Medical decision-making in a patient with a history of cancer and chronic non-malignant pain

The selection of cancer pain treatment modalities depends on careful assessment to establish the pathophysiology of the pain complaint. Treatment may consist of a single modality-e.g., pharmacotherapy-or multiple modalities-e.g., pharmacotherapy, anesthetic intervention, and radiotherapy for bone pain. Cancer patients may present with pain and multiple concomitant medical problems related to their primary neoplastic disease, complications of cancer treatment, or unrelated conditions including preexisting pain of nonmalignant origin. We present the case of a patient with new onset of pain superimposed on chronic nonmalignant pain. This case emphasizes the need for careful assessment and the close cooperation required between the pain consultant and the referring ontology staff to make optimal treatment decisions in the context of a complex medical illness.