Case 17-2015: A 44-Year-Old Woman with Intractable Pain Due to Metastatic Lung Cancer

A 44-year-old woman with metastatic non–small-cell lung carcinoma with an EGFR mutation presented with severe pain, which was worsened by opioids other than hydrocodone and was unresponsive to most other analgesics. Management decisions were made. Presentation of Case Dr. Lecia V. Sequist: A 44-year-old woman with metastatic (stage IV) non–small-cell lung carcinoma was seen in the outpatient cancer center of this hospital because of intractable pain. The patient had been well until approximately 1 year before this evaluation, when pain in her right shoulder and scapula developed, followed by cough and an episode of hemoptysis. A chest radiograph that was obtained at another hospital reportedly showed findings suggestive of pneumonia. Antibiotic agents were administered, but the pain and radiographic abnormalities persisted. Nine months before this evaluation, computed tomography (CT) of the chest revealed an irregular . . .