Prevalence, mechanisms, and psychological outcomes of chronic pain in cancer survivors: a systematic review with narrative synthesis.

PURPOSE: Chronic pain develops as a frequent health issue for cancer survivors. It affects both their physical and mental well-being. Although pain management is important, long-term care strategies are often lacking. The aim of this systematic review and narrative synthesis was to examine the prevalence of chronic pain among cancer survivors, explore the mechanisms of chronic pain, and examine its impact on their mental health.

METHODS

We conducted a systematic review of studies identified through PubMed, Scopus, Web of Science, Embase, and PsycINFO. The review included studies published between 2011 and 2026. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools, and the certainty of evidence across the three outcome domains was evaluated using the GRADE approach. The review protocol was registered in PROSPERO (CRD42025638968).

RESULTS

The research included 32 studies, including cross-sectional and cohort studies that investigated various types of cancer. Chronic pain prevalence varied substantially across studies, ranging from 8.6% to 67.1% among established long-term survivor cohorts. Across the included studies, neuropathic pain features were frequently reported, while some survivor populations showed symptom profiles consistent with nociplastic pain or central sensitization. However, most mechanistic classifications were based on screening instruments rather than diagnostic confirmation. Cancer survivors with chronic pain reported higher levels of anxiety, depressive symptoms, and emotional distress, together with poorer quality of life.

CONCLUSION

Chronic pain represents a substantial and heterogeneous burden among adult cancer survivors and is associated with adverse psychological and functional outcomes. Neuropathic pain features are commonly reported, while evidence for nociplastic mechanisms and central sensitization remains suggestive and is largely based on symptom-based assessment tools. These findings support the need for multidimensional pain assessment in survivorship care while highlighting the need for stronger mechanistic research.

IMPLICATIONS FOR CANCER SURVIVORS: Chronic pain frequently persists after cancer treatment and is linked to psychological distress and poorer quality of life. Survivors should report ongoing pain and emotional symptoms, and survivorship care should include routine assessment of both.