Programmes and populations
The persistent pain programme
For pain that has outlasted the injury. Not a cure, not a suggestion that it is in your head, and not something we are going to pretend is quick.
Pain that persists beyond the healing of the tissue behaves differently from acute pain. It becomes less closely tied to what is happening in the tissue and more to how sensitised the system producing it has become. That is a real, physical process and it is not the same as saying the pain is imagined.
It matters because the treatment is different. Chasing the tissue with more imaging, more injections and more passive treatment tends to disappoint, while graded activity, pacing and accurate information about pain reliably help — not by removing the pain, but by increasing what you can do with it.
What we are not saying
We are not saying the pain is in your head. It is produced by a real nervous system responding to real inputs, and people with persistent pain have usually been told some version of the in-your-head thing by somebody, which is both untrue and corrosive.
We are not saying nothing is wrong. Frequently something was, and the tissue has healed while the pain has not stopped, which is a recognised pattern rather than a mystery.
And we are not going to promise it will go. Some people's does. For a great many the honest goal is a life with substantially more in it, which is a smaller promise and one we can actually work towards.
The three things the programme is made of
Graded activity. Starting below your current tolerance and increasing on a schedule rather than on how you feel on the day — because the boom-and-bust cycle, where a good day is used up entirely and pays for it over three bad ones, is the single most common pattern we unpick.
Pacing. Which is not doing less; it is distributing what you do so that the total goes up over weeks. It is unintuitive and it takes practice.
Information. What persistent pain is, why hurt does not equal harm in this context, and why movement is safe even when it is uncomfortable. Delivered as a conversation rather than a lecture — nobody has ever been educated out of pain by being talked at.
Goals you set
Not a pain score. Specific things: walking to a particular shop, sitting through a film, going back to a job, picking up a grandchild. Written down at the start, measured against, and revised.
This matters because a programme aimed at reducing a number frequently fails on its own terms while the person's life improves, and a programme aimed at the life can succeed while the number stays put.
What else should be in place
Persistent pain sits alongside sleep, mood and medication, and all three affect it substantially. We will ask about them and tell you what is worth raising with your physician. A medication review in somebody on long-term analgesia is frequently valuable and it is not ours to conduct.
Where a psychological component is significant — and it very often is, in the ordinary sense that living with pain for three years affects anybody — we will say that a psychologist working in pain management is a legitimate part of the team rather than an accusation.
Nothing here is a promise that treatment will work. Nothing on this site is a promise that treatment will work. Physical therapy has good evidence behind it for a great many musculoskeletal problems and poor evidence for a few of the things it is sold for, and we would rather tell you which of those you have than take the appointment either way. We publish no success rate, no star rating and no before-and-after photographs, because a clinic that chooses which outcomes to show is not reporting outcomes.
Included as standard
How we treat this
Goals in your terms, not a pain score
A shop, a film, a job, a grandchild. Written down at the start and measured against.
Graded activity on a schedule
Increasing on a plan rather than on how the day feels, which is what breaks the boom-and-bust cycle.
Pacing taught properly
Not doing less — distributing what you do so the total rises over weeks. It is unintuitive and it takes practice.
Information as conversation, not lecture
Nobody has ever been educated out of pain by being talked at.
Sleep, mood and medication asked about
All three affect pain substantially, and a medication review is frequently valuable and not ours to conduct.
No cure promised
For many people the honest goal is a life with more in it. That is a smaller promise and one we can work towards.
When to make an appointment
Signs this is worth an assessment
- You have had pain for more than three months and the original injury has healed.
- Investigations have been normal or have not explained the pain.
- You have good days that you use up entirely and pay for over the following three.
- You have been told there is nothing more to be done.
- You have had several courses of passive treatment that helped briefly.
- Your world has got smaller and you would like some of it back.
Persistent pain — how long a course usually takes
- A typical course over three to four months, combining graded activity, pacing and education. The goal is what you can do, and it is set with you at the start.12 – 20 visits
This is a typical number of visits for this problem, not a quote and not a promise. You get an estimate specific to you, in writing, at the first appointment, and we reassess against the same measurements at visit four rather than at visit ten — so a course that is not working gets changed or stopped instead of extended. What each visit costs is published on the pricing page: $190 for the initial evaluation and $140 for a treatment visit if you are paying yourself, or your plan's copay if you are not. We do not sell blocks of visits in advance.
Questions we are actually asked
Persistent pain — frequently asked
Are you saying my pain is in my head?
No, and we would ask you to hold us to that. Pain is produced by a real nervous system responding to real inputs. What changes in persistent pain is that the system has become more sensitised and the pain is less tied to the state of the tissue — which is a physical process, not an imaginary one.
Can persistent pain be cured?
Sometimes it resolves and we cannot predict who. For many people the honest goal is not the absence of pain but a substantially larger life with it, and that is achievable. We would rather offer the smaller promise we can work towards than the larger one we cannot.
What is pacing?
Distributing activity so the total you do goes up over weeks, rather than using up a good day entirely and paying for it over three bad ones. It is not doing less — that is the commonest misunderstanding — and it is unintuitive enough that it takes practice.
How long is the programme?
Twelve to twenty visits over three to four months, with the work continuing between them. It is a course rather than a treatment, and the goals are set with you at the start.
Should I see a psychologist as well?
Sometimes, and it is not an accusation. Living with pain for three years affects anybody's sleep, mood and outlook, and a psychologist working in pain management is a legitimate part of the team. We will say when we think it would help and why.
Related conditions
Often seen alongside this
Low back pain
The most common reason anybody walks through this door, and the condition where the gap between what sells and what works is widest.
6 – 12 visits
Neck pain
Desk necks, phone necks, slept-badly necks and the ones that are actually a shoulder. Telling them apart is most of the first appointment.
5 – 10 visits
Car accident
No-Fault covers this, on its own timetable and with its own paperwork. Missing the first deadline is the commonest way people lose the benefit.
Billed to No-Fault
Scoliosis & posture
Posture is a much weaker predictor of pain than the industry selling posture correction would like. Here is what the curve actually explains.
6 – 14 visitsSixty minutes, one to one, with the therapist you chose
Book an appointment
The booking page shows each therapist's own diary rather than a generic grid, so a slot you can see is a slot that is genuinely free. Most people do not need a doctor's referral to start — New York's direct access law runs to ten visits or thirty days — though Workers' Compensation, No-Fault and Medicare each need one from the first visit. If you are not sure which of those you are, telephone and we will work it out before you book.