Epidural block and the pain cycle

• Main Authors: Nivedita Page, Vivek Nirabhawane, Ravindra Ghooi
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2016-01-01
• Series: Indian Journal of Pain
• Subjects: Cancer pain; epidural block; morphine; pain cycle
• Online Access: http://www.indianjpain.org/article.asp?issn=0970-5333;year=2016;volume=30;issue=3;spage=209;epage=210;aulast=Page

A 68 year old female with carcinoma vulva, presented with severe unrelenting, burning pain in the vulval region. The pain was not controlled by dispersible Morphine 20 mg q4h, and a dose of 25 mg q4h produced intolerable side effects like nausea, vomiting and drowsiness, without additional pain relief. A ganglion impar could not be done due to altered anatomy. A lumbar epidural block with a catheter to deliver a continuous infusion of 0.125% bupivacaine at 2.0 ml/hour was initiated. She had excellent analgesia and she could be taken off morphine. Her epidural catheter dislodged in 3 days and could not be reinserted immediately. When we started her on morphine, her pain was well controlled with Morphine 5 mg q4h. We propose this increase in sensitivity to morphine to be due to breaking of the pain cycle with the epidural block.