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A 72-year-old female was admitted with severe calciphylaxis-associated bilateral leg pain on a background of end-stage renal failure on hemodialysis. Palliative care input was requested, and following transfer to our unit she was commenced on low-dose methadone as adjunctive analgesic therapy. A remarkable and sustained analgesic response was observed. Calciphylaxis is associated with severe pain, and careful consideration of analgesic agents and their pharmacokinetics in patients with end-stage renal failure is required.

Background: Nausea and vomiting are two interrelated distressing symptoms experienced by patients with malignancies. They are multifactorial in aetiology. Case presentation: A middle-aged woman diagnosed with bilateral ovarian malignancy had undergone chemotherapy and was suffering nausea and vomiting, and was responding to basic therapeutic measures. Case management: She was resistant to treatment with metoclopramide that was commenced by the oncology team, as for any patient with nausea and vomiting. This report examines a ‘mechanistic’ approach to nausea management and life-style modifications. Case outcome: Within 2 days of the evidence-based revision of her management plan, the patient expressed that she had experienced a significant symptomatic relief and an improvement in her general wellbeing. Conclusion: The early identification of the most probable causative factors of nausea and vomiting in patients with advanced malignancies will lead to significant improvements in their quality of life and save time and resources.