Pain Medicine

Introduction:

The Pain Medicine Section is a division of the Department of Anaesthesia and Intensive Care of the Prince of Wales Hospital.
The service is integrated with other pain services in the NTEC
The Pain Medicine Section team members consist of specialist nurses and anaesthesiologists. Anaesthesiologists were one of the first doctors to treat pain in Hong Kong. They also helped found an international organization called the International Association for the Study of Pain dedicated to pain research and treatment.
The Pain Medicine Section of the Department of Anaesthesia and Intensive Care provides treatment and management of chronic intractable pain conditions, cancer related pain as well as acute traumatic and post -operative pain conditions.

I. Acute Pain Service (APS)

Provides:

1.           Education
2.           introduction and supervision of more advanced analgesic techniques e.g. iv PCA
3.           improvement of traditional analgesic treatment
4.           standardization of equipment, standing order, guidelines, protocol
5.           24-hr availability of pain service personnel
6.           collaboration and communication with other medical staff
7.           audit of pain service
8.           research

Acute pain round:

Every day, patients with advanced analgesic techniques e.g. iv PCA or epidural analgesia are reviewed during acute pain round.

Picture: Acute Pain Round

Picture: Abbott pain manger for patient controlled analgesia

Attachment:

1. Acute pain service guidelines  (file: APS_guidelines )
2. Acute pain guidelines for trauma patient at AED (file: trauma pain guideline )
3. Pain management for multiple rib fracture (file: Rib_fracture_protocol )
4. Protocol for management of unsatisfactory epidural analgesia (file: epidural analgesia )
5. Epidural morphine protocol (file: epidural morphine protocol )

II. Chronic Pain

Chronic pain service caters for patients suffering from chronic pain.

We provide in hospital consultation and multidisciplinary outpatient service, in cooperation with other departments.

1. Outpatient service:

a. Combined Oncology Pain Clinic

We see patients at the Combined Oncology Pain Clinic with oncologist every Monday pm at the Li Ka Shing Outpatient Department in Prince of Wales Hospital. With a multidisciplinary approach, we focus on managing cancer pain patients with pharmacological and interventional approach.

For intractable cancer pain not responsive to traditional pharmacological approach, other methods of delivery like intrathecal pump and various nerve block, like celiac plexus block provides satisfactory pain relief. Optimization of pain control can be achieved to improve quality of life in cancer patients.

Picture : Combined Oncology pain clinic

b. Pain Clinic (PC1) at Multidisciplianry Pain Management Centre at Alice Ho Miu Ling Nethersole Hospital

Patients referred from various specialties are assessed by pain specialists every Tuesday. Some patients are seen at the Multidisciplinary Pain Clinic session by pain specialist, clinical psychologist and pain nurse.
Patients are managed accordingly, with drugs, intervention, psychological intervention or cognitive behavioural therapy.

Picture: AHNH Map (file: AHNH_map )

Picture: Patient education at Pain Clinic at Multidisciplinary Pain Management Centre at AHNH

Picture: Facet joint injection in a patient suffering from chronic low back pain

Comprehensive Out-patient Engagement (COPE) is a cognitive behavioural therapy programmme designed for patients suffering from chronic pain at the Multidisciplinary Pain Centre at Alice Ho Miu Ling Nethersole Hospital.

COPE patient selection meeting

Cognitive therapy

Physiotherapy session

Stretching exercise

COPE patient progress meeting

COPE graduation day

Influence on chronic pain patient

Attachment:

Video session of walking:  Pre- and Post- COPE (AVI File:)

c. Combined Neurosurgery Pain Clinic

We assess patients at Combined Neurosurgery Pain Clinic at Li Ka Shing Outpatient Department in Prince of Wales Hospital with neurosurgeons on alternate Friday.
Most patients suffer from post-trauma and post-surgical pain. Together with neurosurgeon, intervention ranges from intrathecal pump, spinal cord stimulation and surgery are provided for patients.
Patients suffering from back pain are referred to the Neurosurgery Spine Clinic.

Combined Neurosurgery Pain Clinic

Attachment:

1. Back pain algorithm (file: back pain algorithm-final )
2. Protocol for Gabapentin prescription (file: gabapentin protocol )

2. Chronic Pain Round

Chronic Pain Round is conducted every Monday and Friday. Patients are referred from various specialties in the hospital.

III. Training

1. Anaesthesia Pain Trainee

Training Objectives

Acute Pain

• Organization of acute pain service and role of acute pain nurse
•   Pain assessment in various groups of patients
• Physiological changes secondary to pain
• Different modalities of pain control
• Pharmacology and side effects of opioid analgesia and non-opioid analgesia
• Principle of patient-controlled analgesia and assessment of its efficacy
• Pharmacology and side effects of epidural/intra-thecal opioid
• Neurological assessment of epidural blockade and management of failed block
• Management of regional blockade – brachial plexus, para-vertebral and intra-pleural block
• Management of epidural abscess
• Substance abuse and acute pain control
• Pain control in concurrent medical diseases – COAD, IHD, bleeding tendency, geriatric
• Pain control in burns patients
• Pain control in trauma patients included multiple rib fracture

Chronic Pain

• Differentiation of nociceptive pain and neuropathic pain
• Mechanism of chronic pain and role of NMDA receptor
• Different modalities of chronic pain management – physical therapy, psychotherapy, neuro-ablation, neuro-augmentation, spinal opioid, interventional neuro-blockade, non-opioid analgesia
• Anatomy, indication, technique and complication of chemical sympathectomy (lumbar sympathectomy, stellate ganglion block, celiac plexus block)
• Principle of management of cancer pain
• Principle of management of non-cancer neuropathic pain – phantom limb pain, post-herpetic neuralgia, complex regional pain syndrome, trigeminal neuralgia
• Principle of management of non-cancer nociceptive pain – myofascial pain, lower back pain, intractable angina, burns, chronic pancreatitis, PVD
• When to refer to pain medicine specialist and role of pain medicine specialist

2. Diploma of Pain Medicine

There are 2 training post of diploma of Pain Medicine in the NTEC. For details, please refer to HKCA pain website

3. Medical student

Medical students are taught on principles of acute and chronic pain  during acute pain round and lectures.

Attachment:

1. Acute Pain Teaching Material Schedule (file: Pain Nausea and vomiting )
2. Chronic Pain Teaching Part 1 Part 2 (file: Chronic pain_1, Chronic pain_2)

IV. Research:

1. Cost effectiveness of Acute Pain Service

V Staff

Dr Simon Chan (Coordinator Pain Service)
Dr MC Chu
Dr Alice Man
Dr Michelle Cheung
Ms Marlene Ma
Ms Josephine Chen
Ms Wendy Fung

 VI Recent update:

Conference:

A Multidisciplinary Pain Meeting is held on alternate Mondays. Interesting topics and cases in pain are discussed.

 Attachement:

1. Schedule for recent Pain Meeting (file: PWH Combined Pain Meeting)

VII. Publications:;

Attachment (publication.doc)

VIII. Link: