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Pain Specialists Australia

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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.

30/11/2025

CRPS and the Budapest Criteria: Getting the Diagnosis Right Matters

CRPS is already a life changing diagnosis. Getting it wrong makes things worse.

The original IASP criteria were very sensitive, they picked up almost everyone with CRPS, but they were not specific. Too many people with other neuropathic pain conditions were being labelled as CRPS, which meant confusion, wrong expectations and sometimes inappropriate procedures.

Harden and colleagues tested new diagnostic rules called the Budapest Criteria in people with confirmed CRPS and people with other limb neuropathic pain. The Budapest clinical criteria kept almost perfect sensitivity (0.99), but significantly improved specificity compared with the old IASP criteria. In simple terms, they were much better at separating “true CRPS” from “other nerve pain” while still missing almost no real cases.

At Pain Specialists Australia, we support using the Budapest Criteria, together with careful specialist assessment, to avoid both overdiagnosis and missed diagnosis. CRPS needs to be recognised early and correctly, so that people are offered the right mix of medical, interventional, physical and psychological care.

If you have ongoing limb pain after an injury or surgery, how confident are you that your diagnosis truly fits what you are living with?

Get Your Diagnosis https://ow.ly/ojJA50XzwGt

27/11/2025

Electric shocks in the face, but the dentist cannot find anything wrong?

Sharp, stabbing pain on one side that feels like a live wire?
These are classic warning signs that the problem may be trigeminal neuralgia, not a tooth.

Trigeminal neuralgia (TN) is one of the most misdiagnosed pain conditions. Many people spend months or years in dental chairs, ENT clinics or on antibiotics, when the real issue is a nerve disorder.

In this video, pain specialist Dr Nick Christelis explains the 4 key signs that help distinguish trigeminal neuralgia from tooth pain, TMJ problems and other causes of facial pain.

This clip is taken from our full episode, where he covers:
• what trigeminal neuralgia actually is
• why it causes sudden, electric shock pain
• the four main TN categories
• a simple 4-point checklist to recognise TN early
• how to separate TN from dental or TMJ pain
• when you need an MRI and what it should look for
• red flags that need urgent review
• who diagnoses and treats trigeminal neuralgia
• treatment pathways in Australia

If you have been searching terms like “electric shock pain in face”, “tooth pain but dentist says nothing is wrong”, or “jaw pain one side”, this may finally help you make sense of what is going on.

Watch the full episode here: https://youtu.be/zDW-d1cYJyE

25/11/2025

Electric shocks in your face?
Before you blame your teeth, hear this.

A huge number of people with trigeminal neuralgia spend months or years chasing dental answers that never fix the pain.

Our new video breaks down the 4 signs that separate nerve pain from tooth pain, and why getting this wrong delays the right diagnosis.

If you’ve had:
• sudden electric pain on one side of your face
• pain triggered by brushing, chewing or talking
• normal dental scans
• pain that disappears between attacks

This video could finally make sense of it.

Coming Friday 28 November 2025.

Subscribe on YouTube so it lands straight in your feed:
https://ow.ly/qfLG50XwzgE

23/11/2025

Phentolamine and Chronic Pain: Why Scientists Are Paying Attention

Phentolamine is an old medication mainly used for blood pressure issues and reversing dental anaesthetic. But new research suggests it may have an unexpected effect on the nerves that drive chronic pain.

Your body has different pain fibres.
A-delta fibres carry sharp, quick pain.
C-fibres carry slow, burning, ongoing pain, the type that becomes overwhelming when it never stops.

The study looked at nerve tissue from mice, pigs and humans. Across every species, phentolamine reduced activity in C-fibres far more than A-delta fibres. The higher the dose, the more these slow pain signals dropped.

The researchers also used mice that lacked two sodium channels, NaV1.8 and NaV1.9. These channels help nerves fire. Without them, C-fibres became less sensitive to phentolamine. Patch clamp tests confirmed the reason. Phentolamine blocks sodium channels, especially NaV1.8, which is heavily found on C-fibres.

What does this mean for people with chronic pain?

It suggests phentolamine is doing more than blocking adrenaline receptors. It may be directly calming the very fibres that produce burning, ongoing pain. Current pain medicines often affect the whole nervous system, which can lead to tiredness or brain fog. A treatment that targets only the fibres responsible for chronic pain would be a major step forward.

