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Pain Specialists Australia

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Richmond, VIC
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.

23/10/2025

Amputation for CRPS: What This New Study Reveals

Amputation for complex regional pain syndrome (CRPS) is one of the most controversial and emotionally charged decisions in pain medicine. For some people, the pain becomes so unbearable that removing the limb feels like the only way forward. It is a decision born from exhaustion, fear, and hope all at once.

A new long-term study from Erasmus MC in the Netherlands followed 39 patients who underwent amputation for severe, therapy-resistant CRPS. These were individuals who had already tried every available medical, interventional, and psychological treatment.

The results were striking:
• Pain dropped on average by almost 3 points, even years later
• 94% said they were satisfied and would choose amputation again
• Quality of life and function improved, though not for everyone
• Yet phantom and residual limb pain remained common, affecting most patients. The stats were
• 77% limb pain
• 85% phantom pain
• 10% CRPS in stump

The findings remind us that amputation is not a cure, but for some, it can bring a measure of peace and the ability to reclaim parts of life once lost. It remains a true last-resort option, one that must be discussed openly, compassionately, and only in specialised multidisciplinary centres where the emotional, physical, and ethical complexities are fully understood.

At Pain Specialists Australia, we believe this study reinforces the importance of early, structured, specialist care for CRPS, to give patients every chance at recovery before such irreversible decisions are even considered.

How should specialists and patients decide when “enough is enough” in severe CRPS?

https://ow.ly/6BsU50XgCvz

19/10/2025

Persistent abdominal pain when all the tests are normal? You are not imagining it.
Many people live with ongoing abdominal pain despite normal scans and repeated tests. It is not always IBS, and it is not “just stress.” Understanding the cause starts with pattern recognition, not more procedures.

What recent evidence shows
Coffin and Duboc reviewed the many overlooked causes of chronic abdominal pain. Their message is simple: look wider, think carefully, and treat precisely.

Common but missed causes
• Mesenteric panniculitis – inflammation of abdominal fat, sometimes found incidentally but can cause pain, bloating, or nausea.
• Chronic mesenteric ischaemia – cramping pain after meals and weight loss from poor blood flow.
• Median arcuate ligament syndrome – compression of the celiac artery; a diagnosis of exclusion.
• Endometriosis – a major cause of pelvic and abdominal pain in women, even with normal imaging.
• Abdominal wall nerve pain (ACNES) – localised, fingertip-sized pain that worsens when you tense your muscles; confirmed by numbing injection.
• Systemic and genetic conditions – adrenal insufficiency, mast cell activation, hereditary angioedema, Ehlers–Danlos, porphyria.
• Centrally mediated abdominal pain syndrome (CAPS) – when the brain–gut pain pathways become overactive, even without visible disease.

What not to do
Routine adhesiolysis surgery for chronic pain does not work and may worsen long-term outcomes.

PSA view
This is an excellent review that reinforces the need for careful clinical diagnosis, multidisciplinary input, and evidence-based care. At Pain Specialists Australia, we regularly see patients with persistent abdominal pain who have been told “nothing is wrong.” Often, there is and it simply needs the right expertise to uncover it.

Reference
Coffin B, Duboc H. Persistent abdominal pain, differential diagnosis and management.

If your scans were normal but pain persists, which of these patterns sounds most like yours?

https://ow.ly/4pER50Xey0n

16/10/2025

Trigeminal Neuralgia, what should we cover?

We are producing new content across our website, social posts, YouTube videos, and our podcast on trigeminal neuralgia, sometimes called the “suicide disease” because the pain can be overwhelming.

Our aim is clear, practical education that helps people feel informed and supported.

Tell us what to prioritise, diagnosis and mimics, medication choices and side effects, image guided procedures like pulsed RF or radiofrequency, when to consider MVD or radiosurgery with neurosurgical partners, flare planning, sleep and mood, accessing care in Melbourne.

https://ow.ly/2X8950XaRnv

What is the one question you want answered first?

14/10/2025

Do Facet Joint Injections Work? A Melbourne Specialist Guide

Back pain that worsens when you stand, arch, or twist can come from the facet joints, the small joints at the back of the spine. When scans look normal, these joints can still be the culprit, which is why diagnosis matters.

What each injection actually does
• Facet joint injection puts anti-inflammatory medicine near the joint. It can settle a flare so you can move, sleep, and exercise better. It does not “cure” arthritis.
• Medial branch block numbs the tiny nerves that carry pain from the facet joints. Relief during the block tells us the joints are the source.
• Radiofrequency ablation (RFA) is considered when blocks are clearly positive. It switches off the pain-carrying nerves for longer relief that can last many months, and can be repeated if pain returns.

Why diagnosis first
Imaging and symptoms often do not match. Some people have arthritis on MRI with no pain, others have severe pain and a normal scan. Numbing the medial branch nerves is the most reliable way to confirm facet pain and decide if RFA is likely to help.

