yen CJ, Hung CH, Huang YT, Yang HL, et al. Effects of exercise in patients undergoing chemotherapy for head and neck cancer: a pilot randomized controlled trial. Int J Environ Res Public Health. 2021;18(3):1291.
https://doi.org/10.3390/ijerph18031291 DOI: https://doi.org/10.3390/ijerph18031291
Tamburin S, Park SB, Schenone A, Mantovani E, Hamedani M, Alberti P, et al. Rehabilitation, exercise, and related non-pharmacological interventions for chemotherapy-induced peripheral neurotoxicity: systematic review and evidence-based recommendations. Crit Rev Oncol Hematol. 2022;171:103575.
https://doi.org/10.1016/j.critrevonc.2021.103575 DOI: https://doi.org/10.1016/j.critrevonc.2021.103575
Tanay MAL, Armes J, Moss-Morris R, Rafferty AM, Robert G. A systematic review of behavioural and exercise interventions for the prevention and management of chemotherapy-induced peripheral neuropathy symptoms. J Cancer Surviv. 2023;17(1):254–77.
https://doi.org/10.1007/s11764-021-00997-w DOI: https://doi.org/10.1007/s11764-021-00997-w
Wang M, Pei Z, Molassiotis A. Recent advances in managing chemotherapy-induced peripheral neuropathy: a systematic review. Eur J Oncol Nurs. 2022;58:102134.
https://doi.org/10.1016/j.ejon.2022.102134 DOI: https://doi.org/10.1016/j.ejon.2022.102134
Wang Z, Zhao B, Li Y, Jing J, Suo L, Zhang G. Comparison of the effects of 19 exercise interventions on symptoms, pain, balance, and muscular strength in patients with chemotherapy-induced peripheral neuropathy: a systematic review and network meta-analysis. Int J Nurs Stud. 2025;164:105014.
https://doi.org/10.1016/j.ijnurstu.2025.105014 DOI: https://doi.org/10.1016/j.ijnurstu.2025.105014
Farshchian N, Alavi A, Heydarheydari S, Moradian N. Comparative study of the effects of venlafaxine and duloxetine on chemotherapy-induced peripheral neuropathy. Cancer Chemother Pharmacol. 2018;82(5):787–93.
https://doi.org/10.1007/s00280-018-3664-y DOI: https://doi.org/10.1007/s00280-018-3664-y
Salehifar E, Janbabaei G, Hendouei N, Alipour A, Tabrizi N, Avan R. Comparison of the efficacy and safety of pregabalin and duloxetine in taxane-induced sensory neuropathy: a randomized controlled trial. Clin Drug Investig. 2020;40(3):249–57.
https://doi.org/10.1007/s40261-019-00882-6 DOI: https://doi.org/10.1007/s40261-019-00882-6
Wang L, Guyatt GH, Kennedy SA, Romerosa B, Kwon HY, Kaushal A, et al. Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies. CMAJ. 2016;188(14):E352–61.
https://doi.org/10.1503/cmaj.151276 DOI: https://doi.org/10.1503/cmaj.151276
Piet J, Würtzen H, Zachariae R. The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: a systematic review and meta-analysis. J Consult Clin Psychol. 2012;80(6):1007–20.
https://doi.org/10.1037/a0028329 DOI: https://doi.org/10.1037/a0028329
van de Graaf DL, Smeets T, van der Lee ML, Trompetter HR, Baars-Seebregts A, Børøsund E, et al. Patient-centered development of Embrace Pain: an online acceptance and commitment therapy intervention for cancer survivors with chronic painful chemotherapy-induced peripheral neuropathy. Acta Oncol. 2023;62(7):676–88.
https://doi.org/10.1080/0284186X.2023.2187260 DOI: https://doi.org/10.1080/0284186X.2023.2187260
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Copyright (c) 2026 Ellen Lund Schaldemose, Bolette Skjødt Rafn, Pernille Envold Bidstrup, Agon Olloni, Katrin Schättiger, Peter Christensen, Cæcilie Borregaard Myrhøj, Maja Johannsen Lindberg, Christoffer Johansen, Sandra Jensen, Ida Hovdenak, Sasja Jul Håkonsen, Lise Ventzel
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