Pain management in the opioid-addicted patient with cancer

Two patients with an active or recent history of opioid abuse had painful complications of cancer that required narcotic analgesic therapy. Initial pain management was difficult due to issues of distinguishing tolerance from disease progression, concurrent methadone maintenance, and drug-seeking behavioral patterns. Pain control was achieved with psychological support, medication contracts, and attention to proper dosing of opioids. Suggested guidelines for management of these cases are offered.