Navigating cancer pain management in the midst of the opioid epidemic

Cancer pain remains prevalent throughout the course of the disease, and it can be challenging to manage adequately. The challenge is compounded by the current opioid misuse epidemic. Substance use disorders (SUDs), including opioid use disorder, are common in the general population and may be seen with greater frequency in oncology settings. Risk factors contributing to the development of cancer, such as smoking or excessive drinking of alcohol, may place some patients at increased risk for SUDs. Additionally, cancer patients have a higher rate of psychological distress than the general population; psychological distress is an important risk factor for SUDs. Careful assessment of pain, function, and risk factors for SUDs, along with physical examination and review of imaging findings, are strategies to define the etiology of pain and guide development of a treatment plan. Multimodal pain therapies are warranted to reduce reliance solely on opioids, and universal precautions are essential to mitigate risk of misuse. Complex care is required for those with comorbid chronic noncancer pain or with past or current SUDs.