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By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Patient information | 16 October 2026 Persistent pain can affect almost every part of life: movement, sleep, work, relationships and confidence. Understanding the influences on pain can open up useful ways of helping, including NHS pain management clinics and programmes. The starting point is that your pain is real. Nothing in this article means that pain is imaginary, “all in your head” or your fault. Anxiety, poor sleep or fear can influence pain without making it any less physical or deserving of care. You do not have to prove that you are positive, resilient or trying hard enough to receive help. [1] [2] On this page Why pain feels different for different people Mental health, sleep and daily life Placebo and nocebo effects What NHS pain clinics do What happens in a pain management programme? Benefits and the research evidence Finding NHS support Sources and further reading Why pain feels different for different people Pain involves the body and its nervous system. Signals from tissues are processed and regulated through nerves, the spinal cord and the brain. Injury, inflammation or nerve disease may contribute, while the sensitivity of the system can also change. Persistent pain can involve several mechanisms together. [2] [3] This helps explain why pain intensity does not always closely match the amount of tissue damage, and why tests may not fully explain someone’s symptoms. A scan cannot measure the whole experience of pain. Physical causes still require appropriate assessment; considering wider influences should never replace that assessment. [2] [3] People also differ in sensitivity because of factors including genetics, hormonal influences and previous experiences. The same physical stimulus need not feel the same to two people. Pain threshold means the point at which something becomes painful; pain tolerance concerns how much pain someone feels able to endure. These can vary over time. Neither measures character or willpower, and a calm appearance does not establish that pain is mild. [1] [4] [5] The meaning of pain can influence what happens next. Someone who believes every painful movement is causing further damage may understandably become watchful and avoid activity. If the condition allows safe movement, continuing to avoid it can make returning to everyday life harder. NICE recognises that fears and beliefs about activity can obstruct recovery from persistent low-back pain. [6] Compare “my back is permanently damaged” with “my back is painful, but I can gradually rebuild what I do”. These interpretations may lead to different actions. A helpful explanation must fit the assessment and answer the person’s concerns. Simply saying “there is nothing wrong” can leave someone feeling dismissed. [6] [7] Mental health, sleep and daily life Mental health and pain affect each other. Anxiety, depression and prolonged stress can affect sleep, concentration, distress and the energy available for rehabilitation. Pain can also worsen mental health through exhaustion, uncertainty, isolation and losing valued activities. A review of low-back-pain research found associations between depressive symptoms, greater disability and poorer recovery. An association does not establish that depression caused an individual’s pain or determine their future. [7] [8] Psychological support can help someone deal with the burden of a physical health problem. Receiving it does not mean that the pain has been judged imaginary, and persistent pain does not require a mental health diagnosis. If pain continues despite someone’s efforts, they deserve reassessment and support, rather than blame. [2] [7] Sleep and daily circumstances deserve attention too. Pain may interrupt sleep, and poor sleep can increase sensitivity and fatigue. Experimental research has shown that disrupted sleep can lower pain thresholds. This is one reason that sleep problems belong in a pain assessment. [9] Other relevant influences include confidence in managing symptoms; previous injuries or distressing treatment experiences; feeling heard and involved in decisions; and support from family, friends or colleagues. Physical demands at work, job insecurity, financial pressures, caring responsibilities and isolation can affect both distress and the practical opportunity to recover. The underlying condition, other illnesses and physical capacity remain important. These influences differ between people and cannot all be changed by individual effort. [3] [7] Placebo and nocebo effects Expectations can affect pain relief. Placebo effects are changes arising from expectations, learned associations and the treatment context. They can involve the body’s own pain-regulating mechanisms. They can accompany active medicines and physical treatments as well as dummy treatments; benefit from these mechanisms does not make the original pain unreal. [10] The reverse is called a nocebo effect: negative expectations can contribute to increased pain or adverse symptoms. Neither response is necessarily conscious or voluntary. A clinician’s explanation and the person’s previous experiences can influence these responses. Honest reassurance, clear information and realistic hope are helpful; necessary risks should still be explained, and promises of a cure should be avoided. [10] Improvement after treatment is not all a placebo effect. It can include the treatment’s specific effects, natural recovery, changes in activity or other care, and normal symptom fluctuation. People often seek help during a particularly bad spell, which may then settle towards their usual level: this is called regression to the mean. There is no universal percentage of recovery attributable to placebo effects, and pain relief alone does not establish that an underlying condition has been cured. [11] What NHS pain clinics do NHS pain clinics offer specialist help when pain is difficult to manage. They commonly see people with pain lasting more than three months that is disrupting life, particularly when initial treatment has not helped enough. This can include persistent back, neck or shoulder pain, nerve pain, fibromyalgia and pain continuing after surgery. [12] [13] Depending on the service, the team may include a pain specialist doctor, physiotherapist, psychologist, specialist nurse, occupational therapist and pharmacist. Their roles complement each other. The clinic can review the problem, discuss treatment options and agree a plan with the person. [13] [14] Part of care What it may involve Assessment Reviewing symptoms, previous treatments and investigations; examination where appropriate; deciding whether another specialist assessment is needed. Medicine review Checking benefit, side effects and whether supervised changes would help. Physical rehabilitation Gradually rebuilding movement, activity and confidence with a plan matched to the person. Psychological support Working with distress, fear, difficult thoughts and the disruption caused by pain. Practical support Planning everyday activities, managing flare-ups and considering useful changes at home or work. Selected treatments Injections, nerve blocks or other specialist procedures when appropriate for the particular condition. Some services offer hands-on treatments or other options. Services vary, and nobody needs every treatment. Procedures are appropriate for selected conditions; a referral does not automatically lead to an injection or stronger medication. [12] [13] [15] What happens in a pain management