Lessons from an Ukrainian woman with clubbing and back pain

We present this case that we consider of particular interest in palliative care because of the difficulty we encountered in palliating the patient's symptoms. The difficulties derived, at least in part, from particular personality traits and complex social circumstances. We think this case is an excellent example to demonstrate the complexity of the process of pain and the different resources and techniques that can be used to manage it. We also wish to underline the importance of clinical signs in diagnosis. In fact, this patient showed signs compatible with Pierre-Marie disease (or pulmonary hypertrophic osteoarthropathy, HOA). Finally, we would like to restate a possible link between neoplastic syndromes and the Chernobyl radiation disaster.