887 - Missed Metastatic Breast Cancer in the “Chronic Pain” Patient: A Case Report.

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

JD

Julia DiSpirito, BS

Medical Student
Albany Medical College
Cumberland, Rhode Island, United States

Co-Author(s)

DH

Douglas Hunter, MD

Resident Physician
Albany Medical College
Albany, New York, United States
BN

Briana Novello, DO

Attending Physician
Albany Medical Center
Albany, New York, United States

Case Diagnosis: Ductal carcinoma of breast origin with humeral metastases.

Case Description: A 62-year-old female was referred to the PM&R Pain Management clinic for “chronic CRPS and adhesive capsulitis.” She had a history of right shoulder CRPS 30 years ago, treated with sympathetic blocks, and, several years later, adhesive capsulitis, both of which had resolved without further recurrence. In 2015, she was diagnosed with breast cancer, treated with chemotherapy and bilateral mastectomy, and was in remission. At her presentation, she reported 5 months of worsening shoulder pain and paresthesia. She had been evaluated by several specialists with "negative” x-ray imaging and a physical examination limited by pain. She failed NSAIDS and was unable to tolerate physical therapy. On our evaluation, her history and physical was inconsistent with CRPS or cervical spine impingement. Non-contrast MRI revealed a large humeral head lesion with biopsy confirmed metastatic ductal carcinoma of breast origin, prompting urgent surgical resection of the shaft and proximal humerus.

Discussions: This case highlights the importance of maintaining a broad differential diagnosis when investigating newer onset or recurrent pain in patients suffering from chronic pain. It highlights the importance of continuity of care to ensure prompt workup and management when conservative measures are unsuccessful. The case emphasizes the importance of recognition of implicit bias when managing patients suffering from chronic pain.

Conclusions: Previous diagnoses of chronic pain disorders may steer the direction of clinical management and result in delay of care. Physicians should aim to avoid implicit bias when evaluating patients with chronic pain complaints.