Suzetrigine (Journavx) as a Non-Opioid Adjuvant for Cancer-Associated Pain: A Case Series

Opioids remain central to managing cancer-associated pain (CAP) but are often limited by constipation, nausea, sedation, and concerns about maladaptive use amid the ongoing opioid epidemic. Suzetrigine (Journavx), a first-in-class, non-opioid, selective NaV1.8 sodium channel inhibitor, was approved by the U.S. Food and Drug Administration in January 2025 for moderate-to-severe acute pain; its role in chronic pain syndromes such as CAP has not been established. This case series describes two patients with CAP of differing pathophysiology started on suzetrigine as an off-label adjuvant analgesic. An 80-year-old man with radicular pain from metastatic prostate cancer to bone, who had declined opioid therapy, had an Edmonton Symptom Assessment Scale (ESAS) pain score that fell from 4/10 at baseline to 1-2/10 over approximately six months, with benefit first reported after three weeks. A 63-year-old man with severe oxaliplatin-associated chemotherapy-induced peripheral neuropathy on a multidrug regimen had an ESAS pain score that improved from 9/10 to 4/10 over three weeks, during which he self-discontinued duloxetine and substantially reduced his gabapentin and oxycodone use. Neither patient experienced adverse reactions. These anecdotal cases suggest suzetrigine may have potential as an opioid- and adjuvant-sparing analgesic across more than one CAP pain phenotype, supporting further prospective study outside its currently approved acute-pain indication.