The patient is a 42 year old female with metastatic breast carcinoma with progressive metastatic brain disease requiring prolonged corticosteroid therapy. Her chief complaint was bilateral aching shoulder pain. Past history was also positive for diabetes mellitus, anemia, radical mastectomy, and gamma knife surgery for brain metastases. Medications included decadron, lamotrigine, oxycodone, fentanyl patch, clonazepam, and lorazepam.