Metabolic Modulation for Cancer Pain Relief: A Retrospective Pilot Study.

PURPOSE: Cancer pain, as a common symptom in patients with advanced cancer, seriously affects quality of life. A metabolism-based therapeutic strategy involving glucose metabolic regulation (hereafter pragmatically referred to as Warburg therapy) may offer clinical benefits for cancer pain management. This study aimed to evaluate the analgesic potential of this metabolic modulation strategy in patients with advanced cancer. METHODS: This was a single-institution retrospective pre-post cohort study involving 71 patients with advanced cancer treated with Warburg therapy. The primary endpoint was the change in pain intensity from baseline to the end of treatment, assessed using the Verbal Rating Scale (VRS). Secondary endpoints included changes in opioid consumption, calculated as oral morphine milligram equivalents (MME), and NSAID use. Changes in tumor marker levels and overall survival were analyzed as exploratory outcomes. RESULTS: After treatment, the median VRS pain score decreased from 4 (IQR: 3-4) at baseline to 2 (IQR: 2-4) following the final treatment course (Wilcoxon signed-rank test, p<0.0001), and 80.3% of patients experienced at least a 20% reduction in pain scores. Among the 50 patients receiving opioids before treatment, 10 discontinued opioid use entirely (7 transitioned to celecoxib). Exploratory analyses demonstrated decreases in tumor markers among a subset of patients. CONCLUSION: Warburg therapy significantly improved pain symptoms in patients with advanced cancer and was associated with reduced analgesic medication use in a subset of patients. Exploratory analyses also suggested potential treatment-related changes in selected tumor markers and imaging findings; however, these observations require further validation in prospective studies.