Home
About the Department
People
Research
Teaching
Clinical Services
Training Net
News / Announcement
Useful Links
CLINICAL SERVICES
Clinical Anaesthesia
Liver Transplant Anaesthesia
Neuroanaesthesia
Obstetric Anaesthesia
Orthopaedic Anaesthesia
Paediatric Anaesthesia
Perioperative Care
Sedation
Vascular Anaesthesia
Division of Pain Medicine
Division of Pain Medicine
Introduction
The Division of Pain Medicine in Department of Anaesthesiology, Queen Mary Hospital (QMH DA) is responsible for taking care of patients who are suffering from acute, chronic and cancer pain problems. Pain are referred from other medical specialists and health care professionals and seen at inpatient or outpatient clinics.

Structure
Director of Division (HKU and QMH)
Prof. Chi Wai CHEUNG
MBBS, MD, FHKCA, FHKAM(Anaesthesiology), Dip Pain Mgt (HKCA)
Clinical Professor, Department of Anaesthesiology, The University of Hong Kong
Director, Laboratory and Clinical Research Institute for Pain, The University of Hong Kong
Honorary Consultant, Queen Mary Hospital, Grantham Hospital, Duchess of Ken Children Hospital

Adviser
Dr. Siu Lun TSUI
MBBS, MD, FANZCA, FFPMANZCA, FHKAM(Anaesthesiology), FHKCA, Dip Pain Mgt(HKCA)
Consultant Anaesthetist and Advisor in Pain Medicine
Honorary Clinical Associate Professor, Department of Anaesthesiology, The University of Hong Kong

Clinical Director & Supervisor of Training (Pain Fellowship)
Dr. Timmy Chi Wing CHAN
MBBS, FANZCA, FHKCA, FHKAM(Anaesthesiology), FFPMANZCA, Dip of Pain Mgt (HKCA)
Consultant Anaesthetist
Honorary Clinical Associate Professor, Department of Anaesthesiology, The University of Hong Kong

Chronic Pain Coordinator:
Dr. Yu Fai CHUNG
MBBS, FHKCA, FHKAM(Anaesthesiology), Dip of Pain Mgt(HKCA)
Consultant Anaesthetist
Honorary Clinical Assistant Professor, Department of Anaesthesiology, The University of Hong Kong

Acute Pain Coordinator & Paediatric Pain Director
Dr. Janice Lai Ming NG
MBBS, FANZCA, FHKCA, FHKAM(Anaesthesiology), Dip of Pain Mgt(HKCA)
Associate Consultant (Anaesthesiology)
Honorary Clinical Assistant Professor, Department of Anaesthesiology, The University of Hong Kong

Pain Fellowship Trainees
Dr. Carrie Fung Ping WONG
MBBS, M Med Sc(HK), MRCP(UK), FHKCP, FANZCA, FHKCA, FHKAM(Anaesthesiology), FHKAM(Medicine), PDipID(HK), DCH(London)
Associate Consultant (Anaesthesiology)
Honorary Clinical Assistant Professor, Department of Anaesthesiology, The University of Hong Kong

Dr. Stanley Sau Ching WONG
MBBS, FHKCA, FHKAM(Anaesthesiology), FANZCA
Clinical Assistant Professor, Department of Anaesthesiology, The University of Hong Kong
Honorary Associate Consultant(Anaesthesiology), Queen Mary Hospital

Nursing Team
Ms Man Ki TSANG
Advanced Practice Nurse
RN, BN, Advanced Diploma in Anaesthetic and Recovery, Post Registration Certificate Course in Perioperative Nursing

Ms. Yin Shan MAN
Advanced Practice Nurse
RN, BN, Post Registration Certificate Course in Perioperative Nursing

Ms Yan Sin KWOK
Registered Nurse
RN, BN

Clerical Officer
Ms. Phyllis Wing Sheung NG

History
The QMH DA has been providing regular pain management services in QMH since 1990. This is the first formal pain management service in Hong Kong. The scope of services includes acute pain service (APS)—providing postoperative and other acute pain management; as well as chronic or cancer pain management—attending to all in-patient consultations from other specialties (with subsequent follow up care). The first out-patient clinic in pain management was jointly established by Department of Clinical Oncology and Department of Anaesthesiology in 1993. It serves patients with intractable cancer pain. The Division's own Pain Clinic was commenced in 1995 to look after out-patient referrals. In 1997, QMH DA was accredited by the Hong Kong College of Anaesthesiologists and became one of the first training centers of Diploma in Pain Management.

