What conditions does Dr Ravi Agrawal treat?

Dr Ravi Agrawal treats a wide range of chronic pain conditions including lower back pain, neck pain, sciatica, spinal stenosis, joint pain (hip, knee, shoulder, sacroiliac), neuropathic pain, complex regional pain syndrome (CRPS), fibromyalgia, headaches and migraines, post-surgical pain, cancer-related pain, pelvic and abdominal pain, and post-herpetic neuralgia.

What treatments does a pain medicine specialist offer?

Dr Ravi offers interventional procedures including epidural steroid injections, radiofrequency ablation, nerve blocks, joint injections, spinal cord stimulation, regenerative medicine (PRP), and comprehensive multimodal pain management combining medication, physical therapy, and psychological support.

Do I need a referral to see Dr Agrawal in Fremantle?

Yes, a referral from your General Practitioner (GP) is required to see Dr Ravi. This referral is necessary for Medicare rebates on specialist consultations in Australia. Your GP can fax or email the referral directly to Cygnet Clinic at 109 Marine Terrace, Fremantle WA 6160.

Where is Dr Ravi's pain clinic located in Perth?

Dr Ravi consults at Cygnet Clinic, 109 Marine Terrace, Fremantle WA 6160, serving the Perth metropolitan area and greater Western Australia. The clinic is in central Fremantle with parking available nearby. Phone: (08) 9467 6373.

What is radiofrequency ablation and how long does it last?

Radiofrequency ablation (RFA) is a minimally invasive procedure that uses controlled heat to temporarily disrupt pain-transmitting nerves. It is commonly used for chronic back pain, neck pain, and joint pain. Pain relief typically lasts 6 to 12 months or longer, after which the procedure can be repeated if needed.

What should I bring to my first appointment with Dr Ravi?

Please bring your GP referral, Medicare card, relevant imaging (X-rays, MRI, CT scans), a list of current medications, previous specialist reports, and private health insurance details if applicable. The initial consultation typically takes 45 to 60 minutes.

Does Cygnet Clinic offer telehealth appointments?

Yes, telehealth consultations are available for appropriate cases. A GP referral is still required for Medicare rebates. Contact the clinic at (08) 9467 6373 to discuss whether a telehealth appointment is suitable for your situation.

What are the consultation fees for Dr Ravi?

Initial consultation (MBS Item 2801): $475.00 fee, $148.35 Medicare rebate. Follow-up in-person (MBS Item 2806): $275.00 fee, $74.25 rebate. Follow-up telephone (MBS Item 92759): $275.00 fee, $43.25 rebate. Injections (MBS Item 18242): $200.00 fee, $134.00 rebate. Fees are subject to change and indexation.

Are the pain procedures covered by Medicare?

Many interventional pain procedures attract a Medicare rebate. There may be out-of-pocket costs depending on the procedure and whether it is performed in a hospital or clinic setting. Our reception team will provide a detailed cost estimate before any procedure.

What qualifications does Dr Ravi Agrawal hold?

Dr Ravi Agrawal holds MBBS (Bachelor of Medicine, Bachelor of Surgery), MD (Doctor of Medicine), FCAI (Fellow of the College of Anaesthetists of Ireland), a Diploma in Pain Management from Ireland, a Fellowship in Pain Management from Singapore, and FFPMANZCA (Fellow of the Faculty of Pain Medicine, ANZCA), which is the highest pain medicine qualification in Australia.

What is Freo Pain Doctor?

Freo Pain Doctor manages 1 data type including referral requests. Helps you organize, track, and share your work in 1 place for teams and solo users.

Epidural Steroid Injections for Lower Back Pain and Sciatica: What Perth Patients Need to Know

A detailed guide explaining how epidural steroid injections work, what conditions they treat, what to expect during the procedure, and recovery at Cygnet Clinic, Fremantle.

What Is an Epidural Steroid Injection?

An epidural steroid injection (ESI) is a minimally invasive interventional pain procedure that delivers a combination of corticosteroid and local anaesthetic directly into the epidural space surrounding the spinal nerves. It is one of the most commonly performed interventional pain treatments for radiating spinal pain, particularly when nerve root inflammation causes pain to travel down the leg (sciatica) or arm.