programme? A pain management programme provides structured rehabilitation. A clinic appointment and a pain management programme, usually shortened to PMP, are related but different. The clinic provides specialist assessment and treatment planning. A PMP is a course that some people are offered to develop practical skills through education, supported activity and repeated practice. [12] [16] Programmes are often delivered in groups over several sessions. They may include individually adapted exercise, pacing activity, relaxation or mindfulness, understanding pain, managing its emotional effects, sleep strategies and planning for setbacks. Participants work towards goals that matter to them, such as walking to the shops, returning to a hobby or spending more time with family. [16] [17] Psychological approaches may include cognitive behavioural therapy (CBT), which explores how thoughts, feelings and actions interact, or acceptance and commitment therapy (ACT), which helps people make room for difficult experiences while taking steps towards what matters to them. In this context, acceptance means finding ways to live meaningfully with the situation as it is now. It does not mean giving up on improvement or agreeing that the pain is acceptable. [15] [17] The aim is to build manageable habits and useful skills. Pacing can help someone find a sustainable level of activity and adjust it, while rehabilitation can support gradual progress. The team should help adapt the plan when symptoms or circumstances make it difficult. Learning alongside others can also provide support and reduce the sense of facing pain alone. [16] [17] For practical examples of pacing and planning difficult days with back pain, see our back pain flare-up guide. Assessment helps establish which programme or form of support is suitable. Format and intensity vary. Some services offer individual alternatives for people who cannot attend a group. Concerns about groups, access or mental health can be discussed with the team rather than assuming that they rule someone out. [18] Benefits and the research evidence The benefit is a coordinated plan that addresses several obstacles together. Imagine someone whose back pain has disrupted sleep, reduced walking and made them frightened of a flare-up. A plan might combine a medicine review, help with sleep, gradual walking practice and a clear approach to difficult days. Each element supports a different part of their situation. This is an illustrative example; the right combination depends on assessment. Useful gains might include doing more, feeling more confident, experiencing less distress and having better ways to handle setbacks. Skills can remain useful after appointments end. The central purpose of a PMP is to improve daily functioning and quality of life, including when pain continues. Pain relief is welcome, but it is not the only worthwhile outcome. [12] [17] There is research supporting this approach, with realistic limits. A Cochrane review published in the BMJ included 41 trials involving 6,858 people with chronic low-back pain. Multidisciplinary rehabilitation improved pain and disability compared with usual care, although the average long-term improvements were small. Individual results vary, and no programme can promise complete pain relief. [19] Related research also supports individual care that addresses pain-related beliefs, behaviour and movement. In the RESTORE trial, cognitive functional therapy improved disability more than usual care for chronic disabling low-back pain, with benefits maintained at one year. This was a specific physiotherapy approach, so it should not be treated as proof that every NHS group programme produces the same results. [20] Finding NHS support A referral is an opportunity to receive additional support. If pain has persisted for several months, is restricting life and remains difficult to manage, a GP can advise about the local pain service. It can help to explain what pain prevents you doing, what has already been tried and what you most want to regain. [12] [16] For a broader comparison of available support, read Choosing the right help for muscle and joint pain. In East Sussex, the usual starting point is the GP and East Sussex MSK service. As of 16 October 2026, the partnership states that a new community pain service will begin operating on 2 November 2026. People already receiving care or waiting for support do not need a new referral because of this change. [21] [22] Pain management recognises that a person’s experience deserves attention even when symptoms cannot be completely explained or removed. A helpful plan works with the person’s priorities and circumstances. Continuing pain should never be treated as evidence that someone is imagining it, has caused it through their attitude, or has failed to try hard enough. [1] [7] Related patient guides Persistent pain: understanding it and finding support Managing a back pain flare-up: staying active day to day Choosing the right help for muscle and joint pain Sources and further reading Select a numbered citation or source title to open the original. Local service information is dated 16 October 2026. 1. International Association for the Study of Pain. Revised definition of pain and explanatory notes 2. British Pain Society. Understanding and Managing Long-term Pain — patient booklet 3. International Association for the Study of Pain. Low Back Pain — mechanisms and the wider influences on recovery 4. International Association for the Study of Pain. Genetic Biomarkers of Pain States 5. International Association for the Study of Pain. Overview of Sex and Gender Differences in Human Pain 6. NICE. NG59 — Low back pain and sciatica in over 16s 7. NICE. NG193 — Chronic pain in over 16s 8. Journal of General Internal Medicine. Association Between Depressive Symptoms or Depression and Health Outcomes for Low Back Pain — systematic review and meta-analysis 9. PAIN. Sleep disruption and activation of cellular inflammation mediate heightened pain sensitivity — randomised clinical trial, 2023 10. International Association for the Study of Pain. Placebo and Nocebo Effects — treatment expectations and the patient–physician interaction 11. Cochrane. Placebo interventions for all clinical conditions — systematic review 12. NHS. How to get NHS help for your pain 13. Surrey and Sussex Healthcare NHS Trust. Pain management — assessment and treatment options 14. NHS England. Adult Specialised Pain Service Specification 15. NHS Education for Scotland. The Matrix — multidisciplinary pain management programmes for chronic pain 16. British Pain Society. Pain Management Programmes — participant information 17. British Pain Society. Guidelines for Pain Management Programmes for Adults, 2021 18. The Walton Centre NHS Foundation Trust. Pain Management Programme — options and assessment 19. BMJ. Kamper and colleagues, 2015 — multidisciplinary rehabilitation for chronic low-back pain, Cochrane review 20. The Lancet. Kent and colleagues, 2023 — RESTORE randomised trial of cognitive functional therapy 21. East Sussex MSK Community Partnership. About Pain Management — referral information 22. East Sussex MSK Community Partnership. The new community pain service — frequently asked questions This general information supports, and does not replace, an individual assessment. Browse all patient guides.