Pain Specialists Australia

Pain Specialists Australia Pain is the centre of our world because we know it's the centre of yours. We're a pain control clinic staffed by specialists & leaders in pain management.

19/04/2026

Why a "Textbook" X-Ray May Not Explain Persistent Knee Pain

When a surgical recovery doesn't go as planned, it can be incredibly frustrating. If a surgeon confirms the joint replacement is structurally sound, yet burning, sensitivity, or night pain persists, we must look beyond the "structure" to the nervous system.

Why can pain persist when the hardware is fine? The answer often involves clinical processes like nerve sprouting and peripheral sensitization. When a nerve is affected during surgery, the body’s natural response is to initiate a healing process. This can involve neurons "sprouting" new connections. In some cases, if this process becomes uncontrolled, these new nerves can become hypersensitive, potentially turning normal movement or light touch into a pain signal.

"Research suggests that across various surgeries, there can be approximately a one in five risk of developing persistent pain." — Dr. Nick Christelis.

Our latest deep-dive explores this 20% statistic and discusses why the nervous system may remain sensitized after a knee replacement.

The first step toward management is an accurate clinical diagnosis. Watch the full clinical discussion here: https://ow.ly/NBLF50YLvUO

Clinical Resources & Pathways:

Persistent Knee Pain: https://ow.ly/btxe50YLvUM

Osteoarthritis & Management Options: https://ow.ly/YMB950YLvUK

Guide to Genicular Nerve Procedures: https://ow.ly/ol5350YLvUN

Did your knee burn before surgery? This might explain why it still hurts.“The joint is stable. The X-ray looks perfect. ...
02/04/2026

Did your knee burn before surgery? This might explain why it still hurts.

“The joint is stable. The X-ray looks perfect. Everything is fine.”

If you have heard this but your knee is still burning, zapping, or feels like it is in a vice, you are not alone.

Around 1 in 5 people have ongoing pain after knee replacement.

A 2025 study found that if you had burning, tingling, or nerve-type pain before surgery, you are 2.75 times more likely to develop persistent pain afterwards.

Read the study here
https://ow.ly/5b7350YAqq3

Surgery can fix the joint, but it does not always reset the nervous system.

Nerves can remain overactive.
Pain pathways can stay switched on.
The system can remain in a protective high alert state.

Scans show structure.
They do not show nerve sensitivity or how pain is being processed.

Persistent pain after knee replacement is often not just a joint problem.
It is a nervous system problem.

The key step is identifying the true driver of pain.
Because treating the joint and treating the nervous system are not the same.

More on pain after knee replacements here https://ow.ly/fnuw50YAqq2

Find us here https://ow.ly/VuuS50YAqq1

Did you have burning or tingling before your surgery?
What does your pain feel like now?

Why does a “perfect” knee replacement still hurt months later?Is your knee still burning, tight, or zapping at night? Do...
29/03/2026

Why does a “perfect” knee replacement still hurt months later?

Is your knee still burning, tight, or zapping at night? Does your surgeon say the hardware is "textbook” and all is “fine”?

You aren’t imagining the pain. You are not alone.

Up to 1 in 3 people experience persistent pain after a knee replacement. A major 2025 review in the Journal of Pain Research (Banks et al.) highlights a key fact: Often, the issue is not the implant. The issue is the nervous system surrounding the implant. https://ow.ly/jJkx50YAqpx

The Science of "The Alarm System"
The research explains that surgery can sometimes trigger a process called sensitisation. While the "plumbing" (the joint and hardware) may be fixed, the "wiring" (the nerves) can stay in a "protective" high-alert state.
• Peripheral Sensitisation: Small nerves around the knee, such as the saphenous nerve, can become hyperexcitable. This happens due to direct irritation or inflammatory markers.
• Central Sensitisation: Prolonged pain signals can cause spinal neurons and glial cells to stay "on." This essentially re-wires the spinal cord or brain to maintain a state of pain long after healing is complete.
• The Scan Gap: X-rays and scans see bone and metal. They cannot see nerve sensitivity, neuro-immune activation, or pain processing.

Diagnosis Before Treatment The Banks et al. study makes one thing clear: There is no "one size fits all" treatment for post-surgical pain after a knee replacement. Because the cause of this pain is often a mix of nerve injury and sensitisation and even inflammation. The most important step is getting the right diagnosis first.

