# Pain spectrum in immune checkpoint inhibitor-related adverse events: evolution, characteristics and management challenges based on bibliometrics

## TL;DR

This study maps research trends and challenges in managing pain caused by immune checkpoint inhibitors, highlighting the need for better strategies and collaboration.

## Contribution

The paper provides a bibliometric analysis of ICI-related pain research, identifying gaps and future directions for precision pain management.

## Key findings

- Oncology is the core discipline, with U.S. institutions leading research on ICI-related pain.
- Current research focuses on characterizing pain phenotypes and immunological mechanisms of ICI-induced adverse events.
- Developing steroid-sparing strategies and predictive biomarkers is critical for precision pain management in ICI-treated patients.

## Abstract

Immune checkpoint inhibitors (ICIs) have transformed cancer treatment, driving increased research into immune-related adverse events (irAEs), including pain. ICI-induced pain differs from traditional cancer pain or pain caused by chemotherapy or radiotherapy in its mechanisms, manifestations, and management. It often necessitates ICI dose reduction, potentially compromising efficacy, and requires careful balancing of immunosuppression and analgesia. Although glucocorticoids are first line for inflammatory pain, their long-term or high-dose use can attenuate ICI effectiveness, increase infection risk, and lead to pain recurrence after withdrawal—making “steroid-sparing strategies” a central clinical challenge. However, bibliometric studies in this area remain scarce. This analysis of 484 publications examines research trends, advances, characteristics, and management challenges of the pain spectrum in ICI-related irAEs.

A systematic literature search was performed in the Web of Science Core Collection (WoSCC), yielding 484 relevant papers. Visualization and analysis were conducted using VOSviewer and CiteSpace. Collaboration networks, keyword co-occurrence, citation relationships, and citation burst detection were analyzed to identify research structures and current focal points.

Oncology forms the core discipline, with U.S. institutions playing a leading role. International collaboration is vital for advancing the field. Current research focuses on characterizing pain phenotypes across different ICIs and elucidating their potential immunological mechanisms. A major clinical challenge lies in early identification and differentiation of ICI-related pain from tumor- or treatment-related pain. Equally important is balancing rapid irAE control with avoiding the negative impact of prolonged steroid use on pain outcomes. Developing “steroid-sparing strategies” and establishing predictive biomarker systems are essential for achieving precision pain management.

This bibliometric study maps the knowledge landscape and developmental trends of pain in ICI-related adverse events, underscores the need for interdisciplinary collaboration, and highlights future directions for overcoming clinical challenges and advancing individualized, precision-based treatment strategies.

The online version contains supplementary material available at 10.1007/s00520-026-10440-4.