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.

Complex Regional Pain Syndrome (CRPS): Symptoms, Diagnosis, and Treatment

A patient guide to CRPS, a complex chronic pain condition, covering early signs, diagnosis, and the multidisciplinary treatment approach at Cygnet Clinic.

What Is Complex Regional Pain Syndrome?

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that most often affects a limb (arm, leg, hand, or foot) after an injury, surgery, stroke, or heart attack. It is characterised by severe, persistent pain that is disproportionate to the severity of the initial injury. CRPS is relatively rare, but when it occurs, it can be profoundly debilitating.

CRPS was previously known as Reflex Sympathetic Dystrophy (RSD) and is sometimes still referred to by that name. There are two types:

CRPS Type 1: Occurs after an illness or injury that did not directly damage a nerve. This is the more common type, accounting for approximately 90 per cent of cases.
CRPS Type 2: Occurs after a direct, confirmed nerve injury.

Both types share the same symptoms and treatment approach.

What Causes CRPS?

The exact cause of CRPS is not fully understood, but it is believed to involve a malfunction in the central and peripheral nervous systems. After an injury, the inflammatory and nervous system responses that normally promote healing become dysregulated, leading to persistent pain, swelling, and changes in skin temperature and colour.

CRPS can develop after:

Fractures (particularly wrist and ankle fractures)
Sprains and soft tissue injuries
Surgery
Crush injuries
Stroke or heart attack
In some cases, no obvious trigger is identified

Early Signs and Symptoms of CRPS

Early recognition and treatment of CRPS is critical, as outcomes are generally better when treatment begins early. The key signs and symptoms include:

Severe, burning or throbbing pain: Disproportionate to the initial injury, often affecting most of the limb rather than just the injury site.
Sensitivity (allodynia): The affected skin becomes extremely sensitive to touch, even light touch from clothing or a breeze.
Swelling: The affected limb may become swollen and puffy.
Changes in skin temperature: The limb may feel warmer or cooler than the opposite limb.
Changes in skin colour: The skin may appear red, purple, blotchy, or pale.
Changes in skin texture: The skin may become shiny, thin, or excessively sweaty.
Changes in nail and hair growth: Nails may grow faster or slower; hair growth patterns may change.
Joint stiffness and reduced range of motion: Particularly in the fingers and toes.
Muscle weakness and loss of function: Difficulty moving the affected limb.

If you experience these symptoms after an injury or surgery, it is important to seek medical assessment promptly.

How Is CRPS Diagnosed?

There is no single test for CRPS. Diagnosis is based on clinical assessment using the Budapest Criteria, which require:

Continuing pain that is disproportionate to the inciting event
At least one symptom reported in each of four categories: sensory (hyperaesthesia or allodynia), vasomotor (temperature or colour changes), sudomotor/oedema (swelling or sweating changes), and motor/trophic (reduced range of motion, weakness, tremor, or changes in hair, skin, or nails)
At least one sign observed in two or more of these categories at the time of assessment
No other diagnosis that better explains the signs and symptoms

Dr Agrawal will conduct a thorough clinical assessment and may order tests (such as bone scans, nerve conduction studies, or X-rays) to exclude other conditions.

Treatment Approach for CRPS

CRPS requires early, multidisciplinary intervention. The goals of treatment are to reduce pain, restore function, and prevent progression. Treatment is most effective when started within the first few months of symptom onset.

1. Physical and Occupational Therapy

This is the cornerstone of CRPS treatment. Graded, gentle exercises to maintain joint mobility, improve strength, and restore function are essential. A physiotherapist or occupational therapist experienced in CRPS management will design a program that progresses gradually, desensitising the affected limb and rebuilding confidence in movement.

2. Medication

Neuropathic pain medications: Gabapentin, pregabalin, amitriptyline, and duloxetine can help reduce nerve-related pain.
Anti-inflammatories: NSAIDs may help reduce inflammation in early CRPS.
Topical agents: Lidocaine patches or compounded creams for localised pain.
Bisphosphonates: In some cases, these medications (which affect bone metabolism) may be used.

3. Interventional Procedures

Sympathetic nerve blocks: Stellate ganglion blocks (for upper limb CRPS) or lumbar sympathetic blocks (for lower limb CRPS) can provide significant pain relief and improve blood flow to the affected limb. These blocks target the sympathetic nervous system, which is thought to play a role in CRPS.
Spinal cord stimulation: For severe, refractory CRPS that has not responded to other treatments, spinal cord stimulation can be highly effective. A trial period is conducted first, and if successful (at least 50 per cent pain reduction), a permanent device is implanted.
Intrathecal drug delivery: In rare, severe cases, implanted pumps deliver medication directly to the spinal fluid.

4. Psychological Support

Cognitive behavioural therapy (CBT): Helps manage the psychological impact of chronic pain, reduce fear-avoidance behaviour, and improve coping strategies.
Graded motor imagery (GMI): A specialised rehabilitation technique that retrains the brain's representation of the affected limb through a sequence of left/right discrimination, imagined movements, and mirror therapy.

5. Multidisciplinary Coordination

At Cygnet Clinic, Fremantle, Dr Agrawal works closely with physiotherapists, psychologists, and other allied health professionals to provide coordinated, holistic care for CRPS patients. Regular follow-up allows treatment to be adjusted based on your response.

Prognosis and Recovery

With early, appropriate treatment, many CRPS patients experience significant improvement or remission. However, recovery can be slow, taking months rather than weeks. Some patients may have persistent symptoms requiring ongoing management. The key message is that CRPS is treatable, and early intervention gives the best chance of a good outcome.

If you or someone you know is experiencing symptoms of CRPS, ask your GP for a prompt referral to Dr Ravi Agrawal at Cygnet Clinic, 109 Marine Terrace, Fremantle WA 6160.