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 16 October 2026. Choosing care is easier when you start with what you need: assessment of a new problem, help with rehabilitation, advice about medicines, or support with persistent symptoms. There is overlap between professions, and an individual practitioner’s experience and approach matter. Check the urgency first Do not delay medical help to arrange a routine treatment appointment. Sudden severe or rapidly worsening pain, a hot swollen joint with fever, or inability to bear weight after an injury may need urgent GP or NHS 111 assessment. Back pain with new bladder or bowel problems, loss of feeling around the genitals or anus, or symptoms in both legs needs emergency assessment. Follow the NHS back pain guidance. For a painful or swollen knee, see the NHS knee pain guidance. Use NHS 111 if you are unsure which service is appropriate; call 999 for an emergency. What the different services can offer Professional or service How they may help Osteopath Muscle and joint assessment, hands-on care, exercise and advice; referral when appropriate. Regulated by GOsC. Physiotherapy Movement and rehabilitation assessment, exercise, education and sometimes manual therapy. Physiotherapists are regulated by HCPC. Chiropractor Musculoskeletal assessment, manual treatments, exercise and advice. Approaches vary. Regulated by GCC. GP / medical team Medical assessment, medicines, tests and specialist referrals. Particularly useful for wider health concerns or feeling unwell. NHS physio / MSK Assessment and rehabilitation through local NHS services. Access and eligibility vary; see the East Sussex self-referral information below. These descriptions are broad. The job title does not tell you exactly which techniques a practitioner will use or guarantee a result. Osteopaths and chiropractors are not medical doctors unless they hold a separate medical qualification. Read the independent descriptions from the GOsC, NHS physiotherapy service and GCC. How to choose a practitioner Check registration and ask whether the practitioner has experience with your type of problem and goals. Registration is a baseline professional safeguard; it does not establish that every proposed treatment is suitable for you. You can check an osteopath through the GOsC website, a physiotherapist using the HCPC register guidance, or a chiropractor through the GCC patient portal. Useful questions include: What is your working explanation for my symptoms, and what remains uncertain? What are my options, including advice, exercise or choosing no hands-on treatment? What benefit is realistic, what are the risks and what evidence supports this approach? What will it cost, how many appointments are initially suggested, and when will we review progress? When would you change the plan or recommend another professional? You can ask for an explanation, decline a technique or stop an examination or treatment. This includes manipulation and needling. Consent should remain an ongoing conversation; agreeing to an appointment does not mean agreeing to every procedure. NHS options in Eastbourne and East Sussex You do not have to choose private treatment to seek help. Ask your GP practice about physiotherapy or a first-contact physiotherapist. NHS physiotherapy may also be available through local self-referral. East Sussex MSK’s published self-referral criteria currently include being aged 16 or over, having a muscle or joint problem lasting at least six weeks, and registration with a GP in its catchment area. Check the current self-referral information and eligibility FAQs before applying, because service arrangements can change. The six-week criterion is an access rule for that self-referral route, not advice to wait if you are worried. Contact your GP or NHS 111 sooner for concerning, worsening or urgent symptoms. Further reading: tests and longer-term support If you are considering an investigation, read Spinal X-rays: when are they useful?. For pain lasting more than three months, the persistent-pain guide explains assessment, treatment reviews and local NHS support. For more detail about specialist support, read what NHS pain clinics and pain management programmes do, including the different professionals involved and realistic expectations of treatment. Costs, expectations and your preferences Before booking privately, check the appointment length, fee, cancellation arrangements and any insurance requirements. Ask about likely review points rather than assuming you need a fixed or open-ended course. A useful plan gives you a role in your recovery and explains how decisions will be made if progress is limited. At Eastbourne Osteopathy, the first visit information explains assessment, consent and clothing. The fees and arrival page covers appointment costs and access. You can also read after your osteopathy appointment before deciding whether this approach suits you. For symptom-specific starting points, see knee pain, lower back pain, neck pain or the Conditions page. No single profession is the right choice for every problem. This guide explains options; it cannot decide which service an individual needs. Information sources checked: 13 October 2026. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. This general information supports, and does not replace, an individual assessment. Browse all patient guides. Sources and further information General Osteopathic Council: what to expect NHS: physiotherapy East Sussex MSK: getting help Reference links checked: 13 October 2026.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 16 October 2026. Pain that continues for more than three months is often described as persistent or chronic pain. It can affect sleep, work, relationships and confidence in movement. The pain is real, including when a scan or examination does not fully explain its intensity. This guide is about the longer-term picture. For soreness after a recent treatment, read After your osteopathy appointment; for a short-term increase in back symptoms, use the back pain flare-up guide. Start with an assessment, not an assumption Persistent pain can accompany an identifiable condition, such as arthritis or nerve injury. This is sometimes called chronic secondary pain. Chronic primary pain is a diagnosis used when no underlying condition adequately accounts for the pain or its impact. Both can occur together. These terms are not a judgement about how much pain you should feel. A clinician should consider the history, examination, relevant investigations and what has changed. New symptoms still deserve attention, even if you have lived with pain for years. Why can pain continue? Pain is influenced by more than the condition of one tissue. The nervous system can become more sensitive, and sleep, stress, previous experiences, illness and daily demands may affect how pain is experienced. The balance differs between people. This does not mean the pain is imagined, that you caused it, or that every symptom is harmless. A useful explanation should make sense of your experience without dismissing symptoms or promising a single correction. Build a plan around what matters to you A helpful starting point is one activity you would like to make easier: a short walk, preparing a meal, returning to a hobby or getting through a working day. Agree how to judge progress in that activity, alongside changes in pain. Find a manageable starting amount. This may be less than you can do on your best day. Spread demanding tasks through the day or week and allow recovery. Pacing should help you participate, rather than become a rule to avoid all discomfort. Change one demand at a time, such as duration, frequency or load, and see how you respond. Review sleep, practical help and work adjustments as part of the