Phentolamine is not a chronic pain treatment yet, but this research points toward future medicines designed to block C-fibres more precisely. For people living with neuropathic pain, burning pain or chronic itch, that is a promising direction.

PSA’s view
This type of research matters. Targeted C-fibre drugs could change how we treat nerve pain. It is early, but it moves us toward treatments that calm the right nerves without unwanted side effects.

If you live with nerve-related pain, what change in your symptoms would matter most to you?

https://ow.ly/CpGP50Xwz2c

20/11/2025

Pulsed Radiofrequency for Morton’s Neuroma. What This New Study Shows

Morton’s neuroma can feel like walking on a pebble or hot wire in the foot. When footwear changes, physio and injections stop helping, many people are left thinking surgery is the only option.

A new 2025 prospective study in Pain Physician followed patients who had ultrasound guided pulsed radiofrequency (PRF) of the interdigital nerve. The results were striking.

• Significant pain reduction at 1, 3 and 6 months
• Better foot function scores and walking tolerance
• Improved overall quality of life
• No major complications reported
• All procedures were performed under ultrasound in a one-needle, targeted approach

Why this matters.
Morton’s neuroma is often treated as a simple foot problem, but for many it becomes a nerve pain condition. PRF offers a minimally invasive, nerve targeted option before committing to surgery. It does not destroy the nerve. Instead, it modulates pain signalling, which may explain why many patients improve without the risks of full ablation.

Pain Specialists Australia’s view: This is encouraging evidence and reflects what we see clinically. For the right patient and the right neuroma size, ultrasound guided PRF can bridge the gap between repeated injections and irreversible surgery. As always, precision and patient selection matter.

If you have forefoot nerve pain that has not improved with standard care, this may be worth discussing with your specialist.

https://ow.ly/yq2y50Xtkms

What would you want your clinician to explain more clearly about treatment options for Morton’s neuroma?

18/11/2025

JAK Inhibitors and Shingles Risk. What This New Study Really Shows

JAK inhibitors have transformed treatment for inflammatory conditions like rheumatoid arthritis, Crohn’s disease, ankylosing spondylitis, psoriasis and psoriatic arthritis. They work fast and they work well, but patients often ask the same question. “Do these medicines increase my risk of shingles?”

A major 2023 network meta analysis in Frontiers in Pharmacology looked at 47 randomised controlled trials and more than 24,000 patients to get a real answer.

Here is the signal clinicians and patients need to know.
- The risk is not the same across all JAK inhibitors.
- The risk is not the same across all immune conditions.

What the study found:

• The increased shingles risk was seen almost entirely in rheumatoid arthritis.
• Three medicines stood out at higher dose ranges: peficitinib 100 mg, baricitinib 4 mg, and upadacitinib 30 mg.
• Lower doses and other JAK inhibitors had no significant increase compared with placebo.
• No increased shingles risk was seen in Crohn’s disease, ulcerative colitis, spondyloarthritis, psoriasis or psoriatic arthritis.
• The authors suggest immune pathway differences in RA, plus baseline higher shingles risk in RA patients, may explain why only this group showed a clear signal.

Pain Specialists Australia’s view:
This is a well structured and rigorous analysis. It reminds clinicians to individualise risk, dose and monitoring, especially in RA. It also reinforces that risk is not uniform across all JAKs or all diseases. Patients deserve clear conversations, balanced information, and planning around vaccination where appropriate.

For people living with chronic pain from immune mediated disease, good treatment is about balancing benefit and risk with eyes wide open.

https://ow.ly/1zsl50XtgJQ

What would you want clinicians to explain more clearly when prescribing medicines like JAK inhibitors?

13/11/2025

Understanding a Break-through in Trigeminal Neuralgia Relief

If you or a family member live with the sharp, electric-shock-like face pain of trigeminal neuralgia (TN), this new study brings encouraging news. Researchers treated 41 patients during serious “pain crisis” episodes with intravenous fosphenytoin and found massive relief — average pain scores dropped from nearly 10/10 to under 1/10 within 2 hours.