Scope of Clinical Services
Currently, the DA Division of Pain Medicine provides a comprehensive scope of pain management services in the QMH. These include APS, Chronic and Cancer pain management services (CPS).

APS
Our APS focuses on pain management of patients after major operations (more than 3,200 patients were treated in 2010 alone). We also receive other pain consultations to manage patients suffering from thermal injury and traumatic painful conditions (e.g. rib fractures). Analgesic medications, patient-controlled analgesia (PCA), epidural analgesia and nerve/plexus blocks are commonly used. The patients are reviewed daily by anesthesiologists and a pain nurse. A twenty-four hour acute pain service is provided by the Department's Emergency Team. On top of this, a member of the Division of Pain Medicine is designated to provide tertiary consultation on 24 hour basis upon the Emergency Team's request.

The Division offers various protocols for acute pain management and patient monitoring. Because of these, high quality acute pain service could be carried out in different clinical areas e.g. the intensive care unit, high dependency unit and general wards. To ensure quality of care, implementation of APS protocols and patient monitoring are supervised by the Pain Nurse, who conducts a daily ward round with anaesthesiologists, as well as providing regular training to ward nurses.

Chronic Pain Service
Our CPS provides a comprehensive tertiary pain management service to both in-patients and out-patients, who are suffering from cancer pain or chronic (non-cancer) pain. We provide regular out-patient Pain Clinic Sessions, as well as Joint Outpatient Pain Clinic Sessions with the Department of Clinical Oncology (for cancer pain patients). CPS commences as soon as we received referrals from other medical specialties. After thorough patient assessment, we will formulate a pain management plan/schedule which is tailor-made to the patient. Treatment modalities ranging from simple analgesic regimens to more sophisticated therapies are provided. These include interventional pain procedures, cognitive behavioral therapy (the SHINE Program) and other multidisciplinary pain management involving other health care teams.

Multidisciplinary involvement is almost mandatory in modern pain medicine. The Division works in close collaboration with other medical specialists, clinical psychologists, physiotherapists, occupational therapists as well as medical social workers in the Hong Kong West Cluster. We play a coordinating role in this multidisciplinary team so as to provide holistic care to our patients. This is achieved through effective patient referral system as well as interdisciplinary case conferences.

Medical Records and Quality Assurance
All APS and CPS patients, have special medical records, both in hardcopies and electronic copies to ensure accurate documentation of diagnosis, treatment and progress. These records are managed by a designated clerical officer of the Division and strict protocols are in place to ensure patient confidentiality. Medical reports are issued upon request by the patient or other medical teams through proper hospital request channels. Moreover, patient care data are computerized for analysis to allow clinical audit and quality assurance activities.

Training Activities
The Division of Pain Medicine is committed to the training of pain specialists, anaesthetic vocational trainees, pain nurses and medical students. The Hong Kong College of Anaesthesiologists has accredited two training posts for the Diploma in Pain Management since 1997. 26 pain physicians have graduated so far. All of them excel at pain medicine, delivering specialist care to acute, chronic and cancer pain patients. The Division also welcomes overseas clinicians for training in pain medicine. Short term clinical attachment and fellowship appointments up to one year are provided.

Academic Activities
In addition to clinical services, the Division of Pain Medicine also conducts research, in collaboration with the Department of Anaesthesiology, The University of Hong Kong. Numerous original articles, published in international peer-reviewed journals, and two medical textbooks and MD Thesis in pain medicine were harvested from this fertile ground of clinical research.

