Pain Clinic in London & Marlborough, Wiltshire

At The Health Equation we help patients find solutions for pain, both acute and chronic pain syndromes, diagnosis is the key.

Acute Pain

There are numerous reasons why patients can develop acute pain and usually these symptoms can be helped easily in a standard biomedical model. This means a history and clinical examination to determine the tissues causing the symptoms. Sometimes imaging and laboratory testing to confirm suspected pathology where medical intervention may be more appropriate or whether it’s a more functional type of problem, in which case interventions such as Osteopathic Manual Treatment (OMT) may be more appropriate. The majority of acute pain can also be self-limiting and will clear up in time with or without treatment, although having a diagnosis and treatment and short term medication can sometimes speed up the process of recovering from acute pain

Chronic Pain

Chronic pain isn’t just a medical condition—it’s a global crisis. It’s actually the leading cause of years lost to disability worldwide, and the numbers are rising fast. From 2020 to 2023, the number of U.S. adults living with chronic pain jumped from 20% to 25%. Even more concerning: the percentage of people whose pain is so severe it limits daily life rose from 6.9% to 8.5%.

There is also the pervasive impact of chronic pain across Europe. The economic cost alone is staggering—estimated at up to €12 billion annually. This figure encompasses not only direct medical expenses but also out-of-pocket costs and productivity losses due to absenteeism and reduced work capacity.

Yet, perhaps even more significant than the financial burden is the personal toll chronic pain takes on the lives of millions: the daily struggle with physical discomfort, fatigue, emotional exhaustion, and the long-term psychological strain.

What remains strikingly under-addressed, especially in early encounters with healthcare professionals, is the intricate and powerful relationship between stress and the experience of pain.

So, what does this mean? It means it’s time to rethink how we treat chronic pain—not just to reduce symptoms, but to restore function and improve quality of life.

The research community is increasingly calling for a shift away from outdated models that rely heavily on medication and short-term fixes. Instead, we need sustainable, multidisciplinary approaches that look at the whole person—body, mind, and environment.

Understanding the Types of Pain

There are three main categories of pain:

Nociceptive Pain – Caused by actual tissue damage (e.g., a sprained ankle, inflammation, cut, or burn).

Neuropathic Pain – Comes from damage to the nervous system (e.g., diabetic neuropathy, trigeminal neuralgia).

Nociplastic or Neuroplastic Pain – Arises from abnormal pain processing in the brain, often without visible injury. Conditions include fibromyalgia, migraine, and phantom limb pain.

We used to think of pain as purely a sensory issue, but that’s changed. There’s now strong evidence for the cognitive and emotional components of pain. For example, a recent 2025 meta-analysis of 376 studies found that nearly 40% of people with chronic pain also suffer from depression or anxiety. Of course people with chronic pain can become depressed or anxious but it is also true that anxiety and depression can often be a maintaining factor in chronic pain.

That’s why new clinical guidelines now emphasize non-drug approaches as first-line treatments. The American College of Physicians recommends starting with physical therapy, exercise, mindfulness, and cognitive-behavioural therapy (CBT) for conditions like low back pain.

Similarly, the American College of Rheumatology prioritizes lifestyle and mind-body therapies for osteoarthritis and fibromyalgia—underscoring a growing consensus: chronic pain needs to be treated holistically.

Mindfulness, the Brain, and Hope

Mindfulness-based practices are proving especially powerful. These approaches teach patients to observe their pain with calm, nonjudgmental awareness—and it’s not just “woo.” Research shows this can change brain regions involved in pain processing, regulate neurotransmitters, and even balance the autonomic nervous system.

So, what do we do at The Health Equation

In my many years of clinical practice, chronic pain is indeed a very common presentation. What I and my patients have found very helpful is a deep exploration of the potential mechanisms behind the pain. There are often multiple and interacting contributory factors which maintain the chronic pain vicious circle. They can be physical, biochemical and emotional/psychological behavioural factors.

One of the challenges is convincing patients with chronic pain that there is not always an ongoing injury to cause that pain, and that the concept of “central nervous system sensation” plays a very big part in the mechanism of ongoing pain.

Whilst there is almost always some sort of initial trauma causing tissue damage and inflammation and “acute pain”, the body usually has a remarkable self-regulatory healing mechanism and much acute pain tends to be short-lived, whilst the body heals itself. Unfortunately, in some people and this is where the other factors coming to play, can develop a chronicity and a vicious circle of chronic pain.

A detailed case history, a chronology in relation to the development of the symptoms, understanding ongoing contributory lifestyle factors, a thorough clinical examination, and appropriate laboratory testing such as blood testing and imaging when required usually gives enough information to a thoughtful clinician to come up with a working diagnosis. The challenge is then to convey this information in a form that the patient understands and then for the patient to accept the likely mechanisms for their chronic pain and then the treatment and the management of the patient can begin.

I separate treatment from management partly because many patients simply think just having “treatment” is the way of sorting out their pain. Therefore, they invariably will have tried numerous “treatments” and “therapists” sadly many ineffectual. Very often the reason for this is really a lack of understanding of the mechanisms behind the pain, the evaluation or diagnosis. Patients with chronic pain do much better with a multidisciplinary approach tackling the multiple factors which are driving their symptoms. It is incredibly rare to have one thing, just causing the pain.

This process is time consuming both for the patient and the clinician. And in our modern world, everyone likes a quick fix. Unfortunately, chronic pain is simply not amenable to simple interventions.

We have patients who will email the practice to say can we help with X, Y and Z symptoms. To the frustration of some of them, we simply reply saying that “it depends”. However, unless you actually have a consultation with the patient it is incredibly difficult to decide whether the treatment and management you can offer is going to be helpful.

So, the pathway to my chronic pain patients tends to be having a Diagnostic Consultation, with a detailed clinical examination and then arranging appropriate testing, if necessary, such as blood testing and imaging.

I will then spend several hours outside of the consultation making sense of all this information to then write a comprehensive report, on average this tends to be at least 10 pages, for the patient to consider, helping them understand the nature of their symptoms.

Only then can we progress to management and treatment of that patient.

This can sometimes be an anathema to some of my colleagues and to patients when they’re going to see a “therapist”, they simply want treatment.

With chronic pain patients, they have already followed this typical pathway often for years with minimal results.

That’s why I don’t call myself a therapist, I am a clinician. Management and treatment can only be effective when we have a good understanding of the diagnosis/evaluation of the patient and importantly, the mechanism that drives their symptoms.

I have yet to come across one of my patients who has not valued and benefitted from their Diagnostic Consultation and my comprehensive follow-up report, many feel relieved and even an improvement of their symptoms after their initial consultation, even though I will often have provided no treatment, but have provided management. In my experience patients who understand and accept the mechanism that drives their symptoms can often get better despite chronic symptoms.