plan. Agree what a manageable flare looks like for you and which changes need medical review. There is no single exercise dose for everyone. The Getting active guide offers ideas for walking, gardening and everyday movement that can be adapted to your situation. What support may help? Depending on the assessment, care may involve a GP, physiotherapist, pain service, rheumatology team or another specialist. NICE recommends appropriate exercise programmes for chronic primary pain and says pain-focused CBT or acceptance and commitment therapy may be considered with suitably trained professionals. Psychological support is a way to reduce the impact of pain, not a claim that it is imaginary. For a fuller explanation of specialist support, read how NHS pain clinics and pain management programmes can help. It explains the roles of movement, sleep, emotions and expectations, and why none of this makes pain imaginary or your fault. Treatment recommendations differ between chronic primary pain and pain linked to another condition. Ask your prescriber about the purpose, benefit and risks of medicines. Do not stop or change prescribed medication abruptly because of something you read online. Osteopathic assessment may help clarify whether a musculoskeletal approach is suitable. If hands-on treatment is considered, agree a practical goal and a review point. It should support your wider plan and ability to manage between visits; repeated treatment without useful progress is a reason to reconsider the approach. Local NHS information East Sussex MSK and East Sussex Healthcare NHS Trust provide information about understanding persistent pain and managing its impact. Ask your GP or existing treating team which local assessment or pain-management route fits your needs. Eligibility and referral arrangements can differ between services. When to seek another assessment Seek medical advice for new or worsening symptoms, unexplained swelling, fever or feeling unwell, or a substantial loss of function. A sudden change should not automatically be labelled another flare. With back pain, new bladder or bowel disturbance, numbness around the genitals or anus, or symptoms affecting both legs can signal an emergency. Go to A&E immediately; do not drive yourself. Sources and further information NICE NG193: assessing chronic pain and managing chronic primary pain East Sussex MSK: understanding persistent pain East Sussex Healthcare NHS Trust: persistent pain resources NHS: ways to manage pain NHS: back pain and urgent symptoms Sources checked: 13 October 2026. This information supports individual assessment and an agreed care plan. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. This general information supports, and does not replace, an individual assessment. Browse all patient guides.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 16 October 2026. When familiar back pain becomes more troublesome, ordinary tasks can feel difficult. A flexible plan can help you decide what to keep doing, what to adapt and when to seek advice. This guide focuses on managing familiar episodes of back pain. Check the warning signs first: new or different symptoms should not automatically be treated as another flare-up. First, check whether you need medical help Call 999 or go to A&E for back pain with symptoms in both legs; reduced feeling around the genitals or anus; new bladder, bowel or sexual-function changes; chest pain; or pain following a serious accident. Do not drive yourself. Contact your GP urgently or NHS 111 if you feel feverish or generally unwell, or severe pain starts suddenly or worsens rapidly. NHS emergency and urgent advice New or worsening leg weakness, including difficulty lifting your foot or a dragging foot, also needs urgent medical advice. Do not wait for a routine treatment appointment. NHS guidance on leg weakness, page 2 Keep some everyday movement Try to keep up manageable daily activities and avoid long periods in bed. Short rests can fit around movement. A wrapped heat or cold pack may help with symptoms. Ask a pharmacist or GP about suitable pain relief. NHS self-care advice With persistent pain, an increase in pain does not automatically mean new damage. That does not make the pain imaginary, or mean you should ignore changed symptoms. Leeds NHS information about persistent pain Make tasks easier to manage Pacing means planning activity in manageable parts. It can help when a busy day is followed by a long period of doing very little. The aim is to support everyday activity and gradually build what you can manage. Leeds NHS advice on pacing These examples are suggestions to adapt, not a fixed schedule or exercise prescription. Walking Choose a short, familiar route with somewhere to pause if needed. Staying near home may be easier than committing to a long outing. Use what you can currently manage as your starting point. Housework Break a large job into smaller tasks. You might clean one room, leave the next for another day, or alternate a demanding task with something easier. Decide what matters today and what can wait. Desk work Break up a long spell at the computer with a change of position or another task. Stand to make a drink, walk briefly or take a seated break elsewhere. A reminder may help if you become absorbed in work. Choose timings that suit you. NHS examples of pacing and changing activities If work is difficult, discuss temporary adjustments with your employer. NICE recommends supporting a return to work and normal daily activities. NICE NG59, recommendation 1.2.15 Build activity back up Once your starting amount is manageable, try a small increase: extend the walking route slightly or complete another part of a household task. Changing one thing at a time can make the result easier to judge. There is no universal number of minutes or percentage increase. Notice how you manage during the activity and afterwards, alongside other daily tasks. A short note can help you spot a useful pattern. If a step up proves difficult, adjust it and reassess. Pacing should leave room to build activity, rather than becoming a permanent limit. NHS guidance on progressing activity Stop an exercise that worsens your pain and seek advice. NHS exercise advice Write a short plan for difficult days When pain is distracting, a few notes can save you having to make every decision again. Include: Activities you can usually manage. Tasks you could shorten, share or postpone. Things that have helped you feel more comfortable. Someone you can contact for practical support. Symptoms that mean you should seek medical help. Review the plan after the episode. Keep what helped and change what did not. Flare-ups can occur despite sensible self-management; having one does not mean you have failed. NHS flare-up planning guidance When an assessment may help See a GP if pain is not improving after a few weeks, limits daily activities or is difficult to cope with. NHS advice on seeking help If you would like help choosing manageable activities, an assessment at Eastbourne Osteopathy can explore your symptoms and whether medical assessment is needed. Advice and exercise should reflect your abilities and preferences. NICE self-management and exercise recommendations For causes, treatment options, sciatica and scans, read our lower back pain guide. When pain is part of a longer-term problem If pain has lasted more than three months, read Persistent pain: understanding it and finding support. It covers the longer-term care plan, pacing and local NHS resources alongside advice for an individual flare. If persistent pain remains difficult to manage, our guide to NHS pain clinics and pain management programmes explains specialist assessment, supported rehabilitation and the benefits people may gain. Sources and further reading NHS: Back pain — self-care and when to seek medical help. NICE NG59: Low back pain and sciatica in over 16s — recommendations 1.2.1, 1.2.2 and 1.2.15. Leeds Community Healthcare NHS Trust: Managing your pain. Cambridge University Hospitals NHS Foundation Trust: Pacing for pain management (2023). Cambridge University Hospitals NHS Foundation Trust: Flare-up and setback management (2024). Tyneside Integrated Musculoskeletal Service: Leg pain linked to low back pain (sciatica), May 2024; page 2. Related patient guides After your osteopathy appointment Choosing the right help for muscle and joint pain Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. This general information supports, and does not replace, an individual assessment. Browse all patient guides. Reference links checked: 13 October 2026.