1. Utilizing a case-based approach, participants will self-report the ability to utilize buprenorphine as an analgesic opioid for complex cancer pain not responding to standard opioid therapy. 2. Utilizing a case-based approach, participants will self-report the ability to integrate buprenorphine microdosing strategy for complex cancer pain in pediatric patients. Pain is a common and distressing symptom of pediatric cancer. Buprenorphine is a high-affinity partial opioid agonist indicated for analgesia and opioid use disorder. Buprenorphine microdosing strategy is considered for patients requiring high opioid doses and at risk of withdrawal. This strategy has not been previously reported in pediatric cancer pain patients. RM is a 17-year-old male (75 kg) with metastatic colorectal carcinoma presenting with uncontrolled abdominal pain and constipation. Prior to hospital admission, RM required escalated doses of extended-release and immediate-release oxycodone. Imaging studies revealed malignant bowel obstruction. Sigmoid colon stent was placed for malignant stenosis. Abdominal pain rated as 10/10 on numeric rating scale (NRS) persisted, requiring hydromorphone infusion. On average, RM required 30-40 milligrams intravenous hydromorphone per day with minimal response. Palliative medicine was consulted. Buprenorphine microdosing strategy was initiated using buccal film preparation at 150 micrograms once on day 1, twice a day on day 2; 300 micrograms twice a day on day 3; buprenorphine sublingual 1 milligram twice a day on day 4; and 2 milligrams twice a day on day 6. RM had better pain relief, mood, and function but started experiencing hand tremors. After a discussion, RM and parents preferred to continue with slow buprenorphine dose escalation. Sublingual dose was further increased to 2 milligrams three times a day, with resolution of hand tremors over the next few days. Significant pain improvement from 10/10 to 2/10 and eventually 0/10 rated on NRS. Hydromorphone PCA was gradually tapered while maintaining buprenorphine sublingual dose at 6 milligrams/day. Buprenorphine has a favorable therapeutic index and side-effect profile compared to full agonists. Microdosing strategy allows patients to be safely transitioned to buprenorphine without precipitating withdrawal. Buprenorphine can be considered for complex cancer pain, poorly responsive to traditional opioids for pediatric patients. [ABSTRACT FROM AUTHOR]