Clinical Crossroads |

A 44-Year-Old Woman With Severe Pain at the End of Life

Kathleen Foley, MD
JAMA. 1999;281(20):1937-1945. doi:10.1001/jama.281.20.1937.
Text Size: A A A
Published online


DR PARKER: Mrs L is a 44-year-old woman admitted to a Boston, Mass, teaching hospital with terminal cancer complicated by severe pain. She lives in the greater Boston area with her husband and has managed care insurance.

Mrs L experienced a flaccid left arm for 5 days prior to admission—the first manifestation of metastatic lung cancer. She also noted some mild weakness in the left leg accompanied by slurred speech and some drooling. There was no associated headache, change in vision, fever, or weight loss. She complained of mild shortness of breath and back pain. Her medical history is complex and notable for a seizure disorder since age 16 years, polycythemia vera, hemiplegic migraine, carcinoid, colitis, pseudotumor cerebri, and distal pancreatectomy for islet cell tumor.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Response


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Causes of sleep disturbance in a specialist palliative care unit. BMJ Support Palliat Care 2014;4 Suppl 1():A56.
Use of ketamine for intractable pain in terminally ill patients. BMJ Support Palliat Care 2014;4 Suppl 1():A77.