Metastatic lung cancer in patient with non-malignant neck pain: A case report.

Background Symptoms from disseminated cancer can develop very slowly. This could be very difficult to distinguish those symptoms from chronic disabilities and nuisances in patients with chronic non-malignant pain. Objective In this report, the case of a woman with both nonmalignant pain and cancer is presented. Case report A 54 years old woman was referred by a general practitioner to Multidisciplinary Pain Center. The diagnosis was chronic non-malignant neck pain on the basis of degenerative columnar disease. The patient was also suffering from osteoporosis. During the first visit in the Center, the patient complained of shooting pains in the neck and had tingling sensations in the fingers - most of his right hand. Moreover, the patient experienced shooting pains in the hips, lower back and spine. The multidisciplinary treatment with medication, physical therapy, TENS and cognitive behavioral therapy was offered. Paracetamol together with gabapentin was used. The patient experienced relief of pain. The doses of gabapentin was escalated up to 2400 mg daily without significant side effects. Afterwards, the dose was gradually increased to 3600 mg daily and the patient experienced fatigue, mild headache and dizziness. These symptoms were initially interpreted as side effects of gabapentin. However, the tingling sensations in the fingers were almost disappeared. The doses of gabapentin was reduced, but without relief of symptoms. Within 2 weeks, the patient developed partial paresis of the right upper limb and aphasia. The patient was urgently referred to the neurologic inpatient clinic. CT- and MR-scans showed multiple cerebral metastases. Under the diagnostic workup the lung tumor was found. The biopsy showed pulmonary adenocarcinoma. Conclusions The symptoms of lung cancer with cerebral metastases can mimic side effects of gabapentin.