What some of the evidence says
• In patients carefully selected by dual diagnostic blocks, RFA outperformed steroid facet injections for pain and function at 3, 6, and 12 months.
• A 2024 network meta-analysis found thermal radiofrequency approaches ranked highly for sustained pain and function in lumbar facet joint syndrome, reinforcing the importance of selecting the right patients and technique.
• Not all trials show benefit when selection is loose, which is why structured assessment and blocks come first.

PSA’s view
Facet injections are a helpful short-term tool to calm a flare and get you moving. Medial branch blocks are the key step that tells us if your pain is truly facet-mediated. When blocks are positive, radiofrequency can provide longer-lasting relief, especially when combined with guided physio and gradual activity.

Safety, recovery, and Medicare
These image-guided procedures are low risk in trained hands. Most people resume light activity the same day. In Australia, you usually need a GP or specialist referral to see a pain specialist and access Medicare rebates in accredited facilities.

https://ow.ly/o7kW50XaR5B

Your turn: What is the one question about facet joint injections, medial branch blocks, or radiofrequency you want answered in plain English?

12/10/2025

Neuromodulation After Spine Surgery Explained by a Pain Specialist.

Had spine surgery and still in pain? A pain specialist explains neuromodulation — spinal cord stimulation and targeted drug delivery — who it helps, when it is considered, and why selection matters. This Short is from the full video Secrets to Relieving Chronic Pain After Spine Surgery.

Watch the full video here https://youtu.be/RGLFQYZ7C7I

Get your pain diagnosis here https://painspecialistsaustralia.com.au/contact

09/10/2025

When MVD helps but pain returns, the next step should be guided by evidence, not guesswork.

Microvascular decompression can be life-changing for trigeminal neuralgia, yet a large review of 8,172 patients found that about 10 percent experience recurrence over time. Risk was higher when symptoms were atypical, when a vein or other non-arterial structure was compressing the nerve, and when pain had been present for longer before surgery. This matters because it sets expectations early, and it helps plan a sensible path if pain comes back.

What a stepwise plan can include
• Re-check the diagnosis, confirm the pain distribution and triggers
• Optimise medicines, often carbamazepine or oxcarbazepine first, others as needed
• Consider image-guided procedures, for example radiofrequency rhizotomy, balloon compression, or glycerol rhizotomy
• Radiosurgery may suit selected patients, especially when repeat open surgery is not ideal
• Individualise the plan to your history and goals, not a one-size-fits-all pathway

PSA’s view
At Pain Specialists Australia, we support MVD when indicated, and we prepare patients for the small but real chance of recurrence. If pain returns, we prefer a diagnosis-led, stepwise approach that balances relief, risks and recovery time. Most people do best with careful selection and the least invasive effective option at the right moment.

Reference
Wu J, et al. Recurrence after microvascular decompression for primary trigeminal neuralgia, pooled recurrence around 10 percent, higher with atypical features, non-arterial compression, and longer disease duration. Front Neurol, 2021. PMID: 34659096.

If your facial pain eased by even 30 percent for the next three months, which everyday activity would feel possible again?

https://ow.ly/yKrh50X7EJz

07/10/2025

Trigeminal neuralgia, what good care looks like today

If facial pain turns brushing your teeth, talking, shaving, or sipping a hot drink into something you dread, you are not alone. Trigeminal neuralgia can feel like electric shocks in the face, and it is linked with anxiety, low mood, and loss of confidence. Fast, accurate diagnosis and a clear plan can change daily life.

What best practice looks like
• Careful diagnosis first, using clinical criteria, then MRI with dedicated trigeminal sequences to confirm the cause and guide treatment.
• Start with the right medicines. Carbamazepine or oxcarbazepine are first line. Lamotrigine, gabapentin, pregabalin, baclofen, and botulinum toxin A can be added or substituted when needed.
• Use gabapentinoids wisely. They can help some people, but are often less effective than carbamazepine or oxcarbazepine for classic TN.
• Opioids are rarely helpful for TN flares. Short term, targeted measures under specialist care are safer and more effective.
• When tablets are not enough, consider procedures. Microvascular decompression for classical TN, radiofrequency rhizotomy, balloon compression, glycerol rhizolysis, or stereotactic radiosurgery, chosen to match the diagnosis, health status, and goals.
• Team care matters. Neurology, pain medicine, neurosurgery, nursing, and psychology working together improves safety and outcomes.

PSA’s view
This is a strong, practical pathway that mirrors how we work in Melbourne. We support early specialist assessment, MRI with trigeminal sequences, thoughtful medication trials, and timely referral for the right procedure when needed. The aim is simple, safe eating, confident speaking, and getting back to everyday life.

If trigeminal pain is limiting your day, which outcome would change the next month most for you, pain free eating, brushing, speaking, or stepping outside without fear?

https://ow.ly/GOSX50X6Web

05/10/2025

What’s the difference between Radiofrequency Ablation (RFA) and Pulsed Radiofrequency (PRF) - and which one actually works better for chronic back pain relief?