Academic Output, Division of Pain Medicine, DA QMH

Medical Textbooks
  • A Guide to Pain Medicine, edited by Joseph C.S. Yang and S.L. Tsui, Hong Kong University Press May 2002. ISBN 962 209 544 5.
  • Pain Medicine, a Multidisciplinary Approach, edited by S.L. Tsui, P.P Chen and Jacobus K.F. Ng, Hong Kong University Press August 2010. ISBN 978-988-8028-16-0.
MD Thesis, University of Hong Kong
  • Tsui SL. Postoperative Analgesia in Chinese Patients: An In-depth Analysis of Postoperative Pain Management in the Queen Mary Hospital of Hong Kong (1997).
  • Cheung CW. Role of Dexmedetomidine in Acute Postoperative Pain Management (2011).
Publications in Peer Reviewed Journals
  • Tsui SL, Chan CS, Chan ASH, Wong SJ, Lam CS, Jones RDM. Postoperative analgesia for oesophagectomy: a comparison of three analgesic regimens. Anaesthesia and Intensive Care August 1991; 19: 329-337.
  • Tsui SL, Tong WN, Lam CS, Lo JR, O'Regan AM, Yang JCS. Cancer pain management: a review with reference to recent experience by anaesthesiologists in a teaching hospital in Hong Kong. Acta Anaesthesiologica Sinica 1994; 32:193-201.
  • Tsui SL, Tong WN, Lam CS, Lo JR, O'Regan AM, Yang JCS, Ng KFJ. A Clinical Audit for Postoperative Pain Control on 1443 Surgical Patients. Acta Anaesthesiologica Sinica 1995; 33: 137-48.
  • Tsui SL. Postoperative pain management: an update. The Cutting Edge 1995 (Dec).
  • Irwin MG, Campbell B, Tsui SL, Yang JCS. Patient maintained alfentanil target-controlled infusion for analgesia during extra-corporeal shock wave lithotripsy. Canadian Journal of Anaesthesia 1996; 34(9).
  • Tsui SL, Tong WN, Irwin MG, Ng KFJ, Lo JR, Chan WS, Yang JCS. The efficacy, applicability and side-effect of postoperative intravenous patient-controlled morphine analgesia: an audit of 1233 Chinese patients. Anaesthesia and Intensive Care 1996; 24: 658-664.
  • Tsui SL, Ng KFJ, Chan WS, Chan TY, Lo JR, Yang JCS. Cancer pain management: the experience of 702 consecutive cases in a teaching hospital in Hong Kong. The Hong Kong Medical Journal 1996; 2(4): 405-413.
  • Yang JCS, Ng KFJ, O'Regan AM, Tsui SL, Tong WN. Recent advances in opioid therapy. The Hong Kong Medical Journal 1996; 2(4): 397-400.
  • Tsui SL, Law S, Fok M, Lo JR, Ho E, Yang JCS, Wong J. Postoperative analgesia reduces mortality and morbidity after esophagectomy. The American Journal of Surgery 1997; 173: 472-478.
  • Ng KFJ, Tsui SL, Yang JCS, Ho ETF. Comparison of tramadol versus tramadol/droperidol for patient controlled analgesia. Canadian Journal of Anaesthesia 1997; 44: 810-815.
  • Tsui SL, Irwin MG, Wong MLC, Fung KYS, Hui WCT, Ng KFJ, Chan WS, O'Regan AM. An audit of the safety of an acute pain service. Anaesthesia 1997; 52: 1042-1047.
  • Chan WS, Peh W, Yang JCS, Tsui SL. Computed tomography scan-guided neurolytic superior hypogastric plexus block complicated by somatic nerve damage in a severely kyphoscoliotic patient. Anesthesiology 1997; 86: 1429-1430.
  • Tsui SL, Lee KWD, Ng KFJ, Chan TY, Chan WS, Lo JR. Epidural infusion of bupivacaine 0.0625% plus fentanyl 3.3 µg/ml provides better postoperative analgesia than patient-controlled analgesia intravenous morphine after gynaecological lower abdominal operations. Anaesthesia and Intensive Care 1997; 25: 476-481.
  • Ng KFJ, Tsui SL, Yang JCS, Ho ETF. Increased nausea and dizziness when using tramadol for post-operative patient-controlled analgesia (PCA) compared with morphine after intraoperative loading with morphine. European Journal of anaesthesiology 1998; 15: 565-570.
  • Tsui SL, Ng KFJ, Wong LC, Tang GWK, Pun TC, Yang JCS. Prevention of postoperative nausea and vomiting after gynaecological laparotomy. A comparison of tropisetron and ondansetron. Anaesthesia and Intensive Care 1999, 27:471-476.
  • Ng KF, Tsui SL, Yang CS. Unilateral approach to posterior retrocrural coeliac plexus block. Chin Med J (Engl) 1999 Jan;112(1):89-92.
