Objective:

To comprehensively evaluate how neural plasticity contributes to cancer-related pain and to determine the effects of cognitive and neuromodulatory interventions such as MBCT, CBT, tDCS, and rTMS on pain modulation as evidenced by neuroimaging and validated clinical outcomes.

Background:

Pain related to cancer has a considerable impact on the quality of life due to maladaptive neural phenomena and neuroinflammation. Cognitive therapies such as MBCT and CBT might be the avenues through which pain perception can be altered via neuroplasticity, yet systematic studies are scarce.

Design/Methods:

Adult cancer patients with pain conditions were searched in PubMed, Embase, and Scopus. Included studies investigated cognitive interventions (MBCT, CBT) that were assessed via neuroimaging (fMRI, PET, EEG) or validated outcomes. The risk of bias was assessed using Cochrane and Newcastle-Ottawa, and the certainty of evidence was assessed using GRADE.

Results:

18 studies of 9 RCTs, 3 longitudinal, 4 pilot, and 4 protocol papers revealed maladaptive plasticity, which includes prefrontal cortex atrophy and anterior cingulate hyperactivity associated with chronic pain. Cognitive training and MBCT reduced pain intensity with the enhanced dorsolateral prefrontal activation, while neuromodulation through tDCS and rTMS and melatonin down-regulated descending inhibition. Pain neuroscience education showed stiff UOR. Findings were limited due to small samples and sample heterogeneity.

Conclusions:

Interventions for the treatment of cancer pain may be cognitive and neuromodulatory therapies to target neural plasticity; however, their full potential can be realized only in biomarker-guided longitudinal trials. From these findings, one can make a strong case for multimodal, mechanism-based interventions that carry hope for increasing pain relief and, subsequently, quality of life in cancer patients.