Pain management strategies for adult cancer patients receiving palliative care in low- and lower-middle income countries: a scoping review

Background Cancer pain is a major source of suffering among patients receiving palliative care, particularly in low- and lower-middle-income countries (LLMICs). Although diverse pain management strategies are available, evidence from resource-limited settings remains fragmented, unevenly distributed, and contextually constrained. This scoping review aimed to map and synthesise existing evidence on pain management strategies for adult cancer patients receiving palliative care in LLMICs and to identify key evidence gaps. Methods A scoping review was conducted following the Joanna Briggs Institute methodological framework and reported in accordance with PRISMA-ScR guidelines. Comprehensive searches were undertaken across major biomedical databases, regional databases and grey-literature sources. Primary studies reporting pain management strategies for adult cancer patients receiving palliative care in LLMICs were included. Country eligibility was verified against the World Bank fiscal year 2025 income classification. Title/abstract and full-text screening were conducted independently using predefined criteria. Data were synthesised descriptively using inductive and deductive approaches. Results A total of 33 studies were included, predominantly quantitative and observational in design, with limited high-level evidence. The evidence base was geographically concentrated, with most studies conducted in India and minimal representation from low-income countries, particularly in sub-Saharan Africa. Pharmacological strategies, largely aligned with the World Health Organization analgesic ladder, and palliative radiotherapy for metastatic bone pain were the most frequently reported approaches and were consistently associated with reductions in pain intensity. Psychosocial, non-pharmacological, and system-level interventions were less frequently evaluated but reported to have complementary benefits. Across studies, implementation and sustainability of pain management strategies were strongly shaped by restrictive opioid regulations, weak supply chains, limited workforce capacity, sociocultural beliefs, and broader health-system constraints. Conclusion This scoping review shows that cancer pain management in palliative care across LLMICs is largely reliant on pharmacological and radiotherapy-based interventions, with limited high-quality evidence and uneven geographical coverage. System-level barriers; particularly opioid regulation, workforce limitations, and inadequate service infrastructure; remain key determinants of pain outcomes, underscoring the need for context-specific research and health system strengthening in resource-limited settings.