Differential Diagnosis
- Single most likely diagnosis
- Night pain, particularly pain that wakes the patient from sleep, is often associated with bone metastasis or primary bone tumors. However, given the description of the pain as pressure-like and its alleviation with position change, osteoarthritis or bone cysts could also be considered. But the most fitting diagnosis, considering the nocturnal nature of the pain and its severity, might be Paget's disease of bone, which can cause bone pain that is worse at night.
- Other Likely diagnoses
- Osteonecrosis: This condition can cause severe bone pain, especially at night, and can be related to various factors including trauma, steroids, or alcohol abuse.
- Stress fractures: Although more common in athletes, stress fractures can occur in anyone and might cause nocturnal pain, especially if the fracture is in a weight-bearing bone or if the patient has osteoporosis.
- Bone infections (osteomyelitis): While less common, bone infections can cause severe, persistent pain that worsens at night.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Multiple myeloma: A type of blood cancer that affects bone marrow, leading to bone pain, especially at night, and can be devastating if not diagnosed early.
- Bone metastasis from an unknown primary cancer: Metastatic bone disease from cancers like breast, prostate, lung, or kidney can cause severe nocturnal pain and is critical to diagnose early for appropriate management.
- Osteosarcoma: A rare but aggressive bone cancer that can cause night pain and is crucial to diagnose promptly.
- Rare diagnoses
- Erdheim-Chester disease: A rare form of histiocytosis that can cause bone pain, among other symptoms.
- Langerhans cell histiocytosis: Another rare condition that can lead to bone lesions and pain.
- Gorham-Stout disease: A rare condition characterized by the replacement of bone with lymphatic or vascular tissue, leading to bone pain and other complications.
Each of these diagnoses should be considered in the context of the patient's full medical history, physical examination, and appropriate diagnostic tests to determine the underlying cause of her symptoms. The patient's psychological state, including grief over her daughter's suicide, should also be addressed as part of her comprehensive care.