Watch the full podcast here: https://youtu.be/Fv8CKWbf8sY

In this short video, pain specialists Dr Nick Christelis and Dr Bradley Lewinsohn from Pain Specialists Australia explain how both radiofrequency ablation and pulsed radiofrequency treatments work, when each is used, and what outcomes patients can expect.

Learn how these minimally invasive pain management techniques can target nerves that carry pain from the facet joints, sacroiliac joints, or spinal discs — and how pulsed RF differs from standard nerve ablation by modulating rather than destroying the nerve.

If you’re considering RFA or PRF for chronic pain, this video covers:
• How radiofrequency ablation works
• What pulsed radiofrequency does differently
• Which technique helps most for facet joint pain, radicular pain, or chronic back pain
• What to expect from an interventional pain procedure

30/09/2025

Many people living with chronic pain are prescribed opioids. These medicines can help in certain situations, but they can also affect the body in ways that are less well known.

A large US study using national health survey data found that people taking opioids were more likely to have low testosterone levels compared with those not on opioids. Low testosterone, sometimes called opioid induced androgen deficiency (OPIAD), can cause fatigue, low mood, reduced libido, loss of muscle, and weaker bones.

Opioids affect hormone balance because they act not only on pain pathways but also on the brain centres that control hormone release. Over time, this can reduce the body’s natural production of testosterone. Both men and women can be affected, although symptoms may appear differently.

This does not mean everyone on opioids will develop these problems. Age, other medical conditions, and overall health also play a role. What it does mean is that regular check ups and honest conversations with your pain specialist are important. Blood tests can check hormone levels, and your treatment plan can be adjusted if needed.

The key message is that opioids are not just pain medicines. They can influence your hormones, energy, and wellbeing. A specialist can guide safe management, review your options, and make sure that both your pain and your overall health are looked after.

If you or a loved one is on long term opioids, have you noticed changes in energy, mood, or strength that might be worth raising with your doctor?

https://ow.ly/YGNm50WZKfG

28/09/2025

Living with nerve pain can feel overwhelming. Two of the most commonly prescribed medications are gabapentin and pregabalin. They work in similar ways, but sometimes one provides better relief than the other.

The good news is that if gabapentin doesn’t help enough, or side effects become difficult, your pain specialist may consider switching you to pregabalin - or vice versa. Both are used for nerve-related pain such as sciatica, diabetic neuropathy, or shingles pain.

A recent NHS medicines guide explains that switching between the two drugs is safe when done carefully under medical supervision. Factors such as kidney function, other medications, and the dose you are on all need to be considered. Here is some more info for your perusal: https://ow.ly/smsx50WZKhJ NHS Specialist Pharmacy Service – Switching between gabapentin and pregabalin for neuropathic pain.

This is where having an experienced pain specialist matters. They can assess whether switching could give you more relief, while keeping you safe.

If you’ve tried one of these medications, what was your experience - and did your specialist ever recommend a change?

https://ow.ly/O1pc50WZKca

25/09/2025

Struggling with chronic back pain and unsure which treatment is right for you?

Watch the full episode here: https://ow.ly/oKky50X0MPG

What’s the one back pain treatment you’ve always wondered about, but never had explained properly?

https://ow.ly/Ax1B50X0MPE

23/09/2025

Trigeminal neuralgia (TN) is often called the “suicide disease” because the sudden, electric shock-like facial pain can be so severe it disrupts every part of life. Eating, speaking, even a gentle breeze can trigger agony. For many, medications bring little relief or cause intolerable side effects, leaving surgery as the next step—an option many patients fear.

A major clinical trial published in The Journal of Headache and Pain (Jia et al., 2023) has given new hope. Researchers tested a minimally invasive technique called high-voltage pulsed radiofrequency (PRF) against traditional nerve blocks. In this study of 134 people with TN who did not respond to medication, 73% of those treated with PRF had meaningful pain relief one year later, compared with just 33% in the nerve block group. Remarkably, many patients maintained benefit at two years. Side effects were mild, such as temporary numbness or dizziness, and resolved on their own.

This matters because PRF is not destructive like some surgical options. Instead, it gently “resets” nerve activity, reducing pain without major complications. It could be an important middle path for people stuck between failed drug therapy and invasive surgery.

For families, this study validates the suffering of loved ones and shows that safe, evidence-based alternatives are emerging. While TN remains challenging, research like this is shifting the outlook from despair to possibility.

If you or someone close to you lives with trigeminal neuralgia, what has been the hardest daily challenge, and what has helped most in coping with it?

https://ow.ly/WRrO50WZK4j

Address

Level 4, 600 Victoria Street
Richmond, VIC
3121

Opening Hours

Monday	8:30am - 5pm
Tuesday	8:30am - 5pm
Wednesday	8:30am - 5pm
Thursday	8:30am - 5pm
Friday	8:30am - 5pm

Telephone

+611300798682

Website

https://painspecialistsaustralia.com.au/

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