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Neuropathic pain in a cancer patient responding to subcutaneously administered lignocaine
J E Devulder1, L Ghys, W Dhondt
1Department of Anesthesia-Section Pain Clinic, University Hospital Gent, Belgium.
Objective:
To demonstrate difficulties encountered in alleviating neuropathic pain in a terminally ill cancer patient, with the very tentative diagnosis of postherpetic neuralgia.
Setting:
A multidisciplinary pain department in a university hospital.
Patients:
A patient with Hodgkin's lymphoma and leiomyosarcoma in the liver developed an unusual manifestation of neuropathic pain.
Intervention:
Oral drug treatment with morphine associated with amitriptyline, valproic acid, mexilitine, flufenazine, and methylprednisolone failed to suppress pain attacks. Only the subcutaneous instillation of lidocaine (2 mg/kg/h) could partially suppress pain. A dorsal root entry zone lesion intervention could only temporary stop the pain attacks. Infiltration and nervous stimulation techniques were not helpful.
Outcome Measures:
In determining pain control, the visual analog scale rating scale and the number of attacks per hour were considered.
Results:
Only the subcutaneous administration of lignocaine could partially suppress pain. Because of the patient's poor hepatic circulation, variable lidocaine plasma concentrations were responsible for intolerable side effects.
Conclusions:
Subcutaneous lignocaine administration remains a useful method in treating neuropathic cancer pain. The poor metabolic condition of the patient can lead to deleterious high plasma levels. A dorsal root entry zone lesion could only temporarily stop the pain.