An expert who can look past the hardware and identify the specific "pain generator" is required.

Only when the driver of the pain is identified can a targeted treatment plan be created. Specialists with FFPMANZCA qualifications are trained to find these biological answers and treat pain holistically. Remember we have to also treat the person that is suffering from the pain.

Pathways to Relief when standard rehab and medications don’t help, targeted options can help quieten the nervous system:
• Genicular Nerve Blocks: To precisely diagnose the source of pain.
• Radiofrequency Ablation (RFA): To desensitise the nerves for 6 to 12 months.
• Neuromodulation: Advanced and more targeted treatments for nerves to interfere with pain signals at the source.

The team at Pain Specialists Australia focuses on moving people from "technically successful" to "clinically restored."

What does your pain feel like right now? Is it burning, a tight band, or sharp zaps? Are you getting pain at night?

https://ow.ly/qiOy50YAqpz

Get a diagnosis https://ow.ly/eVcp50YAqpy

25/03/2026

You’ve had a knee replacement.
The X-ray looks perfect.
The surgeon says everything went well.

So why are you still in pain?

Up to 1 in 5 people experience persistent pain after knee replacement. It often burns, feels sensitive, or is worse at night. Many are told “everything looks fine” but don’t feel fine.

In this episode of The Pain Diaries Podcast, Dr Nick Christelis and Dr Andy Kwok, explain what’s really going on.

In many cases, it’s not the implant. It’s the nerves around the knee.

We break down:
• Why a normal scan does not rule out real pain
• The difference between joint pain and nerve pain after surgery
• Why symptoms like burning, tingling, or pain from light touch occur
• What CRPS is and how it differs
• What actually helps when pain doesn’t settle

If your knee replacement was “successful” but your pain isn’t, this is worth your time.

Watch the Podcast Episode here https://youtu.be/O0sKEEgKJTY

Why does bending or twisting hurt after spinal fusion surgery?Many patients expect that once the bones fuse, the pain sh...
23/03/2026

Why does bending or twisting hurt after spinal fusion surgery?

Many patients expect that once the bones fuse, the pain should disappear.

But some people notice something strange.

They bend forward.
They twist slightly.
Or they try to get out of a chair.

And suddenly there is a sharp pulling pain down the leg or deep in the back.

One possible reason is something called nerve tethering.

After spinal surgery, scar tissue can form around the nerves in the spine. This process is known as epidural fibrosis. While scar tissue itself is normal after surgery, it can sometimes attach to nearby nerve roots.

Normally nerves glide freely when you move your spine.

But if a nerve becomes tethered by scar tissue, movement can stretch or irritate the nerve. That stretching can trigger sharp, electrical, or burning pain when you bend, twist, or change position.

This is one reason why a spinal fusion can look perfect on MRI or X-ray, yet the patient still experiences ongoing nerve pain.

Understanding the biology of pain after spinal surgery is often the key to finding the right treatment pathway.

At Pain Specialists Australia, we frequently see patients who have been told their surgery was technically successful but are still living with persistent pain. In many cases, the problem is not the hardware or fusion, but the way the nervous system is behaving after surgery.

You can read more about persistent pain after spinal fusion here:
https://ow.ly/xGP950YujQs

More information and referral details:
https://ow.ly/5iLi50YujQt

If you have had spinal fusion surgery, do certain movements like bending, twisting, or standing from a chair trigger your pain more than others?

20/03/2026

Why Does Your "Perfect" Knee Replacement Still Hurt?

Is your knee replacement "perfect" on X-ray, but you are still in pain?

If a surgeon says the hardware is fine while you struggle to walk or sleep, the problem is likely the wiring, not the plumbing. Chronic pain after knee replacement affects 1 in 5 patients. The "20% Club" experience is real, and the distress often stems from nerve sensitisation rather than a mechanical failure of the joint.

Watch the full video to discover how we diagnose the true biological cause of post-surgical pain at our Richmond, Heidelberg, and Bayside clinics.

