Document resource
Pain is among the most common and distressing symptoms experienced by patients with cancer. Opioids remain the cornerstone of cancer-related pain management and, for many patients, represent the only viable option for achieving adequate analgesia. However, their use is also associated with potential complications, including misuse driven by their reinforcing and addictive properties. Emerging evidence suggests that misuse of prescribed opioids is more prevalent than previously recognized; approximately one in five patients receiving opioids for cancer pain may be at risk. Opioid craving, misuse, and use disorder represent points along a single spectrum of complications that could arise from prescribed opioid therapy.Opioids stimulate mu-opioid receptors, triggering the release of neurotransmitters such as dopamine and serotonin within the reward pathway. Over time, this same stimulation leads to activation of the anti-reward pathway, characterized by increased release of corticotropin-releasing factor, noradrenaline, and dynorphin, which contribute to escalating stress and dysphoria. The combined effects of reward-driven pleasure and anti-reward–driven emotional distress can ultimately precipitate opioid craving and its downstream consequences.Management strategies for these opioid-related complications may include pharmacologic interventions such as buprenorphine, methadone, and naltrexone, alongside integration of non-pharmacological strategies during routine opioid therapy. In this presentation, I will provide a brief overview of the role of opioids in cancer pain management and highlight the risks and neurobiological mechanisms underlying misuse of prescribed opioids. I will also discuss practical strategies to help clinicians strike an appropriate balance between optimizing cancer pain control and mitigating nonmedical opioid use.