Dr Nathan Johns MBBS (Hon) FAFRM (RACP)
Dr Nathan Johns is a specialist Rehabilitation Medicine Physician (also known as a Physiatrist) with over 20 years working in and studying Rehabilitation Medicine.
Dr Johns graduated from Monash University with a Bachelor of Medicine and Surgery in 1996. He has been a Fellow of the Australasian Faculty of Rehabilitation Medicine (AFRM, RACP) since 2005.
Dr Johns has speciality training and clinical experience in all aspects of rehabilitation medicine including persistent pain (back pain, neck pain, musculoskeletal pain, post-surgical pain, post-fracture, arthritis, fibromyalgia, neuropathic) neurological rehabilitation (for stroke, traumatic and acquired brain injury), orthopaedic rehabilitation, reconditioning, amputee medicine and the rehabilitation of Older Adults.
Dr Johns has been the Clinical Director of Rehabilitation Medicine, Aged Care, Palliative Care and Persistent Pain at Peninsula Health since 2022. Prior to this he has held positions of Head of Unit Rehabilitation Medicine at Peninsula Health, Medical Director at St John of God Frankston Rehabilitation and he has been a visiting specialist at Epworth Healthcare since 2006.
Dr Johns provides rehabilitation medicine consultations at Brighton Spine and Sports on Tuesday and Thursday afternoons.
Dr Johns lives in Melbourne, Australia with his wife, 3 children and his golden Cocker Spaniel dog Lola.
With a passion for rehabilitation medicine, a thirst for more pain knowledge and to give in to an entrepreneurial side, Dr Johns enrolled in a part-time PhD at Monash University entitled “Redesigning rehabilitation to treat persistent post-surgical pain” in 2018.
His primary supervisor is Professor John Olver AM from Epworth Monash Rehabilitation Medicine Unit (EMREM), part of the School of Clinical Sciences at Monash University. It is due for completion in May 2025!
Dr Johns has received two research grants from the Epworth Medical Foundation to fund research trials for his PhD and a grant from the Peninsula Health Rehabilitation Medicine Special Purpose Fund.
Dr Johns is an adjunct lecturer at the Monash University Peninsula Clincial School, teaching Monash medical students about pain.
Dr Johns remains an accredited supervisor and examiner for trainee registrars for the Austalasian Faculty of Rehabilitation Medicine
PhD Publications
Link to published article
This article, published in 2022, evaluated the pain outcomes of 1064 Australian adults who had a total knee replacement for osteoarthritis. The trial aimed to determine if inpatient rehabilitation was predictive of people having severe pain at 3-months after surgery.
The average age of participants was 68 years and 55% were female.
After surgery, participants in the trial either went straight home (65%) or went to inpatient rehabilitation (35%).
Main Findings:
1. Going to inpatient rehabilitation did not predict less severe pain at 3-months
2. 73% of people had severe knee pain before surgery.
10% of people had severe knee pain at 3-months after surgery
5% of people had severe knee pain at 12-months after surgery
6% of people had severe knee pain at 36-months after surgery
3. Predictors of more severe pain at 3-months included
– having severe pain before surgery
– having back pain or another lower limb pain before surgery
– having a complication in the first 3-months after surgery
– people with a younger age were more likely to have pain
More detail:
At 3-months, 11.6% of the group who went to inpatient rehabilitation had severe pain and 9.5% who went home had severe pain. Statistically, these percentages were not significantly different. There is no evidence to recommend going to inpatient rehabilitation after surgery to try to prevent more severe pain especially given the far greater expense of inpatient rehabilitation.
Future directions:
There is a significant minority of people who experience severe pain at 3-months to 3 years after knee replacement who need further support and a change in rehabilitation to help them reduce pain. A redesign of inpatient rehabilitation is recommended to achieve better outcomes.
Link to published article
This article, published in 2024, looked at the pain, function and quality of life outcomes over a 3 year period for 718 people who had a primary (1st) total knee replacement for osteoarthritis.
The average age of participants was 68 years and 57% were female.
Main Findings: Pain varies over time and can be “sticky”
1. 14% of people experienced severe pain at either 3-, 12- or 36- months after surgery
2. 2.5% of people experienced severe pain at all 3 timepoints.
3. For people with severe pain at 3-months, 34% still reported severe pain at 12-months and 35% at 36-months
4. People with severe pain at 3-months were 24 times more likely to still have severe pain at 12-months compared to those without severe pain
5. For people with severe pain at 12-months, 68% still reported severe pain at 36-months
6. People with severe pain at 12-months were 19 times more likely to still have severe pain at 36-months
7. People with more severe pain at 3-, 12- or 36-months had significantly poorer function and reduced quality of life
Future Directions:
With 1 in 7 people experiencing severe persisting pain at 3, 12- or 36- months after knee replacement surgery, that impacts on function and quality of life and research of new treatments to help is required.
(Whilst doing things the usual and same way will benefit most people, 1 in 7 need a change to their treatment regime).
Link to published article
This article, also published in 2024, looked to discover if any randomised controlled trials had been done, that involved using rehabilitation treatment or strategies to reduce persistent pain after knee replacement.
Main Findings: Only 1 research trial was found
This study compared 12 weeks of exercise and neuroscience education to neuroscience education alone and found that there were no significant differences. Importantly, there were no significant differences found in pain or function with this program.
Future Directions:
More rehabilitation research trials aimed at reducing pain and improving function and quality of life to treat people with persistent pain after knee replacement are urgently needed!