Watch the full video here:https://ow.ly/Jb0e50YsGGz

Key Highlights:
00:00 Why "Perfect" Surgery Still Hurts
00:50 The 20% Club: Validation for Persistent Pain
03:45 Wiring vs. Plumbing: The Biological Cause
05:50 Hidden Nerve Injury in Knee Surgery
13:05 Diagnosis and Treatment Pathways
18:59 Seeking an Expert Second Opinion in Melbourne

Resources & Contact:
Knee Pain Webpage: https://painspecialistsaustralia.com.au/understanding-knee-pain
Chronic Pain After Surgery Blog: https://painspecialistsaustralia.com.au/blog/2024/11/15/why-am-i-still-in-pain-after-surgery-understanding-post-surgical-pain
Get in Touch: https://painspecialistsaustralia.com.au/contact

Why can pain continue even after a successful spinal fusion?Many people assume that if the surgery worked, the pain shou...
18/03/2026

Why can pain continue even after a successful spinal fusion?

Many people assume that if the surgery worked, the pain should disappear.

But spinal fusion only fixes the structure of the spine.
It does not always fix the biology of pain.

After surgery, several things can still drive ongoing pain:

• Nerve sensitisation
If a nerve was compressed or irritated for a long time before surgery, it may remain hypersensitive even after the pressure is removed. The nervous system keeps firing pain signals.

• Scar tissue around nerves
Internal scarring, sometimes called epidural fibrosis, can tether nerve roots and make movement painful.

• Changes in pain signalling
The spinal cord and brain can remain in a heightened “alarm state”, amplifying normal signals into pain.

This is why scans can look stable, the hardware can be perfect, yet the pain persists.

At Pain Specialists Australia, we often explain this difference to patients as the difference between fixing the plumbing and fixing the electricity. Surgery may repair the structure, but the nervous system may still need treatment.

Understanding this difference is often the first step toward finding the right treatment pathway.

If you want to learn more about persistent pain after spinal fusion, we explain the mechanisms and treatment options in detail here:
https://ow.ly/1fI350YujPN

If your scan looks “normal” but your pain is still there, what explanations have you been given so far?

More information and referral details: https://ow.ly/Ef8950YujPJ

Why a “perfect” scan doesn’t always mean a pain-free life. Many people undergo a laminectomy or spinal fusion and are to...
15/03/2026

Why a “perfect” scan doesn’t always mean a pain-free life.

Many people undergo a laminectomy or spinal fusion and are told the surgery was a technical success.

The hardware looks stable.
The bones have healed.
The MRI or X-ray looks “perfect”.

Yet the pain is still there.

For many patients, this creates enormous frustration. You are told everything looks fine, but your body is telling a very different story.

The reason is simple. A scan shows anatomy. It does not show pain biology.

Imaging can show screws, plates and bone healing. What it cannot show is the microscopic environment around your nerves.

Several biological processes can keep pain going after spinal surgery.
Internal scarring
Also called epidural fibrosis, scar tissue can form around nerve roots and tether them to the surgical site. When the spine moves, the nerve cannot glide normally and this can trigger pain.

Nerve sensitisation
If a nerve was compressed for a long time before surgery, the nervous system may remain on high alert. Even after pressure is relieved, pain signalling in the spinal cord can stay switched on.

Adjacent segment stress
When part of the spine is fused, the joints above and below often take on more mechanical load. Over time this can lead to new sources of pain.

This is why understanding pain after spinal surgery requires looking beyond the scan.

The key step is identifying the true pain generator, which means assessing how the nerves and joints are functioning, not just how the bones look on imaging.

Many people living with persistent pain after spine surgery are not “imagining it”. The biology of pain is simply more complex than a picture.

Have you ever been told your scan looks perfect even though the pain is still there?

More info here: https://ow.ly/Sjpv50YujNs
Reach out here: https://ow.ly/8Ojw50YujNt

Coming Soon: Why Does Knee Pain Persist After a “Perfect” Knee Replacement?We are putting the final touches on our next ...
11/03/2026

Coming Soon: Why Does Knee Pain Persist After a “Perfect” Knee Replacement?

We are putting the final touches on our next YouTube video looking at one of the most frustrating experiences patients face after surgery.

Your knee replacement looks perfect on X-ray.
Your surgeon says the operation went well.
But months later the pain is still there.

If this sounds familiar, you are not alone. Around 1 in 5 patients experience chronic pain after knee replacement surgery. This condition is known as chronic post-surgical pain (CPSP) and it is increasingly recognised as a problem of pain biology and nerve signalling, not simply joint mechanics.

