Pain Management in Malaysia

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Indications for Pain Specialist referral

  • Current pain treatment is not effective
  • Patient who suffers from side effect of oral analgesia
  • Patient who does not want operation
  • Patient who is still having pain even after surgery (Post-Surgical Pain)
  • Patient who wants second opinion/ alternative

Anti-neuropathic medications (Gabapentin, Pregabalin)

Even when the pain is controlled, if patients are suffering from side-effects of medications, e.g.: dizziness, somnolence, which prevent them from normal daily activity, interventional pain treatment, such as radiofrequency (RF) treatment should be offered to patients.

Case sharing

28 years old female lawyer, diagnosed to have right Trigeminal Neuralgia (V2 and V3) by neurologist. She was prescribed Pregabalin 75mg on morning and 150mg on night. Pain was well controlled with occasional break through pain after 3 months oral intake of pregabalin. However, patients having difficulty in focusing at work, sleepiness in daytime until medical leave was required as frequent mistake was make during work. This patient was treated with RF trigeminal ganglion. She is pain free and back to work until now.


Neck Pain

Over 70% of neck pain origins from cervical facet and muscle, even in the presents of disc prolapse in cervical MRI.

Cervical facet pain: neck movement (neck movements turning to sides, left or right will be restricted due to pain, tenderness at facet area during palpation of spine).

Trapezius muscle (upper) is commonly accompanied with cervical facet pain and is effectively treated with trigger point injection.


Low Back Pain
Lumbar facet joint pain (most common)

History: low back stiffness during morning, pain during change of low back movement (sit to stand, ask patient to bend forward, backward and sideways with 2 hangs on the waits), pain usually never extend beyond popliteal fossa.

Physical Exam: Tenderness at facet area during palpation of spine.


Lumbar disc problem

Pain comes after sit or stand too long (discogenic pain)

Physical exam: positive straight leg test, tenderness at spinous process (middle of spine)


Palliative Care

Cancer of abdominal and pelvic origin, radiofrequency treatment or chemical neurolyisis will improve quality of life, when all other measures fail


Scientific Publications
  1. Chen Chee Kean, Nizar AJ. Myofascial pain syndrome in chronic back pain patients. The Korean Journal of Pain 2011; 24; (2): 100-104. [Impact Factor (2010): 0.161]
  2. Chen Chee Kean, Phui VE. The efficacy of ultrasound-guided oblique subcostal transversus abdominis plane block in patients undergoing open cholecystectomy. South Africa Journal of Anaesthesiology and Analgesia 2011; 17(4):308-310. [Impact factor (2010): 0.087]
  3. Chen Chee Kean, Phui VE, Saman MA. Alcohol neurolysis of lateral femoral cutaneous nerve for recurrent meralgia paresthetica. The Journal of Turkish Society of Algology (Agri) 2012; 24(1):42-44. [Impact Factor (2011): 0.327]
  4. Chen Chee Kean, Nizar AJ. Prevalence of piriformis syndrome in chronic low back pain patients. A clinical diagnosis using modified FAIR test. Pain Practice (United State of America) 2013; 13(4): 276-81. [Impact Factor (2011): 2.207]
  5. Chee Kean Chen, Peter CS Tan, VuiEng Phui, ShuChing Teo. The Efficacy of Oblique Subcostal Transversus Abdominis Plane Block in Laparascopic Cholecystectomy. A Randomized Controlled Trial. Korean Journal of Anesthesiology 2013; 64: 511-6. [Impact Factor: 0.131]
  6. Chen Chee Kean, Phui VE, Nizar AJ, Yeo SN. Percutaneous T2 and T3 Radiofrequency Sympathectomy for Complex Regional Pain Syndrome secondary to Brachial Plexus Injury: A Case Series. The Korean Journal of Pain 2013; 26: 401-5. [Impact Factor (2012): 0.276]
  7. Chee Kean Chen, Shu Ching Teo, Vui Eng Phui, Mat Ariffin Saman. Analgesic Efficacy of Transversus Abdominis Plane Block for Neonate and Early Infant undergoing Colostomy and reversal of Colostomy. The Journal of Turkish Society of Algology (Agri) 2015; 27(4):210–214.
  8. Chee Kean Chen, Francis CS Lau, Woo Guan Lee, Vui Eng Phui. Levobupivacaine vs racemic bupivacaine in spinal anesthesia for sequential bilateral total knee arthroplasty: retrospective cohort study. Journal of Clinical Anesthesia 2016; 33, 75-80.
  9. Vui Eng Phui, Clare Hui Hong Tan, Chee Kean Chen, et al. Causative organisms and outcomes of peritoneal dialysis-related peritonitis in Sarawak General Hospital, Kuching, Malaysia: a 3-year analysis. Renal Replacement Therapy 2017; 3(35):1-7.
  10. Olav Rohof, Chee Kean Chen. The response of radiofrequency neurotomy of medial branches including a bipolar system for thoracic facet joints. Scandinavian Journal of Pain 2018; 18(4):747-753.
  11. Chee Kean Chen, Chung Chek Wong, Yian Yong Teo, Vui Eng Phui. Single entry posterior parasagittal approach radiofrequency neurotomy of cervical medial branch. A feasible alternative to conventional approaches in the treatment of cervical facet pain. International Journal of Spine Surgery. To be published in May 2021.