CASE REPORT

This 65yr old woman with metastatic breast cancer presented with incident type breakthrough pain in the left leg (i.e. pain on weight-bearing / walking). A plain X-ray demonstrated a lytic lesion in the shaft of left femur (Figure 1 a), which was consistent with a bone metastasis from breast cancer. She received a number of interventions, including surgical pinning of the left femur (Figure 1b), radiotherapy to the left femur, intravenous bisphosphonate therapy, and alteration of her rescue medication (“breakthrough medication”); the former interventions resulted in a significant improvement in the frequency / severity of the breakthrough pain episodes, whilst the later intervention allowed her to lead an almost normal lifestyle. She would take the rescue medication whenever she was planning to walk for a long period (i.e. prophylactic usage), and also whenever the pain developed unexpectedly or after minimal exertion.

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