title: Opioid abuse in cancer pain: report of two cases and presentation of an algorithm of multidisciplinary care.
abstract: BACKGROUND
  The growing awareness of opioid abuse and addiction in the chronic pain population, along with increasing cancer survivorship, has heightened our awareness of this potential problem in the cancer patient. An increasing number of patients who abuse opioids have been identified in our clinical setting.
  
  
  OBJECTIVE
  We present an algorithm of multidisciplinary care for the treatment of cancer patients at risk for abusing opioids.
  
  
  METHODS
  Two illustrative patient examples were identified recently from our clinic.
  
  
  RESULTS
  These 2 patient examples demonstrate our multidisciplinary approach to treatment. A discussion of safe prescribing principles adapted from the literature is presented. Also, a brief point of added complexity is introduced; specifically, ethical considerations due to the unique nature of cancer pain.
  
  
  CONCLUSIONS
  Although validation studies exist for the use of screening tools in patients with chronic noncancer pain, there have been no instrument validation studies on patients with cancer pain. The educational treatment model that we refer to regarding facilitating safe use of opioids also has not been studied on patients with cancer pain. Lastly, we express caution in generalizing our guidelines to patients with noncancer pain. Our patient population differs in the multiple co-existing stressors and symptom burden associated with cancer.
  
  
  CONCLUSIONS
  We have become increasingly aware of the problem of opioid abuse in the cancer pain population. With an approach to using safe prescribing principles adapted from chronic pain literature, and an ethically based multidisciplinary approach, clinicians can continue to treat pain successfully in the opioid-misusing cancer patient. We outline our approach in this article.
authors.affiliation: University of Texas, MD Anderson Cancer Center, Dept. of Anesthesiology & Pain Medicine, Unit 409, 1400 Holcombe Blvd, Houston TX 77030-0409, USA. dkoyyala@mdanderson.org
authors.forename: Dhanalakshmi
authors.initials: D
authors.lastname: Koyyalagunta
authors.forename: Allen W
authors.initials: AW
authors.lastname: Burton
authors.forename: Marco Perez
authors.initials: MP
authors.lastname: Toro
authors.forename: Larry
authors.initials: L
authors.lastname: Driver
authors.forename: Diane M
authors.initials: DM
authors.lastname: Novy
mesh_terms: D000465:Algorithms; D000701:Analgesics, Opioid / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009293:Opioid-Related Disorders / Q000175:diagnosis*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D018570:Risk Assessment / Q000379:methods; D015813:Substance Abuse Detection / Q000379:methods*; D011795:Surveys and Questionnaires
chemical_list: D000701:Analgesics, Opioid