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Edited by
Siu Lun TSUI,
Phoon Ping CHEN, and
Kwok Fu Jacobus NG
Pain
Medicine
A Multidisciplinary Approach

Pain Medicine

is book is dedicated to all patients with
acute, chronic or cancer pain,
their families and the health care workers
who assist them in the fight against
this human suffering

Edited by
Siu Lun TSUI
Phoon Ping CHEN
Kwok Fu Jacobus NG
Pain
Medicine
A Multidisciplinary Approach

Hong Kong University Press
14/F Hing Wai Centre
7 Tin Wan Praya Road
Aberdeen
Hong Kong
© Hong Kong University Press 2010
ISBN 978-988-8028-16-0
All rights reserved. No portion of this publication may be reproduced or
transmitted in any form or by any means, electronic or mechanical, including
photocopy, recording, or any information storage or retrieval system, without
prior permission in writing from the publisher.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library.
Secure On-line Ordering
http://www.hkupress.org
Printed and bound by ColorPrint Production Ltd, Hong Kong, China
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Contents
Foreword ix
Joseph Chuan Shih YANG
Preface xi
Siu Lun TSUI
Editors, Contributors & Co-contributors xiii
Section A Scientific Basis of Pain Medicine
Chapter 1 1
Neurobiology and Mechanisms of Pain
Michael G. IRWIN, Gordon T.C. WONG
Chapter 2 9
Psychological Concepts of Pain
Michael K. NICHOLAS
Chapter 3 19
Principles of Pain Assessment and Evaluation Tools
Joanne W.Y. CHUNG
Chapter 4 31
e Clinical Evaluation of Pain
Paul J. WRIGLEY, Philip J. SIDDALL
Chapter 5 49
Epidemiology in Chronic Pain, Gender and Cultural Aspects
Mary CARDOSA, Phoon Ping CHEN
Chapter 6 63
Biostatistics in Pain Medicine
Jacqueline YAP, Tony GIN
Chapter 7 81
Ethics in Pain Medicine
Ramani VIJAYAN
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vi Contents
Section B Common Clinical Pain Conditions
Chapter 8 93
Acute Pain Management
Phoon Ping CHEN, Christopher Ping Wing CHU, Edmond Kin Nam CHUNG
Chapter 9 131
Cancer Pain
Siu Lun TSUI, Chi Wai CHEUNG
Chapter 10 157
Headache
Chi Tim HUNG, Steven H.S. WONG
Chapter 11 187
Orofacial Pain
Chi Tim HUNG, eresa Tak Lai LI
Chapter 12 199
Neck Pain
Ping Hong CHIN
Chapter 13 207
Back Pain
Hau Yan KWOK, Kenneth M.C. CHEUNG
Chapter 14 221
Muscular Pain Conditions
Milton L. COHEN
Chapter 15 235
Neuropathic Pain
Kwok Fu Jacobus NG
Chapter 16 253
Painful Arthritis and Rheumatic Conditions
Chak Sing LAU
Chapter 17 275
Pain Associated with Medical Diseases
Simon K.C. CHAN, Alice K.Y. MAN
Chapter 18 299
Pain in the Older Person
C. Roger GOUCKE
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vii
Contents
Chapter 19 311
Pain in Children and Adolescents
George CHALKIADIS
Section C Pain Pharmacology
Chapter 20 339
Principles of Pharmacological Treatment
Carina Ching Fan LI
Chapter 21 347
Opioid Analgesics
Ming Chi CHU
Chapter 22 367
NSAIDs, COX-2 Inhibitors and Paracetamol
Libby Ha Yun LEE
Chapter 23 379
Antidepressants and Anticonvulsants
Philip Wenn Hsin PENG, Geoff Alexander BELLINGHAM
Chapter 24 393
Other Medications and Adjuvants in Pain Management
Anne Miu Han CHAN
Section D Interventional Procedures in Pain Management
Chapter 25 405
Interventional Procedures in Pain Management: An Overview
Steven H.S. WONG
Chapter 26 419
Peripheral Nerve Blocks
eresa Tak Lai LI
Chapter 27 439
e Sympathetic Chain: Efficacy of Sympathetic Blockade and Sympathectomy
Philip FINCH
Chapter 28 459
Interventional Procedures for Back and Neck Pain
Kai On SUN, Henry Ka Fai TONG
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viii Contents
Chapter 29 473
Neuraxial Analgesia
Kok Eng KHOR
Chapter 30 501
Spinal Cord Stimulation
Tsun Woon LEE
Chapter 31 511
Neurosurgery in Pain Management
Kwan Ngai HUNG
Section E Multidisciplinary Pain Management
Chapter 32 523
Radiotherapy in the Management of Pain in Cancer Patients
Rico K.Y. LIU, Arthur YUE, Gordon K.H. AU
Chapter 33 537
Palliative Care for Patients with Advanced Cancer
Rico K.Y. LIU, Raymond S.K. LO
Chapter 34 547