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 16 October 2026. A stiff or painful neck can make checking over your shoulder, working at a desk or getting comfortable in bed difficult. Symptoms may begin suddenly, build up gradually or return from time to time. At Eastbourne Osteopathy, I take time to understand the problem and how it affects you. An assessment helps us decide whether care here is appropriate and what you can do to manage your symptoms. On this page: Medical help · Arm symptoms · Self-care and exercise · Treatment choices · Scans · GP and specialist care Your appointment in Eastbourne First appointment £70 · approximately 60 minutes. Follow-ups £60 · approximately 30 minutes. Andy Duckmanton, GOsC Registered Osteopath. Natural Fitness and Therapies, Royal Parade, Eastbourne BN22 7AQ. Book a first appointment | Call 01323 335052 When to get medical help Call 999 for neck symptoms accompanied by new difficulty walking, sudden loss of coordination or loss of bladder or bowel control. A stiff neck with a severe headache, fever, confusion or sensitivity to light can be a sign of meningitis. If you suspect meningitis, call 999 or go to A&E; do not wait for a rash. Call 999 for sudden facial drooping, arm weakness or difficulty speaking, or sudden loss of vision or marked loss of balance. These can be stroke symptoms, even if they improve. Do not drive yourself to A&E. Seek an urgent GP appointment or NHS 111 advice for severe neck pain that starts suddenly or worsens quickly, new or increasing arm or leg weakness, or tingling accompanying neck and arm pain. Significant injury also needs prompt medical assessment. See a GP if pain persists for several weeks, you have a cold arm, unexplained weight loss or other symptoms that concern you. These signs should be assessed before a routine treatment appointment. What may be contributing Neck pain can involve muscles, joints and surrounding tissues. It may follow an unfamiliar activity, an awkward sleeping position or long periods in one position. Sometimes there is no clear trigger. Age-related changes in the neck are common and do not always cause symptoms. Sleep, general health and stress can also influence how pain is experienced. An assessment considers the wider picture instead of assuming there is one cause. Pain spreading towards the shoulder or arm The neck can refer pain towards the shoulder blade or arm. Irritation of a nerve may also cause symptoms such as tingling, numbness or weakness further down the arm or into the hand. These symptoms have more than one possible explanation. Tell me where you feel them, whether they are changing and whether you have noticed difficulty gripping or using your hands. New or worsening neurological symptoms need medical advice. New difficulty with buttons or handwriting, dropping things, limb heaviness or worsening balance can sometimes indicate pressure on the spinal cord. East Sussex MSK advises immediate A&E assessment for a combination of these warning signs. Do not wait for bladder or bowel symptoms. Call 999 if walking becomes newly difficult or coordination is lost suddenly. NHS inform: Cervical radiculopathy — nerve-related neck and arm symptoms Read about shoulder pain Managing work, sleep and everyday movement Work and desk tasks For uncomplicated neck pain, keep gently moving within a comfortable range and change position regularly. Break up long periods at a desk or looking down at a device. Adjust your screen and work position so you are not holding your head turned for long periods. Sleep and comfort At night, try a pillow that supports your head in line with your body and avoid sleeping with your neck twisted. Heat or cold packs may provide temporary comfort; protect your skin with a cloth. A pharmacist can advise on suitable pain relief. Returning to everyday activity For persistent neck pain, exercise may include neck and shoulder-blade strengthening, endurance work and general physical activity. Research has not identified one approach that is consistently best for everyone. Choose a manageable starting point and build up according to your goals and response. An individual plan is preferable if you have arm symptoms, a recent injury or other health concerns. Do not drive or cycle if restricted movement prevents you from checking around you safely. Avoid forcing stretches or continuing exercises that cause new or worsening arm symptoms. How might rehabilitation progress? For example, if desk work is your main difficulty, we might begin with manageable periods of work, regular movement breaks and a few exercises you can do comfortably. As these become easier, we can adjust repetitions, resistance or time spent on the task. Your starting point and progression will depend on your assessment and response. We can track goals that matter to you, such as working more comfortably, turning your head or sleeping better. What your assessment involves We will discuss when the problem began, any injury, what changes your symptoms and how work, sleep and daily activities are affected. Your medical history, medicines and previous investigations are also relevant. I will examine the movements and areas relevant to your symptoms. Where appropriate, this can include checks of arm strength, sensation and reflexes. I will explain the findings and whether treatment, self-management advice or further medical assessment is suitable. Treatment choices and your preferences Where appropriate, osteopathic care may include hands-on techniques for muscles and joints alongside advice about movement and exercise. The approach takes account of your symptoms, health and preferences. A Cochrane review published in December 2025 found that manual therapy combined with exercise may improve everyday function but make little or no difference to pain compared with sham treatment. Compared with no treatment, larger benefits were reported. The evidence mainly concerned persistent neck pain, and confidence in the findings was low. This does not establish that manipulation is essential or that one profession provides better care. Harms were incompletely reported, so the review cannot rule out rare serious adverse events. You can choose advice and exercise without manipulation. Hands-on care can cause temporary soreness or a short-lived symptom flare. Rare serious neurological or blood-vessel events have been reported following cervical manipulation. Their frequency and the contribution of treatment are difficult to establish; small trials cannot exclude rare harm. A normal examination or neck-position