Personalised Cancer Pain Management: Myth or Emerging Reality?

Why does one patient achieve excellent pain relief with lowdose morphine, while another with seemingly similar disease requires escalating opioids, multiple adjuvants and eventually an intrathecal intervention?'Every palliative care physician has encountered this dilemma.The answer reminds us that cancer pain is far more than a symptom; it is a highly individual experience.This raises an important question: Is personalised cancer pain management finally becoming a reality, or are we still chasing an attractive concept?For nearly four decades, the WHO analgesic ladder has remained the cornerstone of cancer pain management.Its simplicity and global applicability have transformed clinical practice and continue to benefit millions of patients.[1] Yet, daily clinical practice teaches us that pain intensity alone rarely determines the optimal treatment.The biology of the tumour, mechanism of pain, previous opioid exposure, psychological distress, family support, socioeconomic circumstances and patient preferences all influence outcomes.Perhaps, without calling it so, palliative care has always practiced personalised medicine.What has changed is our understanding of cancer pain.We are gradually moving away from an opioid-centric approach towards mechanism-based, multimodal management.Identifying nociceptive, neuropathic, visceral or mixed pain now influences the choice of analgesics, adjuvant drugs, radiotherapy, rehabilitation and interventional pain procedures.Recent literature has appropriately described this transition as moving 'from tradition to precision' , emphasising that effective cancer pain management requires integrating biological, pharmacological, psychological and functional domains rather than simply escalating opioid doses.[2,3] Equally important is the growing role of interventional pain management.Ultrasound-and fluoroscopy-guided nerve blocks, neuraxial drug delivery