A team-based approach to effective management of pain and opioid use disorder in patients with cancer: Case report

The recent decline in cancer mortality combined with the surge in cases of opioid use disorder (OUD) has increased the complexity of pain management for long-term cancer survivors. We describe here the case of a 69-year-old man with a history of substance use who was successfully treated for tonsillar cancer in 2010 with no subsequent evidence of disease. The patient experienced long-term functional impairment and chronic pain due to recurrent trismus and diffuse osseous destruction of the left jaw. Pain was effectively managed by the oncology team with hydrocodone/acetaminophen. After nearly a decade, the patient began to demonstrate signs of non-medical opioid use and was diagnosed with OUD. Using a multi-disciplinary approach led by oncology, the patient has been treated for OUD and his pain is effectively managed with buprenorphine/naloxone. This case highlights the need for evidence-based strategies available to oncology to mitigate the risk of OUD while managing cancer-related pain in long-term cancer survivors with a history of substance use.