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.

Fibromyalgia: Understanding and Managing Widespread Chronic Pain

An evidence-based guide to fibromyalgia, its symptoms, diagnosis, and the multimodal treatment approach used at Cygnet Clinic, Fremantle.

What Is Fibromyalgia?

Fibromyalgia is a chronic pain condition characterised by widespread, bilateral pain affecting the muscles, soft tissues, and joints above and below the waist, persisting for more than three months. It is classified as a central sensitisation syndrome, meaning the nervous system becomes amplified in its processing of pain signals, causing normally non-painful stimuli to be experienced as painful.

Fibromyalgia affects approximately 2 to 5 per cent of the population, with women being more commonly diagnosed than men. It frequently coexists with other conditions such as irritable bowel syndrome, chronic fatigue syndrome, migraines, anxiety, and depression.

Common Symptoms of Fibromyalgia

Fibromyalgia is a multisystem condition. While widespread pain is the hallmark symptom, patients typically experience a cluster of associated symptoms:

Widespread pain: A deep, aching, or burning pain affecting both sides of the body, above and below the waist, and including the axial skeleton (neck and back).
Fatigue: Profound, unrefreshing tiredness that is not relieved by rest or sleep.
Sleep disturbance: Difficulty falling asleep, frequent waking, and non-restorative sleep patterns.
Cognitive difficulties (fibro fog): Problems with concentration, memory, and mental clarity.
Heightened sensitivity: Allodynia (pain from non-painful stimuli) and hyperalgesia (amplified pain responses).
Morning stiffness: Particularly in the hands, feet, and spine.
Headaches and migraines: Frequently coexisting with fibromyalgia.
Mood disturbances: Anxiety and depression are common.

How Is Fibromyalgia Diagnosed?

There is no single blood test or scan that diagnoses fibromyalgia. Diagnosis is clinical, based on a thorough history and examination. Dr Agrawal will assess the pattern and duration of your pain, associated symptoms, sleep quality, and impact on daily function. Blood tests may be ordered to exclude other conditions (such as inflammatory arthritis, thyroid dysfunction, or vitamin deficiencies) that can mimic fibromyalgia symptoms.

The key diagnostic criteria include:

Widespread pain on both sides of the body, above and below the waist, for at least three months
The presence of associated symptoms such as fatigue, sleep disturbance, and cognitive difficulties
Exclusion of other conditions that could fully explain the symptoms

Understanding Central Sensitisation

A core concept in understanding fibromyalgia is central sensitisation. In a healthy nervous system, pain signals are transmitted from the site of injury to the brain, where they are processed and perceived. In fibromyalgia, the central nervous system (brain and spinal cord) becomes sensitised, amplifying pain signals and lowering the threshold for pain perception. This means that signals that would normally be experienced as touch or pressure are perceived as painful.

This understanding is important because it means that treatments targeting only the peripheral tissues (such as joint injections alone) are often insufficient. Effective management must also address the central nervous system through medication, psychological strategies, sleep optimisation, and graded activity.

Evidence-Based Treatment Approach

Fibromyalgia requires a multimodal, multidisciplinary approach. No single treatment is effective on its own. Dr Agrawal coordinates care across several domains:

1. Medication Optimisation

Neuromodulatory medications: Pregabalin, gabapentin, and duloxetine have evidence for reducing fibromyalgia pain and improving sleep.
Low-dose antidepressants: Amitriptyline or nortriptyline, taken at night, can improve sleep quality and reduce pain.
Pain management: Paracetamol and certain anti-inflammatories may provide partial relief. Opioids are generally not recommended for fibromyalgia.

2. Physical Rehabilitation

Graded exercise: Gradually increasing aerobic exercise (walking, swimming, cycling) is one of the most evidence-based treatments for fibromyalgia. Starting slowly and building gradually is key, as sudden increases in activity can trigger flare-ups.
Physiotherapy: Tailored programs to improve strength, flexibility, and posture without overexertion.
Pacing: Learning to balance activity and rest to avoid the boom-and-bust cycle that is common in fibromyalgia.

3. Psychological Support

Cognitive behavioural therapy (CBT): Helps identify and change unhelpful thought patterns about pain, improve coping strategies, and reduce the impact of pain on mood and function.
Acceptance and commitment therapy (ACT): Focuses on accepting what cannot be changed (chronic pain) while committing to actions that align with personal values.
Mindfulness-based strategies: Meditation, relaxation techniques, and breathing exercises to reduce the stress response that amplifies pain.

4. Sleep Optimisation

Sleep hygiene education
Treatment of coexisting sleep disorders (such as sleep apnoea or restless legs syndrome)
Cognitive behavioural therapy for insomnia (CBT-I)

5. Interventional Procedures

While fibromyalgia is primarily a central pain condition, many patients also have superimposed peripheral pain generators (such as osteoarthritic joints, trigger points, or nerve entrapments). Targeted injections or nerve blocks for these specific pain sources can reduce the overall pain burden and make the central sensitisation more manageable.

Living Well with Fibromyalgia

Fibromyalgia is a chronic condition, but it is not progressive or life-threatening. With the right combination of treatments, most patients can achieve meaningful improvements in pain, function, and quality of life. The goals of treatment are realistic: not to eliminate pain entirely, but to reduce its intensity, improve sleep and energy, and restore the ability to participate in the activities that matter to you.

If you suspect you may have fibromyalgia, ask your GP for a referral to Dr Ravi Agrawal at Cygnet Clinic, 109 Marine Terrace, Fremantle WA 6160.