test cannot reliably rule out every blood-vessel problem. Neck manipulation is not a requirement of an appointment. If a technique is proposed, I will explain its purpose, relevant risks and alternatives. You can ask questions, decline it or stop treatment at any time. Tell me if your symptoms change or the agreed plan is not helping. How long will it take to improve? Many episodes settle within a few weeks, but persistent or recurring symptoms can take longer. There is no fixed number of appointments that suits everyone. We will review your progress and discuss whether to continue, change the approach or seek another opinion. Common questions Physiotherapy or osteopathy for neck pain? Both can include assessment, advice, exercise and hands-on treatment, although the approach varies between practitioners. Physiotherapists are regulated by the Health and Care Professions Council; osteopaths by the General Osteopathic Council. Ask how the proposed care will support your goals, what you can do yourself and how progress will be reviewed. Do I need an X-ray or MRI? Many episodes of neck pain can be assessed without a scan. Further investigation depends on the history, examination and whether the result would affect your care. If it is indicated, I will explain the appropriate medical route. Scans may be useful after significant injury, for worsening nerve symptoms or when another medical condition is suspected. Age-related changes are common and do not always explain pain. Scan findings need to be interpreted alongside your symptoms and examination. The guide to spinal X-rays explains what these images can show, the limits of routine imaging and questions to ask before an investigation. When might I need GP or specialist treatment? If neck pain is not settling after a few weeks, or is disrupting sleep or everyday activities, a GP can review pain relief and physiotherapy options. A pharmacist can advise on medicines suitable for you, taking account of other medicines and health conditions. East Sussex MSK offers physiotherapy self-referral for eligible local patients. Check whether your GP practice is covered and read the current eligibility criteria. These include age 16 or over and symptoms lasting at least six weeks. Do not delay GP or urgent advice while waiting to meet self-referral criteria. For persistent nerve-related arm pain, a specialist may discuss a targeted injection. Relief can be temporary, some people get no benefit, and the possible benefits and risks need careful discussion. Surgery is not usual treatment for uncomplicated neck pain. It may be considered for selected cases of nerve compression or pressure on the spinal cord. Worsening weakness, hand clumsiness or balance changes need prompt medical assessment; follow the urgent advice above rather than waiting for a routine referral. Is clicking or creaking a cause for concern? Neck noises are common and, on their own, rarely indicate damage. The symptoms around them matter more than the sound. If new noises follow an injury, or occur with weakness, numbness or balance changes, follow the medical-help advice above. Northumbria NHS neck guidance. Can neck pain cause headaches or dizziness? Some headaches arise from the neck, but migraine and other headache disorders can also involve neck stiffness. Dizziness has several possible causes and should not automatically be attributed to the neck. New or changing symptoms may need medical assessment. Call 999 for a sudden, extremely painful headache that does not go away, or the stroke symptoms listed above. Read our guide to neck-related headaches. What if my neck pain followed an injury? Neck pain after a fall, collision or other injury needs advice suited to the injury; the general movement advice above may not apply initially. Follow any medical advice you have been given. Once serious injury has been excluded, gradually returning to everyday activities is usually encouraged for whiplash. Seek medical advice if symptoms are severe, worsening or accompanied by the warning signs above. Appointments at the Eastbourne clinic I am Andy Duckmanton, a GOsC-registered osteopath who qualified in 2007. The clinic is at Natural Fitness and Therapies, Royal Parade, Eastbourne BN22 7AQ, on the seafront promenade beside the Redoubt Fortress. First appointment £70 · approximately 60 minutes. Follow-ups £60 · approximately 30 minutes. Book a first appointment | Call 01323 335052 There are three entrance steps and one internal step. Please call before booking if you have access needs. See online booking for current appointment availability, or call if you cannot find a suitable time. Location, fees and cancellation terms | About Andy | Your first appointment For more on assessment and treatment, read why treatment can still help when the exact cause of pain is unclear. Sources and further reading Research and clinical guidance 1. Davies BM, Mowforth OD, Smith EK, Kotter MRN. Degenerative cervical myelopathy. BMJ. 2018;360:k186. DOI · Free full text 2. Wilhelm M, Cleland J, Carroll A, Marinch M, Imhoff M, Severini N, Donaldson M. The combined effects of manual therapy and exercise on pain and related disability for individuals with nonspecific neck pain: A systematic review with meta-analysis. Journal of Manual & Manipulative Therapy. 2023;31(6):393–407. DOI · Free full text 3. Pankrath N, Nilsson S, Ballenberger N. Adverse Events After Cervical Spinal Manipulation – A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Pain Physician. 2024;27(4):185–201. DOI · PubMed abstract 4. Yaghi S et al. Treatment and Outcomes of Cervical Artery Dissection in Adults: A Scientific Statement From the American Heart Association. Stroke. 2024;55(3):e91–e106. DOI · PubMed abstract 5. Rasmussen-Barr E et al. Summarizing the effects of different exercise types in chronic neck pain – a systematic review and meta-analysis of systematic reviews. BMC Musculoskeletal Disorders. 2023;24:806. DOI · Free full text 6. El-Allawy A, Hecht N, Luedtke K, Schleicher P, Weidner N, Kötter T. Clinical Practice Guideline: Nonspecific Neck Pain. Deutsches Ärzteblatt International. 2025;122(20):552–557. DOI · Free full text 7. Seemungal BM et al. The Bárány Society position on ‘Cervical Dizziness’. Journal of Vestibular Research. 2022;32(6):487–499. DOI · Free full text 8. Rushton A et al. International IFOMPT Cervical Framework (2020): assessment for possible vascular pathology before cervical manual therapy. Framework PDF 9. Chacko N and colleagues. Manual therapy with exercise for neck pain. Cochrane Database of Systematic Reviews. 2025;12:CD011225. Cochrane summary · DOI: 10.1002/14651858.CD011225.pub2 Patient information and professional standards NHS: Neck pain — self-care and when to seek advice NHS inform: Cervical radiculopathy NHS: Cervical spondylosis · Stroke symptoms · Subarachnoid haemorrhage · Whiplash East Sussex MSK: Early warning signs of spinal cord compression · Physiotherapy self-referral Hull University Teaching Hospitals NHS Trust (2026): Cervical nerve root block / transforaminal epidural steroid injection HCPC: Professions we regulate · General Osteopathic Council: Training and registering General Osteopathic Council: What to expect at your appointment Institute of Osteopathy: Muscle and joint conditions — individual assessment and shared decisions Existing reference links checked: 12 October 2026. Cochrane 2025, Northumbria neck guidance and East Sussex MSK eligibility checked: 16 October 2026. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. This general information supports, and does not replace, an individual assessment. Browse all patient guides.