  • Mak PH, Tsui SL, Ip WY, Irwin MG. Brachial plexus infusion of ropivacaine with patient-controlled supplementation. Canadian Journal Anaesthesia 2000, 47:903-906.
  • Yong BH, Tsui SL, Leung CC, Lo CM, Liu CL, Fan ST, Young C. Management of postoperative analgesia in living liver donors. Transplant Proc. 2000 Nov;32(7):2110.
  • Leung CC, Chan YM, Ngai SW, Ng KF, Tsui SL. Effect of pre-incision skin infiltration on post-hysterectomy pain -- a double-blind randomized controlled trial. Anaesth Intensive Care. 2000 Oct;28(5):510-6.
  • Yang JC, Clark WC, Tsui SL, Ng KF, Clark SB. Preoperative multidimensional affect and pain survey (MAPS) scores predict postcolectomy analgesia requirement. The Clinical Journal of Pain 2000;16:314-320.
  • Mak PH, Tsui SL, Ng KF. Long-term therapy of chronic non-malignant pain with potent opioids in an active police officer. Can J Anaesth 2002 Jun;49(6):575-8.
  • Clark WC, Yang JCS, Tsui SL, Ng KF, Clark SB. Unidimensional pain rating scales: a multidimensional affect and pain survey (MAPS) of what they really measure. Pain 2002;98:241-7.
  • Yuen TS, Ng KF, Tsui SL. Neurolytic celiac plexus block for visceral abdominal malignancy: is prior diagnostic block warranted? Anaesth Intensive Care 2002;30:442-8.
  • Ng KF, Tsui SL, Chan WS. Prevalence of common chronic pain in Hong Kong adults. Clin J Pain. 2002 Sep-Oct;18(5):275-81.
  • Mak PH, Irwin MG, Tsui SL. Functional improvement after physiotherapy with a continuous infusion of local anaesthetics in patients with complex regional pain syndrome. Acta Anaesthesiol Scand 2003 Jan;47(1):94-7.
  • Tsui SL, Yong BH, Ng KFJ, Yuen TST, Li CFC, Chui KY. Delayed epidural catheter removal: the impact of postoperative coagulopathy. Anaesth Intensive Care 2004; 32: 630-636.
  • Ng KFJ, Yuen TS, Ng VM. A comparison of postoperative cognitive function and pain relief with fentanyl or tramadol patient-controlled analgesia. J Clin Anaes 2006 May;18(3):205-10.
  • Wong GT, Yuen VM, Chow BF, Irwin MG. Persistent pain in patients following scoliosis surgery. Eur Spine J 2007 Oct;16(10):1551-6.
  • Cheung CW, Ying CLA, Chiu WK, Wong GTC, Irwin MG. A Comparasion of Intravenous Sedation with Dexmedetomidine and Midazolam for Unilateral Third Molar Extraction under Local Anaesthesia. Anaesthesia 2007 Nov;62(11):1132-8.
  • LH Lee, MG Irwin, TJ Yao, MK Yuen, CW Cheung. Timing of intraoperative parecoxib analgesia in colorectal surgery. Acute Pain 2008; 10:123-130.
  • Kong V, Irwin MG. Gabapentin: a multimodal perioperative drug? Br J Anaesth 2007 Dec; 99(6): 775-86.
  • Kong V, Irwin MG. Adjuvant analgesics in neuropathic pain. Eur J Anaesthl 2009 Feb; 26(2): 96-100.
  • Cheung CW, Ying CLA, Lee LHY, Tsang SF, Tsui SL, Irwin MG. An audit of postoperative intravenous patient-controlled analgesia with morphine: Evolution over the last decade. European Journal of Pain 2009; 13(5): 464-71.
  • Albert Kam Ming, Chi Wai Cheung, Yeow Kuan Chong. Alpha-2 Agonists in Acute Pain Management. Expert Opinion in Pharmacotherapy 2010;11(17):2849-2868.
  • Kwok Bun Chan, Lee Ka Tam, Yu Fai Chung, Chun Yin Wat, Siu Lun Tsui, Chi Wai Cheung. Opioids in Chonic Non-cancer Pain Management. Expert Opinion in Pharmacotherapy 2011 Apr;12(5): 705-20.
  • Chi Wai Cheung, Kwok Fu Jacobus Ng, Wing Shan Choi, Wai Kuen Chiu, Chee Lun Aaron Ying, and Michael Garnet Irwin. Evaluation of the analgesic efficacy of local dexmedetomidine application. Clinical Journal of Pain 2011 Jun; 27(5): 377-82.
  • Chi Wai Cheung, Wing Shan Choi, Yiu Yan Leung, Frances Lui, Jacobus Kwok Fu Ng, Anthony Ming Hei Ho, Michael Garnet Irwin. A double blind randomized crossover study to evaluate the timing of pregabalin for third molar surgery under local anesthesia. Journal of Oral and Maxillofacial Surgery 2012 Jan;70(1):25-30.
