Pain Management in Malaysia

Modern Pain Management

Relieving pain and suffering of patients perhaps is the most rewarding job for doctors. More so when medicine has advanced into another higher level that allows doctors to have better understanding on the actual cause of pain and to provide a more targeted treatment.

Treatment of complex pain disorder is always challenging as patients present with a wide variety of symptoms. Pain medicine is a specialized branch of medicine which encompasses a multi-disciplinary approach in order to provide a holistic management.

Better understanding and improved therapy for severe difficult pain returns patients to near normal function in their daily life.

About Doctor

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DR. CHEN CHEE KEAN

MD, MMED, FIPP, AM

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Dr. Chen Chee Kean is a consultant anesthesiologist and interventional pain physician practicing in Kuching Specialist Hospital, Malaysia. He obtained his MD from University Malaysia Sarawak in 2002 and subsequently completed Master in Medicine (Anaesthesiology) from University Science Malaysia. He is a Fellow of Interventional Pain Practise of World Institute of Pain, USA after completed his training in pain management in India and passed the fellowship examination in 2012.

Besides providing anaesthetic service to surgical patients, Dr. Chen started to provide pain care to chronic pain patients when he was practising in Sarawak General Hospital, Normah Medical Center, Columbia Asia Puchong since 2010. Dr. Chen is passionate about relieving chronic pain conditions through therapies, which enables early rehabilitation and recovery after injury. His main focus is providing multi-disciplinary pain care for myofascial pain syndrome, spine conditions (neck and back pain), facial pain, headache, joint pain, cancer pain, visceral pain and after surgery pain.

To improve the standard of pain care for patients, Dr. Chen has been active in clinical research and become one of the member of Academy of Medicine Malaysia. He has published more than 20 scientific papers including abstracts in the field of interventional pain management and regional anaesthesiology. He has presented his work and research in conferences both locally and abroad. He is serving as an expert reviewer for international peer reviewed journals, including Indian Journal of Pain and Korean Journal of Pain. Dr. Chen has been very active in local pain community in promoting pain medicine in the region. He has organized various pain management workshops for paramedics and clinicians. He is also a keen facilitator in teaching interventional pain technique in national symposiums and workshops.

Pain Conditions

Headace and Facial Pain Neck Pain Low Back Pain Abdomen Pain Foot Pain Joint Pain Pain Condition

Cluster Headache

  • Strictly one sided, first attack usually at the age of 20 to 40 years old

  • men more common

  • trigger by alcohol or certain medicine (hypertension medicine)

  • Pain comes in cluster, surrounding eyelid, swelling of face around eye region

  • Associate with red eyes, tearing, running nose, blurred vision, flushing face, palpitation and fainting episode.

Migraine

  • Aura (visual, sensory and speech disturbances)

  • One sided, throbbing, pain lasting for hours

  • Associated with photophobia, nausea, vomiting, mood disorders, motion sickness and sensory abnormalities

Single sided headache usually response well to radiofrequency treatment if oral pain relief medication fails to control pain.

Trigeminal Neuralgia

  • Consisted either one or two of the three distribution of Trigeminal nerve. Usually one sided. Excruciating, spontaneous, severe in nature. Facial movement such as chewing, laughing, yawning, coughing are severely affected

  • Radiofrequency treatment of trigeminal nerve is very effective in controlling trigeminal neuralgia pain.

  • Muscle: myofascial pain syndrome of trapezius, scalene, sternocleodomastoid. Muscle tension and pain can be treated with muscle (trigger point) injection and followed by physiotherapy.

  • Facet joint pain, one of the most common cause of neck pain. Head and neck movement is limited. The pain usually never extend beyond shoulder. Treatment of choice radiofrequency of facet joint (medial branch).

  • Disc prolapse: patient usually presents with radicular pain according to level of involving cervical nerve root. Treatment can be either epidural injection of laser shrinkage of the prolapse disc.