Acupuncture and Traditional Chinese Medicine
Anne KWAN
Chapter 35 561
Physiotherapy
Anthony W.K. LAU, Leo C.T. CHEUNG
Chapter 36 573
Occupational erapy for Chronic Pain:
Enhancement of the Role of Productivity and Return to Work
Chetwyn C. H. CHAN, Connie Y. Y. SUNG
Chapter 37 581
Psychological management in chronic pain
Peter W.H. LEE, Amy S.M. FUNG
Chapter 38 599
Functional Rehabilitation and Cognitive Behavioural Interventions
Tak Yi CHUI, Michael K. NICHOLAS
Index 621
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e world in the 21st century is shaped by
technological advances and human demands which
inspire new aspirations. People wish not only to
live longer but also better, such that the demand
for and improvement in their quality of life is more
than before a life priority.
Pain is at the centre of suffering. For the patient,
it becomes an unmitigated evil. For the health
care giver, pain relief has been their task since the
beginning of time. Yet, the goal of satisfactory pain
control at times remains elusive.
Pain can be acute or chronic. But unlike most
symptoms, the difference between acute and
chronic pain is more than just chronological; the
mechanisms are also vastly different. Acute pain
with its nociceptive function has a physiological
meaning. It serves as an alarm or warning system
which is fundamental to survival. In this way, pain
is rooted in our body’s defence mechanism and
intimately relates to other functions, such as those
of the autonomic nervous system or gastrointestinal
regulation. Chronic pain, on the other hand, often
loses its protective function and becomes a disease
state. e pain transmission system provides a
high capacity for plastic changes, which through
the effects of humoral messengers and neural
connections affect various organs in different ways.
Given the complexity of the extensive mechanisms
involved, it is only logical that it is often difficult
to deal with pain within any one single medical
specialty. e characteristics of pain transmission
and the perception systems clearly indicate the
need for a holistic approach in treatment. e
human body is too complicated for any individual
branch of medicine to master all the information
and expertise needed to deal with pain. Doctors
are usually trained within set boundaries, and each
specialty and discipline will have its own paradigms.
Different disciplines will exercise their own ways
to influence the specific pain condition. eir
knowledge goes to the depth rather than the width
of the matter. ere is a need to think outside the
box to provide the most appropriate and effective
treatment.
Guidelines to deal with pain need to be established
from specialty to specialty. ere are also other
questions: Can viewpoints about pain differ
significantly between various disciplines? How
can one exploit treatments offered by those whose
training is other than one’s own? Would a more
targeted therapy be achieved by referring patients
to other specialties? e answers to these problems
lie in multidisciplinary pain medicine. ey are
embedded in this comprehensive book which is
edited by Drs. Siu-lun Tsui, Phoon-ping Chen and
Kwok-fu Jacobus Ng.
Pain Medicine: A Multidisciplinary Approach can
be read not only to know more about one’s own
specialty, but also to learn how other disciplines deal
with the problems of pain. It can thus encourage
dialogue between the specialties. While the book
is directed toward practitioners managing pain
patients, it provides a valuable resource to those in
training. It offers all the opportunity to discover
new horizons in dealing with the oldest affliction
of mankind.
Foreword
Joseph C.S. Yang
MD, Dip Am Board (Anesthesia & Pain Management), FFARCSI, FHKCA, FHKAM, Dip Pain Mgt (HK)
Adjunct Professor of Anesthesiology, Columbia University, USA
Former Professor and Head, Department of Anaesthesiology, e University of Hong Kong
Former Chairman, Pain Management Committee, Hong Kong College of Anaesthesiologists
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