343 posters, 5 videos, 2 audios, 18 topics, 33 sessions, 263 authors, 202 institutions

24th Annual Pain Medicine Meeting 2025

November 13-15, 2025| JW Marriott Austin, Austin, Texas

2189744

Atypical case of widespread pain due to spinal metastasis from gastrointestinal cancer

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Poster Presenter

Daniel Wang

Authors

Daniel Wang

Affiliations

University of Miami Miller School of Medicine/Health System

Part of Topic

Medically Challenging Cases

An atypical case of widespread pain due to spinal metastasis from gastrointestinal cancer

Daniel Wang, DO¹; Kerstin Yu, MD²; Seyed Ali Mostoufi, MD¹; Diana Molinares, MD¹

¹University of Miami Miller School of Medicine, Miami, FL;

²Georgetown University/MedStar National Rehabilitation Hospital, Washington, DC

Introduction

•Spinal metastases occur in 2-14% of gastrointestinal cancers (GI CA) depending on the specific cancer type (1).

•While back pain is the most common symptom, atypical presentations lead to misdiagnosis (2).

•This case involves a patient with known GI CA with severe generalized pain and weakness that was consistently attributed to cancer fatigue and deconditioning.

•After extensive workup, she was found to have spinal metastasis from metastatic GI CA.

Assessment and Results

Patient:

•41-year-old female with gastric adenocarcinoma and suspected peritoneal carcinomatosis presenting with progressive lower extremity weakness, contractures, and intractable widespread pain

Physical Exam:

•Significant functional deficits: worsening lower extremity (LE) weakness and hypertonia (Modified Ashworth Scale 4 tone in bilateral LEs), hyperreflexia, and positive Babinski sign bilaterally

Hospital Course:

•Neurological symptoms, including oropharyngeal dysphagia, tongue atrophy, and left upper extremity contractures, evolved rapidly over 1–3 months without a clear inciting event.

ØDDX included motor neuron disease, paraneoplastic syndrome, or functional neurological disorder,

•Despite no acute trauma, she continued with uncontrolled back and widespread pain, and developed severe LE contractures and worsening dysphagia, necessitating enteral support.

Imaging:

•MRI of the spine revealed spinal metastases throughout her spine, providing an etiology for her pain and neurological deficits (Figures 1, 2). This, combined with her entire clinical context, prompted a shift in management toward palliative care.

Discussion and Conclusion

•Metastasis of gastrointestinal cancer to the spine is relatively rare and often presents with nonspecific symptoms, making diagnosis challenging (1,2).

•In this case, pain and motor deficits mimicked functional or neurodegenerative disorders, delaying recognition.

•Rapid progression and atypical findings prompted MRI, revealing spinal metastases.

•This underscores the need for early imaging and high suspicion in cancer patients with evolving neurological symptoms.

•Multidisciplinary care is essential for preserving function and improving quality of life.

References

1.Shah LM, Salzman KL. Imaging of spinal metastatic disease. Int J Surg Oncol. 2011;2011:769753.

2.Chaudhry F, Ahmed M, Nadeem M, et al. Functional neurological disorder: A complex diagnosisrequiring a multidisciplinary approach. J Neurol Sci. 2021;428:117621.