Muscle

  • Piriformis muscle pain mimics disc prolapse causing sciatica. Quadratus lumborum and poses muscle pain causing severe pain that patient could not stand straight. Main treatment for muscle pain is to inject local anesthetic in to trigger point and followed by stretch and strengthening exercise.

Facet joint pain

  • Spine movement especially forward and backward bend will be difficult. Patients invariably will describe ‘low back is jammed’. Gold standard of treatment for this condition is radiofrequency of facet joint (medial branch of dorsal rami nerve) with higher than 90% success rate.

Disc origin

  • Radicular pain: Pain is due to compression of nerve root by protruding disc. Patient feels leg pain The pain is felt as travelling down from low back right down to foot and caff. The treatment of choice is laser shrinkage of the protruding disc and nerve root injection.

  • Discogenic pain: Pain is felt only around low back area without travelling down to leg. The back pain increases with sitting or standing too long. The pain is due to local chemical inflammation caused by protruding disc. The treatment is radiofrequency small nerve inside the disc (rami communicans) which is responsible for localised back pain.

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Shoulder

  • Frozen shoulder/ adhesive tendinitis limits shoulder movement among elderly and diabetes mellitus.

  • Osteoarthritis, due to long standing micro-trauma or aging process, commonly happens among middle age or older

  • Supraspinatus tendinitis, usually due to trauma among younger age group.

Hip joint

  • Osteoarthritis is a common cause among elderly.

  • Avascular necrosis among younger age group.

  • Other causes: rheumatoid arthritis, labrium tear, bursitis

Knee joint

  • Osteoarthritis is the most common cause among elderly, overweight people.

  • Epigastric pain due to chronic pancreatitis, cancer of pancreas, gastritis
  • Lower abdominal pain can be due to bladder causes (cancer, infection, inflammation)
  • Pelvic pain most slightly due to repeated urinary tract infection, gynaecology tumour, bladder or prostate tumour

Ischemic means lack of blood flow. It is usually due to diabetes mellitus, arteriosclerosis disease, extreme cold injury (frost bite)

Treatments

  • Conventional: treatment for any pain involving sensory nerve only, such as facet joint, discogenic pain, occipital neuralgia, knee and hip joint, ischemic limb pain, complex regional pain syndrome etc. Conventional RF makes precise lesion in the nerve responsible to the pain.
  • Pulsed: treatment for pain involving nerve which has both sensory and motor components, such as radicular pain, trigeminal neuralgia, shoulder joint pain etc. This method of treatment will interrupt the travelling of pain signal without causing any damage to surrounding tissue.

Treatment for disc prolapse causing radicular pain. Laser is used to reduce disc fragments which bulge out causing nerve root compression, which give rise to radicular pain such as sciatica.

Main treatment for myofascial pain syndrome. It involves both dry and wet needling into trigger point of the involved muscle.

Involving ultrasound or X-Ray guided injection of local anesthetic, anti-inflammatory medication or ‘lubricant’ directly into the painful joint, such as shoulder, hip or knee joints.

This technique serves both diagnostics and therapeutic purposes. At times, the source of pain is not easy to be determined. By decreasing pain more than 50 percent from baseline after nerve injection, source of pain can be determined. Some of the nerve block such as dorsal root ganglion block provide intermediate to long term pain relieving effect as well.

Nerve injection also works very well in nerve entrapment condition, such as meralgia paresthetica, post-surgery abdominal nerve entrapment etc.

Contact

or (Dr. Chen) : +60125255262

KL

KPJ SENTOSA KL SPECIALIST HOSPITAL

Kompleks Damai, 36

Jalan Cemur, 50400

WP Kuala Lumpur, Malaysia

Kuching

KUCHING SPECIALIST HOSPITAL SDN BHD

Lot 18807, Block 11,

Muara Tebas Land District, Jalan Stutong

93350, Kuching, Sarawak, Malaysia