42 year old female with metastatic breast cancer. Diagnosed with bony metastases to thoracic spines 1 and 3, and lumbar spine (L1 with a compression fracture) 2 weeks ago. This patient had undergone chemotherapy and radiation to the left breast after modified radical mastectomy 2 years ago. She was admitted for intractable pain in her spine and burning pain in her left shoulder and forearm, decrease appetite and dehydration. She was started on IV hydration and a Patient Controlled Analgesia (PCA).
She was on Avinza (sustained release morphine) 180 mg/ day, and she used hydromorphone 20 mg every 4 hours for breakthrough pain.