Pain Clinic in London and Marlborough, Wiltshire

Pain may be acute and relatively straightforward, or persistent, complex and influenced by several interacting factors. At The Health Equation, the starting point is not simply to suppress the symptom, but to establish the clearest possible understanding of why the pain has developed and what may be preventing recovery.

Led by Mr Gerry Gajadharsingh DO, Osteopath and Diagnostic Consultant in Integrated Medicine, the Pain Clinic provides comprehensive assessment and individually tailored management for people with acute, recurrent or chronic pain. Consultations are available at 86 Harley Street in London and Alton Barnes, near Marlborough in Wiltshire.

Acute Pain

Acute pain usually develops suddenly following injury, inflammation, illness or physical strain. It serves an important protective function by drawing attention to tissues that may have been damaged or placed under excessive load.

A careful clinical history and examination can often identify the likely source of the pain. Where necessary, diagnostic imaging, blood tests or referral for specialist medical assessment may be recommended to clarify the diagnosis or exclude more serious pathology.

Depending upon the findings, management may include:

  • Advice about activity, movement and recovery
  • Osteopathic manual treatment where appropriate
  • Rehabilitation exercises
  • Short-term pain management in collaboration with the patient’s GP or pharmacist
  • Diagnostic imaging or specialist referral when clinically indicated

Most acute pain improves as healing takes place. An accurate diagnosis and an appropriate management plan can help support recovery while reducing the risk of the problem becoming persistent.

Persistent and Chronic Pain

Pain that continues beyond the expected period of tissue healing is often more complex. Although an identifiable structural problem may still be contributing, persistent pain is not always explained by the degree of tissue damage seen on a scan.

Over time, the nervous system can become increasingly sensitive and protective. Sleep disturbance, stress, reduced activity, previous injury, breathing-pattern dysfunction, metabolic or inflammatory factors and fear of further damage may all influence how pain is experienced and maintained.

This does not mean that the pain is imagined or “all in the mind”. The pain is real, but its persistence may reflect changes across several interacting regulatory systems rather than a single damaged structure.

Effective management therefore begins by understanding the individual patient’s pain, its chronology and the factors that may be perpetuating it.

Understanding Different Types of Pain

Pain is not a single process. More than one mechanism may be present, particularly when symptoms have persisted for a long time.

  • Nociceptive pain arises when tissues are injured, inflamed or placed under mechanical stress. Examples include a sprain, osteoarthritis or pain following surgery.
  • Neuropathic pain results from a lesion or disease affecting the nerves or nervous system. It may be experienced as burning, shooting, electric-shock sensations, tingling or numbness.
  • Nociplastic pain involves altered processing of pain signals without sufficient evidence of ongoing tissue damage or a nerve lesion to explain the severity or persistence of the symptoms.

Many patients have mixed pain, involving a combination of these mechanisms. Identifying the most likely contributors is important because different types of pain require different approaches to treatment and management.

The Importance of an Accurate Diagnosis

Pain is a symptom rather than a diagnosis. Similar symptoms may arise from very different causes, and an abnormality identified on an X-ray or MRI scan may not necessarily be responsible for the pain being experienced.

Assessment therefore involves distinguishing between:

  • Identifiable tissue injury or structural pathology
  • Inflammation or irritation affecting joints, muscles, fascia or nerves
  • Referred pain arising from another part of the body
  • Altered nervous-system sensitivity and pain processing
  • Functional, metabolic or wider systemic factors that may influence recovery
  • Symptoms requiring further medical investigation or specialist referral

The purpose is not always to find one simple cause. In complex cases, the most accurate explanation may involve several interacting factors. Establishing this clearly helps avoid unnecessary treatment and allows management to be directed towards the mechanisms most relevant to the individual patient.

Your Initial Diagnostic Consultation

All new patients begin with a 60-minute Diagnostic Consultation with Mr Gerry Gajadharsingh DO. This provides sufficient time to explore both the pain itself and the wider clinical context in which it has developed.

The consultation may include:

  • A detailed medical history and chronology of symptoms
  • Review of previous diagnoses, investigations, scans and treatments
  • Screening for warning signs that may require medical investigation
  • Neurological, cardiovascular and musculoskeletal examination where appropriate
  • Assessment of movement, posture, joints, muscles and connective tissues
  • Consideration of sleep, breathing, stress, activity, medication, nutrition and other factors that may influence pain
  • Discussion of the likely diagnosis and pain mechanisms

Further blood tests, diagnostic imaging or specialist referral may be recommended where clinically appropriate.

Following the consultation, patients receive a comprehensive written report at no additional cost, usually within two working days. This explains the clinical findings, the likely factors contributing to the pain and the recommended next steps.

Looking Beyond the Site of Pain

The location of pain is important, but it does not always reveal the complete explanation. Persistent symptoms may be influenced by interactions between different parts of the body and several regulatory systems.

Using the Integrated Regulatory Systems Framework, the assessment may consider the contribution of:

  • Respiratory function and breathing pattern
  • Neural regulation and pain sensitivity
  • Circulation and tissue health
  • Endocrine and hormonal factors
  • Immune and inflammatory activity
  • Metabolic health and energy regulation
  • Musculoskeletal function, including joints, muscles and fascia

This broader perspective is particularly valuable for patients whose pain is persistent, recurrent, widespread or accompanied by symptoms such as fatigue, poor sleep, digestive disturbance, anxiety, reduced exercise tolerance or difficulty recovering from physical activity.

