The ultrastructure and synaptic relationships of orexin A-like immunoreactive neuronal fibers in the dorsal horn of the rat cervical spinal cord were examined at both the light and electron microscopic levels. At the light microscopic level, many intensely immunostained orexin A-like fibers were found, while at the electron microscopic level, immunoreactivity in these fibers was mostly confined to axon terminals. Most of the axon terminals contained dense-cored vesicles. Immunoreactive and immunonegative dense-cored vesicles were occasionally found within the same orexin A-like immunoreactive axon terminals, which were often found making synapses with immunonegative dendrites. These synapses were both asymmetric and symmetric, with the asymmetric ones predominant. Orexin A-like immunoreactive processes that contained no synaptic vesicles were also found with less frequency. These processes were also observed receiving synaptic inputs from immunonegative axon terminals, but the synapses were mostly asymmetric. Sometimes, such processes were found to receive multiple synaptic inputs for which the presynaptic immunonegative axon terminals could make synapses on other immunonegative dendrites simultaneously. Occasionally, synapses between the orexin A-like immunoreactive axon terminals and orexin A-like immunoreactive processes containing no synaptic vesicles were also found. The present results provide solid morphological evidence that orexin A may be involved in pain-inhibition mechanisms in the spinal cord and suggest that this function may be complex and occur in conjunction with the regulatory effects of other neurotransmitters.