  • Chi Wai Cheung, Kwok Fu Jacobus Ng, Jie Liu, Man Ying Vivian Yuen, Ming Hei Anthony Ho, and Michael Garnet Irwin. Analgesic and sedative effects of intranasal dexmedetomidine in third molar surgery under local anaesthesia. British Journal of Anaesthesia 2011 Sep;107(3):430-7.
  • Hung KL, Chan MY, Tai W, Chen YS, Chung SK, Cheung CW. Over-expression of endothelin-1 in astrocytes, but not endothelial cells, ameliorates inflammatory pain response after formalin injection. Life Sciences. 2012 (Accepted for publication).
  • Fu-Yuen Ng, Jacobus Kwok-Fu Ng, Kwong-Yuen Chiu, Chun-Hoi Yan, Chi-Wing Chan. Multimodal periarticular injection Vs continuous femoral nerve block after total knee arthroplasty. The Journal of Arthroplasty. In Press. Online 8 February 2012.
  • Cheung CW. Role of Dexmedetomidine in Acute Postoperative Pain Management (2011).
Recent Presentations in International Congress
  • Cheung CW, Ying CLA, Tsang S, Tsui SL, Irwin MG. An audit of postoperative intravenous patient-controlled analgesia with morphine: improvement over the last decade. New Zealand Anaesthesia ASM 2007. 7th – 9th November 2007.
  • Cheung CW, Chiu WK, Ng KFJ, Wong GTC. The preventive analgesic effect of dexmedetomidine in third molar surgery under general anaesthesia. 12th World Congress on Pain 17th -22nd August 2008 (Poster).
  • Liman S, Cheung CW, Ng KFJ. Serum pro-inflammatory indiced in chronic post-ischemia pain (CPIP) rat model of complex regional pain syndrome (CRPS) type I. The American Society for Clinical Investigation (ASCI)/ The Association of American Physicians (AAP) 2010 Joint Meeting 23rd to 25th April 2010 (Poster).
  • Cheung CW, Liu J, Chiu WK, Ng KFJ, Irwin MG. Analgesic effect of intra-nasal dexmedetomidine in third molar surgery. 13th World Pain Congress, Montreal, Canada, 29th August to 2nd, September, 2010 (Poster)
  • Chi Wai Cheung, Suryamin Liman, Jacobus Kwok Fu Ng. Effect of ketamine on chronic post-ischemia pain (CPIP) model in Sprague-Dawley rats. Combined Scientific Meeting (Australia and New Zealand College of Anaesthetists and Hong Kong College of Anaesthesiologists) 2011. Hong Kong, 14th -17th May 2011. Poster.
  • Victor KL Hung, Ann YC Chen, Samantha MY Chan, Lydia W Tai, Sookja K Chung, and CW Cheung*. Over-expression of endothelin-1 in astrocytes, but not endothelial cells, ameliorates inflammatory pain response after formalin injection. The Twelfth Conference on Endothelin. Cambridge, United Kingdom. 11th – 14th September 2011.
Postoperative Analgesia - Patient Controlled Analgesia (PCA) Machine
Postoperative Analgesia - Infusion Pump for Epidural Analgesia
Postoperative Pain Control - Thoracic Epidural Analgesia
Postoperative Pain Control - Supraclavicular Brachial Plexus Block Infusion
Sphenopalatine Ganglion Block (1)
Sphenopalatine Ganglion Block (2)
Percutaneous Radiofrequency Lesioning of Trigerminal Ganglion (1)
Percutaneous Radiofrequency Lesioning of Trigerminal Ganglion (2)
Percutaneous Radiofrequency Lesioning of Trigerminal Ganglion (3)
Cervical Facet Joint Injection
Lumbar Facet Joint Injection
Two Radiofrequency Lesioning Machines
Percutaneous radiofrequency neurotomy of the lumbar medial branch nerves (1)
Percutaneous radiofrequency neurotomy of the lumbar medial branch nerves (2)
Percutaneous radiofrequency neurotomy of the lumbar medial branch nerves (3)
Cooled Radiofrequency for Sacroiliac Joint Pain
Lumbar Sympathetic Block - Neurolytic (1)
Lumbar Sympathetic Block - Neurolytic (2)
Caudal Epidural Steroid Injection (1)
Caudal Epidural Steroid Injection (2)
Ganglion of Impar Block
Coeliac Plexus Block (1)
Coeliac Plexus Block (2)
Coeliac Plexus Block (3)
Intercostal Nerve Block – Neurolytic
Intrathecal Pump Implantation
Spinal Cord Stimulator Implantation
Cognitive Behaviour Therapy - SHINE Program
Shine Program (1)
Shine Program (2)
Shine Program (3) - Sharing and Goal Setting
Shine Program (4) – Physiotherapy
Shine Program (5)- Occupational Therapy