A Personalised Pain Management Plan

Following assessment, the findings are explained clearly and a management plan is developed through shared decision-making. The aim is to reduce pain where possible, improve function and confidence, and address factors that may be delaying recovery.

Depending upon the individual patient, the plan may include:

  • Osteopathic manual treatment
  • Movement, exercise and rehabilitation advice
  • Breathing re-education supported by capnometry and heart-rate variability assessment where appropriate
  • Strategies to improve sleep and regulate stress
  • Nutritional and metabolic support
  • Advice about pacing, activity and returning to normal function
  • Review of existing investigations or medication with the appropriate medical clinician
  • Referral for diagnostic imaging, blood tests or specialist medical opinion

Treatment is not based upon a predetermined protocol. The combination and sequence of interventions are tailored to the diagnosis, the pain mechanisms involved and the patient’s priorities.

The Role of Osteopathic Manual Treatment (OMT)

Osteopathic Manual Treatment (OMT)  may be helpful when joint restriction, muscular tension, altered movement, previous injury or connective-tissue dysfunction is contributing to the pain presentation.

Treatment is adapted to the patient’s diagnosis, age, general health and individual tolerance. It may include gentle joint articulation, soft-tissue and fascial techniques, mobilisation and carefully selected manipulative techniques where appropriate.

Manual treatment is not presented as the solution to every form of pain. In persistent or complex cases, it is usually most effective when incorporated into a broader plan that also addresses movement, rehabilitation, breathing, sleep, stress and other relevant clinical factors.

Where examination suggests that treatment is unsuitable or that further investigation is required, this will be discussed and the appropriate referral recommended.

Pain Problems We Commonly Assess

The Pain Clinic provides assessment and management for a wide range of presentations, including:

  • Back, neck and spinal pain
  • Shoulder, hip, knee and other joint pain
  • Muscular and myofascial pain
  • Pain associated with osteoarthritis
  • Persistent pain following injury or surgery
  • Recurrent pain that has not responded as expected to previous treatment
  • Nerve-related pain, including burning, tingling or shooting sensations
  • Widespread pain and heightened pain sensitivity
  • Pain associated with fibromyalgia or other complex syndromes
  • Pain accompanied by fatigue, poor sleep, stress or other systemic symptoms

Patients do not need to know which category their pain belongs to before arranging an appointment. The purpose of the Diagnostic Consultation is to clarify the presentation and determine the most appropriate next steps.

Working With Other Healthcare Professionals

Some pain problems require input from more than one clinician. Where appropriate, The Health Equation works collaboratively with GPs, medical consultants, physiotherapists, psychologists, pain specialists and other healthcare professionals.

Referral may be recommended when a patient requires:

  • Further diagnostic imaging or laboratory investigation
  • Specialist neurological, rheumatological or orthopaedic assessment
  • Review of medication or medical pain management
  • Psychological support, including approaches such as cognitive behavioural therapy
  • A structured rehabilitation programme
  • Surgical opinion or interventional pain procedures

The objective is to ensure that each patient receives the most appropriate care, whether this is provided at The Health Equation, jointly with another clinician or through referral to a specialist service.

Understanding Pain as Part of Treatment

Persistent pain can be frightening, particularly when investigations have not provided a clear explanation or when different clinicians have offered conflicting opinions. Patients may become concerned that movement will cause further damage, leading to reduced activity, loss of confidence and greater sensitivity.

A clear and credible explanation can help interrupt this cycle. Understanding the difference between pain and ongoing tissue damage allows patients to approach movement and rehabilitation with greater confidence.

This does not dismiss the symptom or imply that a patient should simply think differently. It recognises that education, reassurance and shared understanding can produce meaningful physiological and behavioural changes and form an important part of an evidence-informed pain-management programme.

Who May Benefit From the Pain Clinic?

The Pain Clinic may be particularly helpful for people who:

  • Have persistent or recurrent pain without a satisfactory explanation
  • Have received different or conflicting diagnoses
  • Have undergone investigations but remain uncertain about what the findings mean
  • Have tried several treatments without sustained improvement
  • Experience pain involving more than one area of the body
  • Have symptoms influenced by sleep, stress, fatigue, breathing or activity
  • Want a comprehensive assessment before deciding upon further treatment
  • Would value a written clinical explanation and a coordinated plan

The clinic is equally suitable for patients with a newly developed pain problem who want a thorough initial assessment and for those managing a longstanding or more complex condition.

Booking a Pain Clinic Appointment

New patients should book a 60-minute Diagnostic Consultation with Mr Gerry Gajadharsingh DO.

Appointments are available at:

  • London: 86 Harley Street, London W1G 7HP
  • Wiltshire: Alton Barnes, near Marlborough, Wiltshire SN8 4LB

You are welcome to bring copies of relevant medical letters, blood-test results and imaging reports. These can also be submitted securely before the consultation so that they can be reviewed as part of the assessment.

Book a Diagnostic Consultation

If you are unsure whether the Pain Clinic is appropriate for your symptoms, please contact The Health Equation before booking.