Article Text

Download PDFPDF
Deafferentation Pain Exacerbated by Subarachnoid Lidocaine and Relieved by Subarachnoid Morphine: Case Report
  1. Robert P. Iacono, M.D.*,
  2. Mark V. Boswell, M.D., Ph.D. and
  3. Monica Neumann, M.D.
  1. *From the Division of Neurosurgery, Department of Surgery, and Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, California;
  2. Department of Anesthesiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio; and
  3. Department of Anesthesiology, Loma Linda University School of Medicine
  1. Reprint requests: Mark V. Boswell, M.D., Ph.D., Assistant Professor, Department of Anesthesiology, Case Western Reserve University and University Hospitals of Cleveland, 2078 Abington Road, Cleveland, OH 44106.


Background and Objectives. Neuropathic pain syndromes are often resistant to traditional pharmacologic treatment. The authors describe a patient with chronic deafferentation pain of the legs associated with peripheral neuropathy that was refractory to multidisciplinary pain clinic management.

Methods. Numerous medications had been tried, including nortriptyline, mexiletine, and oral and parenteral opioids. Spinal cord stimulation was also ineffective, despite a satisfactory pattern of stimulation-induced paresthesias. For diagnostic purposes, differential spinal anesthesia with lidocaine and morphine was performed, with evoked potential monitoring used to evaluate the intensity of spinal anesthetic block.

Results. Paradoxically, lidocaine spinal anesthesia exacerbated pain, whereas subarachnoid morphine provided rapid pain relief. Longterm pain control has been maintained with an implanted spinal infusion pump.

Conclusions. Evoked potential data acquired during lidocaine spinal anesthesia and the rapid pain relief provided by subarachnoid morphine suggest that deafferentation pain may involve segmental, opioid-sensitive dorsal horn pain generators. The long-term pain relief afforded the patient demonstrates that subarachnoid opioids may be efficacious for some forms of neuropathic pain.

  • neuropathic pain
  • deafferentation
  • spinal anesthesia
  • spinal cord stimulation
  • evoked potentials
  • subarachnoid morphine
  • hydromorphone

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • This work was performed at Loma Linda University School of Medicine.