Conditions Treated with Epidural Injections

Dr Ravi Agrawal uses epidural steroid injections at Cygnet Clinic, Fremantle, to treat:

Lumbar radiculopathy (sciatica): Pain radiating from the lower back into the buttock, thigh, and leg, caused by compression or inflammation of a lumbar nerve root, typically from a herniated disc.
Spinal stenosis: Narrowing of the spinal canal that compresses nerves, causing pain, numbness, and weakness that worsens with walking or standing.
Cervical radiculopathy: Pain radiating from the neck into the shoulder, arm, and hand due to a compressed nerve in the cervical spine.
Disc herniation: When the inner gel-like material of a spinal disc protrudes and presses on a nearby nerve root.
Degenerative disc disease: Age-related breakdown of spinal discs that can irritate nerve roots.

How the Procedure Works

The corticosteroid medication (commonly triamcinolone or methylprednisolone) reduces inflammation around the affected nerve root, while the local anaesthetic (such as bupivacaine) provides immediate, short-term pain relief. By reducing the inflammatory cascade around the nerve, the injection can break the cycle of pain and allow the body to heal.

There are three main approaches to an epidural injection, each chosen based on your anatomy and pain source:

Interlaminar epidural: The needle is guided between the bony plates (laminae) of the spine into the posterior epidural space.
Transforaminal epidural: The needle is guided through the intervertebral foramen (the opening where the nerve root exits the spine), delivering medication precisely to the affected nerve root. This is often the preferred technique for unilateral radiculopathy.
Caudal epidural: The needle is inserted through the sacral hiatus at the base of the spine, useful for certain lower lumbar conditions.

What to Expect During the Procedure

All epidural injections performed by Dr Agrawal use real-time fluoroscopic (X-ray) guidance to ensure precise needle placement and maximise safety. Contrast dye may be injected to confirm correct positioning before the medication is delivered.

Before the procedure: You may be asked to temporarily stop blood-thinning medications (such as warfarin or clopidogrel) after consulting your GP. Fasting is usually not required. The procedure is performed as a day case, meaning you go home the same day.

During the procedure: You will lie on an X-ray table, typically face down. The skin is cleansed and local anaesthetic is used to numb the area. Using fluoroscopic guidance, Dr Agrawal advances a fine needle into the epidural space. You may feel some pressure but should not experience significant pain. Once the needle is correctly positioned, the medication is injected. The entire procedure usually takes 15 to 30 minutes.

After the procedure: You will rest in the recovery area for 1 to 2 hours. Your vital signs will be monitored. You may experience temporary numbness or weakness in the legs, which resolves as the local anaesthetic wears off. You should not drive for 24 hours after the procedure and should arrange for someone to take you home.

How Effective Are Epidural Steroid Injections?

Epidural steroid injections are not a cure, but they can provide significant pain relief that allows you to engage in physiotherapy, rehabilitation, and daily activities. Research indicates that approximately 50 to 70 per cent of patients with radicular pain experience meaningful improvement following an epidural injection. The duration of relief varies widely, from several weeks to several months, and the procedure can be repeated if beneficial.

Potential Risks and Side Effects

Epidural steroid injections are generally safe when performed by an experienced specialist using image guidance. Common side effects include:

Temporary soreness at the injection site
Transient increase in pain for 1 to 3 days (a steroid flare)
Temporary numbness or weakness
Minor bruising

Rare but serious complications include infection, bleeding, nerve damage, and allergic reaction to the contrast dye. Dr Agrawal will discuss all risks and benefits with you in detail before the procedure.

Booking an Epidural Injection in Perth

If you are experiencing persistent lower back pain, sciatica, or neck pain with radiating symptoms, ask your GP for a referral to Dr Ravi Agrawal at Cygnet Clinic, 109 Marine Terrace, Fremantle WA 6160. Call (08) 9467 6373 or book online to schedule your consultation.