Meta-analysis finds no overall link between chronic pain and cancer mortality but notes potential site-specific risks

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Cancer metastasis reviews Published May 12, 2026 Medically reviewed May 12, 2026 Study authors: Lai Chun Hei, Hefteh Natalia, Kingsford Sophie, La Caze Adam, Sheikh Mahdi, Shrestha Shakti, Parat M… PubMed ↗ DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Note potential site-specific cancer risks with chronic pain but no overall mortality association in this observational meta-analysis.

This systematic review and meta-analysis examined the relationship between chronic pain with minimal or non-inflammatory features and cancer outcomes. The authors analyzed data from 23 studies, comprising 12 prospective and 11 retrospective designs, with 10 studies included in the meta-analysis. The primary outcomes assessed were cancer incidence and mortality, with secondary outcomes including cancer mortality rate ratios and site-specific incidence and mortality for breast, prostate, and lung cancers.

The meta-analysis showed no association between chronic pain and cancer-related mortality, with a hazard ratio of 1.00 and a 95% CI of 0.97-1.04. However, site-specific analyses suggested a potential increase in breast cancer incidence with a standardized incidence ratio of 2.12-4.8 and a potential increase in prostate cancer incidence with a standardized incidence ratio of 1.49-5.59. Additionally, increased lung cancer mortality was associated with chronic pain, showing a mortality rate ratio of 3.09 and a 95% CI of 1.45-6.62.

The authors highlight limitations including reverse causation, confounding factors such as the association between pain and opioid use, and methodological obstacles. High-quality studies that rigorously address reverse causation and confounding are warranted. The review does not support an overall association between chronic pain and increased risk of cancer mortality or incidence, and findings are observational and may be subject to reverse causation and confounding.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

PMID42115445

View Original Abstract ↓

Evidence from experimental studies suggests that pain may influence cancer development. We conducted a systematic review (registration osf.io/ms437) of the epidemiological studies assessing whether chronic pain, with minimal or non-inflammatory features, increases the risk of cancer incidence or mortality. The search used Scopus and Web of Science up to 11/03/2025. Quality assessment used the Newcastle-Ottawa Scale. Study characteristics and outcomes were analysed using narrative synthesis, with random-effects meta-analysis and meta-regression conducted where appropriate. A total of 23 studies (12 prospective, 11 retrospective) met the inclusion criteria, of which six were rated as high quality. The outcome data synthesis indicates a small increase in cancer mortality rate ratios, and a potential increase in a subset of organs. A total of three body site-specific analyses suggest that chronic pain may be associated with higher incidence for breast (SIR 2.12-4.8) and prostate (SIR 1.49-5.59) cancers, and with increased mortality for lung cancer (MRR 3.09, 95% CI 1.45-6.62). Ten studies were included for meta-analysis, including four studies rated as high quality. Meta-analysis of hazard ratios showed no association between cancer-related mortality and pain (HR 1.00, 95% CI 0.97-1.04), with consistent estimates across pain subtypes in meta-regression. Our review and meta-analysis do not support an overall association between chronic pain and increased risk of cancer mortality or incidence and highlight multiple methodological and conceptual obstacles to exploring this relationship, including reverse causation and confounding factors such as pain and opioid use association. High-quality studies that rigorously address reverse causation and confounding are warranted.