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 16 October 2026. Lower back pain is one of the most common problems I assess at my Eastbourne osteopathy clinic. I will ask what it is stopping you from doing and what you would like to get back to. What matters first Most lower back pain is non-specific: there is no single clearly identifiable cause. Manageable activity is usually helpful, and improving symptoms may need only self-care. Assessment also checks for problems needing medical attention. X-rays and MRI scans are not routinely necessary. On this page When to get medical help Self-care and exercise Causes and recovery Osteopathy and physiotherapy Sciatica and specialist care Recurring pain and progress Your appointment in Eastbourne First appointment £70 · approximately 60 minutes. Follow-ups £60 · approximately 30 minutes. Andy Duckmanton, GOsC Registered Osteopath. Natural Fitness and Therapies, Royal Parade, Eastbourne BN22 7AQ. Book a first appointment | Call 01323 335052 When back pain needs medical help Call 999 or go to A&E for back pain with any of the following: Symptoms affecting both legs, including pain, tingling, weakness or numbness. Reduced sensation around the genitals or anus; new bladder or bowel changes, such as difficulty passing urine or loss of control; or new changes in genital sensation or sexual function. Chest pain, or pain beginning after a serious accident. Do not drive yourself to A&E or wait for an osteopathy appointment. Ask for an urgent GP appointment or contact NHS 111 if back pain comes with feeling feverish, shivery or generally unwell, or severe pain starts suddenly or worsens quickly. Seek urgent medical advice for new or worsening leg weakness, such as difficulty lifting your foot or a foot that starts dragging. Contact your GP urgently or NHS 111; do not wait for a routine osteopathy appointment. Follow the emergency instructions above if any of those warning signs are present. NHS guidance on leg weakness (page 2) See a GP if pain is not improving after a few weeks, limits everyday activities, is worse at night, or comes with unexplained weight loss. The NHS back-pain page gives fuller guidance. NHS back-pain guidance What can I do to help my back pain? If your symptoms are manageable and improving, self-care may be enough. Keep track of your progress and follow the medical-help advice above if warning symptoms develop or the pain is not improving. NHS self-care advice Keep moving and continue manageable daily activities rather than staying in bed. Try short, comfortable bouts of activity. Wrapped heat or cold packs may help temporarily. Stop an exercise that worsens pain and seek advice. Ask a pharmacist or GP which pain relief is suitable for you. Anti-inflammatory medicines such as ibuprofen are not suitable for everyone. Paracetamol on its own is not recommended for lower back pain. NHS pain-relief advice If you are unsure how to start exercising, an assessment can help you choose a starting point. Seek medical advice first if pain is severe or worsening, or you have new leg weakness or other warning symptoms listed above. Which exercises can help persistent back pain? Exercise can help reduce persistent non-specific back pain and improve everyday function, although average gains in function are smaller. Walking, other aerobic activity and strengthening are all options. Choose something you can manage and are willing to continue. Cochrane exercise review · NICE exercise guidance Start with a manageable amount, then increase gradually. For example, a short walk may be a better starting point than a long outing. Pilates or adapted yoga are also options, but neither is essential. Yoga has not shown a clear advantage over other back-focused exercise. If an exercise worsens your pain, stop and seek advice. Cochrane yoga review NHS advice on starting small and building up For example, if walking is difficult, we might start with a short distance you can manage, then review how you feel during and afterwards before increasing it. The aim is a useful return to your activities, with the starting point and progression adjusted to your response. Choose a practical guide For practical ideas on adapting walks, housework and desk work, read our back pain flare-up guide. For pain lasting more than three months, Persistent pain: understanding it and finding support covers assessment, practical goals and local NHS resources. For symptoms travelling down the leg, read the sciatica guide, including when to seek medical help. Low back pain treatment Causes of lower back pain Muscles, joints, discs and nerves can all contribute to back pain. Often, an examination cannot identify one structure as the cause. This is called non-specific lower back pain. The assessment focuses on your symptoms, movement and daily activities, while checking for conditions that need different care. How long does back pain last? A recent episode of non-specific low back pain often improves considerably in the first six weeks, although some symptoms can last longer. Recovery times vary. Recovery research (CMAJ, 2024) Pain lasting more than three months is usually called persistent or chronic pain. This describes its duration; it does not, by itself, mean permanent damage. Pain can continue after an injury has healed. New or changing symptoms still need assessment rather than being dismissed as part of an old problem. NHS information on persistent pain Muscles, joints and discs Muscles and spinal joints can contribute to pain after unfamiliar activity or alongside age-related changes. Tenderness and restricted movement help guide the assessment, but do not reliably identify one painful structure. Changes seen on scans can also occur in people without symptoms. Discs sit between the bones of the spine. A “slipped disc” has not literally slipped: part of it has bulged or pushed out. If a nearby nerve is irritated or compressed, this can cause leg pain, tingling, numbness or weakness. Not every disc problem causes symptoms, and not all sciatica is caused by a disc. NHS: slipped disc Changes seen on a scan do not necessarily explain your pain; disc bulges and age-related changes can also be found in people without back pain. Scan findings need to be checked against your symptoms and examination. Routine imaging is not usually needed for uncomplicated back pain or sciatica. Even a specialist referral does not automatically mean you need a scan: it is considered when the result is likely to change your care. NICE guidance on scans Osteopathic treatment for lower back pain At your first appointment, I ask about your pain, general health and the activities you are struggling with. I examine your back and any other areas relevant to your symptoms, and check whether you need further medical assessment. We then discuss what may help. Depending on the assessment, this could include exercises, advice on daily activities and hands-on treatment such as joint mobilisation, manipulation or soft tissue techniques. Mobilisation uses controlled movements of a joint. Manipulation uses a brief, controlled thrust. You can ask which technique is being suggested and why. Cochrane: manual treatment explained For low back pain, with or without sciatica, NICE says manual therapy should only be considered as part of a treatment package that includes exercise. NICE NG59 guidance on manual therapy and exercise Hands-on treatment is optional. You can choose advice and exercise without manipulation. A 2026 Cochrane review found little average