Our upcoming video explores exactly why this happens and what can be done about it.

In the meantime, a recent review paper provides an excellent overview of the science behind this condition.

Banks DW, Park H, Oehlermarx W, et al. Chronic Post-Surgical Pain After Hip and Knee Arthroplasty: An Update on Mechanisms, Risk Factors, and Interventional Treatment Modalities. J Pain Res. 2025 Nov 20;18:6205-6219. https://ow.ly/CKae50YsChi

The authors highlight several important themes.

Why pain can persist after joint replacement
• Changes in the way nerves around the joint transmit pain signals
• Central sensitisation, where the nervous system becomes hypersensitive
• Ongoing inflammation and neuro-immune activation
• Pre-existing pain conditions that prime the nervous system

Who may be at higher risk
• Patients with severe pain before surgery
• Anxiety, depression, or pain catastrophising
• Widespread pain conditions such as fibromyalgia
• Surgical and tissue factors affecting nerve pathways

Emerging treatment approaches
• Targeted nerve blocks
• Genicular nerve procedures
• Radiofrequency neurotomy
• Neuromodulation strategies in selected patients

The key message is simple but important.

Persistent pain after joint replacement is real.
And understanding the underlying neurobiology of pain is often the first step toward finding better treatment options.

Our new video breaking this down for patients and families will be released within the next 48 hours.

Check out our YouTube channel here https://ow.ly/8ogj50YsChe

Get in touch here https://ow.ly/UZu050YsChh

In the meantime, if you have experienced pain after a knee replacement, what is the one question you would most like answered about why this happens?

19/01/2026

Trigeminal Neuralgia pain can be invisible on MRI.

Many people with trigeminal neuralgia are told their scan is “normal” or that nothing serious is going on, yet the pain is relentless, debilitating, and life-altering.

In this episode of The Pain Diaries Podcast, pain specialist Dr Nick Christelis speaks with highly experienced neurosurgeon Dr Jeremy Russell about how trigeminal neuralgia is really diagnosed, why MRI reports are often misleading, and why listening to the patient matters more than the scan.

We discuss:
• Why TN is a clinical diagnosis, not a scan diagnosis
• How MRI scans can miss the real cause of facial pain
• When microvascular decompression (MVD) works — and why it sometimes doesn’t
• What “nerve combing” (internal neurolysis) is and when it’s considered
• Other treatment options, including Gamma Knife and balloon compression
• The psychological toll of severe facial pain

If you’re living with facial pain, have been told your MRI is normal, or feel stuck with no clear answers, this conversation may help you understand what to ask next.

▶️ Watch the full episode here: https://youtu.be/LrFqpYPc3xY

14/01/2026

That is the blunt reality check most back pain patients don't expect to hear from a surgeon.

In this episode, Neurosurgeon Dr. Jeremy Russell reveals why he refuses to operate on most back pain cases and why "treating the MRI" instead of the patient is a recipe for disaster.
If you are considering spinal surgery or fusion, you need to hear this first.

WATCH THE FULL EPISODE: https://youtu.be/XZ1L93YtRjY

08/01/2026

⚡️ RFN vs PRF: The Cheat Sheet

Confused by the acronyms? Here is the simple breakdown:

1️⃣ RFN (Radiofrequency Neurotomy): Uses heat to "burn" or lesion the nerve. Great for facet joint pain.
2️⃣ PRF (Pulsed Radiofrequency): Uses energy bursts to "stun" or reset the nerve. Often better for sensitive areas.

Choosing the wrong one is a common reason why treatments fail.

Dr. Anthony Njo and Dr. Nick Christelis explain exactly how to choose the right path in this week's episode of the Pain Diaries Podcast
👇👇👇
https://ow.ly/gOE150XTmWv

Find us here: https://ow.ly/QQ7P50XTmWx

Address

Level 4, 600 Victoria Street
Richmond, VIC
3121

Opening Hours

Monday 8:30am - 5pm
Tuesday 8:30am - 5pm
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Thursday 8:30am - 5pm
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+611300798682

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Pain is the centre of our world because we know it's the centre of yours. We're a pain control clinic staffed by specialists & leaders in pain management.