At Pain Specialists Australia we recognise how frightening these attacks are, they interrupt eating, talking, even a gentle touch of the face. While our core mission has always been long-term pain control, this study highlights a valuable option for those acute, in-the-moment flare-ups.

What you should know:
• This isn’t yet standard first-line care, it’s best in specialist settings and under supervision.
• It doesn’t replace your ongoing treatment plan; it adds a potentially powerful “emergency relief” tool.
• If you’re in the midst of such flare-ups, speak to your pain specialist or neurologist about whether this kind of approach might suit you.

At PSA our view: consider rapid-relief strategies like this with long-term stabilisation, advanced diagnostics and personalised management gives patients the best chance of regaining control.

What’s your experience with acute flare-up treatments in trigeminal neuralgia - have you or someone you know tried something like this, and how did it compare with the usual medications? Let’s discuss.

https://ow.ly/Z4su50XpPf3

11/11/2025

The State of Pain in Australia - Trailer

One in five Australians live with chronic pain. Yet most are still told to just live with it.

In this episode of The Pain Diaries Podcast, pain specialist Dr Nick Christelis speaks with Monika Boogs, CEO of PainAustralia, about why so many people still feel ignored, gaslit or left behind by our healthcare system.

They explore:
• Why chronic pain remains invisible in Australia’s health system
• The emotional and economic cost of being told it is all in your head
• What needs to change in policy, treatment and awareness
• Where people can finally find real help and hope

Watch the trailer now and join the conversation Australia needs to have about pain.

Full episode out now on YouTube: https://youtu.be/IFbpZ1_nzyI

What do you think needs to change for people with chronic pain to finally be believed and supported in Australia?

28/10/2025

Complex Regional Pain Syndrome: When Pain Crosses Every Line

CRPS is one of the most painful and misunderstood conditions we treat. It can begin after an injury or surgery, then spiral into severe, burning pain, swelling, and sensitivity so intense it can feel unbearable.

In this short trailer from The Pain Diaries Podcast, Dr Nick Christelis and Dr Bradley Lewinsohn discuss what advanced treatment looks like today, why early diagnosis matters, and the difficult conversations many avoid, including when amputation is considered for therapy-resistant CRPS.

This episode goes beyond the usual discussion. It looks at the full spectrum of CRPS care, from nerve blocks and ketamine to neuromodulation and, in rare cases, amputation. It is about evidence, innovation, and confronting the taboos that surround this devastating condition.

At Pain Specialists Australia, we believe no one should have to face pain that controls their life.

Watch the full episode here: https://youtu.be/CGTApaIkorc

If you or someone you know lives with CRPS, what part of this conversation do you think is still too “taboo” in the world of pain medicine?

painspecialistsaustralia.com.au/contact

26/10/2025

Could diabetes and weight-loss drugs help with chronic pain?

New 2025 review: The Journal of Headache and Pain examined GLP-1 receptor agonists, the same class as many diabetes and weight-loss medicines, and found early signs they may reduce pain through anti-inflammatory, neuroprotective, and β-endorphin pathways.

What the review suggests
• Potential signals across inflammatory pain, osteoarthritis, visceral pain and IBS, neuropathic pain including diabetic neuropathy, headache and raised intracranial pressure, and cancer pain.
• In osteoarthritis, human benefits often track with weight loss rather than a direct analgesic effect.
• For neuropathic pain and IBS, most data are preclinical or early clinical, so high-quality trials are still needed to confirm real-world benefit and dosing.

Our take at Pain Specialists Australia
This is a promising direction that fits what we see clinically, where metabolism, inflammation, and pain often intersect. GLP-1 therapies could become a helpful add-on for selected patients, especially those with obesity or diabetes, but they are not a replacement for careful diagnosis, targeted interventions, and rehabilitation. The big question is whether GLP-1s relieve pain independent of weight loss. That needs rigorous trials. And we need to understand gthe side effect profile first!

For patients and families
• Do not start or stop any prescription without medical advice.
• If you live with chronic pain and metabolic issues, ask your specialist whether emerging GLP-1 research is relevant to your situation.
• Good care still begins with an accurate diagnosis and a whole-person plan.

If future trials show clear pain relief that is independent of weight loss, which pain condition do you suffer from that you'd you most want prioritised for access?

https://ow.ly/2fqY50XhZtn

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

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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