NEUROPATHIC PAIN IN A CANCER-PATIENT RESPONDING TO SUBCUTANEOUSLY ADMINISTERED LIGNOCAINE

Objective: To demonstrate difficulties encountered in alleviating neur opathic pain in a terminally ill cancer patient, with the very tentati ve diagnosis of postherpetic neuralgia. Setting: A multidisciplinary p ain department in a university hospital Patients: A patient with Hodgk in's lymphoma and leiomyosarcoma in the liver developed an unusual man ifestation of neuropathic pain. Intervention: Oral drug treatment with morphine associated with amitriPtYline, valproic acid, mexilitine, fl ufenazine, and methylprednisolone failed to suppress pain attacks. Onl Y the subcutaneous instillation of lidocaine (2 mg/kg/h) could partial ly suppress pain. A dorsal root entry zone lesion intervention could o nly temporary stop the Pain attacks. Infiltration and nervous stimulat ion techniques were not helpful. Outcome Measures: In determinating pa in control, the visual analog scale rating scale and the number of att acks Per hour were considered. Results: Only the subcutaneous administ ration Of lignocaine could partially suppress pain. Because of the pat ient's Poor hepatic circulation, variable lidocaine plasma concentrati ons were responsible for intolerable side effects. Conclusions: Subcut aneous lignocaine administration remains a useful method in treating n europathic cancer pain. The poor metabolic condition of the patient ca n lead to deleterious high plasma levels. A dorsal root entry zone les ion could only temporarily stop the pain.