difference in pain and a small improvement in everyday function at one month compared with other non-surgical care for persistent back pain. The evidence was uncertain. These findings concern manipulation and mobilisation; they do not show that osteopathy as a profession is better than other forms of care. Cochrane review, 2026 Before treatment, I explain the possible benefits, relevant risks and alternatives, and ask for your consent. You can ask questions or ask me to stop. Temporary soreness can occur afterwards; contact me if you are concerned, and follow the urgent medical advice above for warning symptoms. GOsC appointment guidance Physiotherapy or osteopathy? Physiotherapists and osteopaths can both offer assessment, exercise advice and hands-on treatment. Approaches vary between practitioners, so ask what the plan involves and how progress will be checked. Physiotherapists are regulated by the HCPC and osteopaths by the GOsC. NHS physiotherapy · GOsC: what to expect For NHS physiotherapy locally, the East Sussex MSK Community Partnership offers self-referral for eligible patients. Check whether your GP practice is covered and read the current eligibility information before applying. Is lower back pain the same as sciatica? No. Sciatica usually causes pain travelling from the buttock down the leg, sometimes with tingling, numbness or weakness. It happens when a nerve supplying the leg is irritated or compressed. You can have back pain without sciatica, or sciatica with very little back pain. The examination helps check for signs of nerve involvement. When might a specialist opinion help? If sciatica remains disabling despite non-surgical care, a GP or specialist can discuss further assessment. Surgery to relieve pressure on a spinal nerve may be considered when pain or function has not improved and scan findings match the symptoms. NICE guidance on surgery for sciatica Call 999 or go to A&E now for any emergency symptoms listed above. NHS emergency guidance What if the pain keeps returning? It can help to note what was happening around each episode, including changes in activity or work. We can use this to plan exercise and ways to manage a flare-up. Repeated hands-on treatment is not automatically the best answer. After recovery from an episode of non-specific back pain, the WalkBack trial found that an individual walking programme combined with education delayed another episode that limited activity. Physiotherapists supported the programme. This supports a gradual, supported return to activity; it does not establish the same benefit from walking alone. WalkBack trial (The Lancet, 2024) Persistent pain can disrupt sleep, work and mood as well as movement. Tell your clinician which of these are affecting you, so they can be included in your care. Addressing these difficulties does not mean the pain is imagined. New or changing symptoms still need medical assessment. WHO guidance on low back pain How will we judge progress? We agree on a few practical goals, such as walking, dressing, sleeping or working more comfortably. At follow-up, we review those activities, your pain and how the exercises are going, then decide whether the plan needs to change. What if treatment is not helping? If treatment is not helping, we reconsider the assessment and discuss changing or stopping treatment, other rehabilitation options or medical advice. New or worsening symptoms need earlier review. There is no fixed course of treatment that everyone must complete. About the author Andy Duckmanton BOst (Hons) is a registered osteopath (GOsC registration 6400) who has been practising since 2007. He assesses and treats patients with lower back pain at his Eastbourne clinic. The clinic is on the seafront promenade beside the Redoubt Fortress. There are three entrance steps and one internal step. Please call before booking if you have access needs. See online booking for current appointment availability, or call if you cannot find a suitable time. Location, fees and cancellation terms | About Andy | Your first appointment Book a back pain appointment If you would like help with your back pain, you can book an assessment with me at Eastbourne Osteopathy. We will discuss what the findings mean and what to do next. If you need medical investigation, I will explain the next steps. More about scans Wondering whether you need an X-ray or scan? Spinal X-rays: when are they useful? explains what imaging can show and when it can change care. For more on assessment and treatment, read why treatment can still help when the exact cause of pain is unclear. Sources and further reading NHS: Back pain — symptoms, self-care and when to seek help NICE NG59: Low back pain and sciatica — recommendation 1.2.7 General Osteopathic Council: What to expect at your appointment Institute of Osteopathy: Muscle and joint conditions — individual assessment and shared decisions Hayden JA and colleagues. Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews. 2021; CD009790. de Zoete A and colleagues. Spinal manipulative therapy for adults with chronic low back pain. Cochrane Database of Systematic Reviews. 2026; CD008112. Wallwork SB and colleagues. The clinical course of acute, subacute and persistent low back pain: a systematic review and meta-analysis. CMAJ. 2024;196:E29–E46. NICE NG59: additional recommendations on exercise (1.2.2), imaging (1.1.4–1.1.6) and spinal decompression for sciatica (1.3.8). NHS: Physiotherapy — assessment, treatment and access World Health Organization: Low back pain — rehabilitation and self-care Pocovi NC and colleagues. Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial. The Lancet. 2024;404(10448):134–144. Wieland LS and colleagues. Yoga for chronic non-specific low back pain. Cochrane Database of Systematic Reviews. 2022;(11):CD010671. Leeds Community Healthcare NHS Trust: Understanding chronic or persistent pain. Tyneside Integrated Musculoskeletal Service: Leg pain linked to low back pain (sciatica), May 2024. Page 2: new leg weakness. NHS: Slipped disc — symptoms and treatment. NHS back-pain and slipped-disc guidance checked: 15 October 2026. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. This general information supports, and does not replace, an individual assessment. Browse all patient guides.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 15 October 2026. A cervicogenic headache is a headache attributed to a problem in the neck. Neck pain or stiffness can also accompany other headache disorders, so these symptoms alone do not confirm the cause. Assessment considers the headache pattern, medical history and neck findings before deciding whether osteopathic care is appropriate. When to seek medical help Call 999 or go to A&E for a sudden, extremely painful headache, or headache with weakness, numbness, speech or balance problems, confusion, a seizure or loss of vision. A headache following a head injury within the past three months, or with signs of meningitis such as a high temperature and stiff neck, also needs emergency assessment. Do not drive yourself to A&E. Contact your GP urgently or NHS 111 for headache with eye or vision problems, vomiting, jaw pain when eating or a tender scalp, or a headache triggered by coughing, bending or exercise. See your GP if headaches recur, worsen or do not improve. Do not delay medical care while waiting for an osteopathy appointment. See NHS advice on headaches and urgent symptoms for further guidance. How is a neck-related headache assessed? Migraine can include neck stiffness, nausea and sensitivity to light or sound. Aura is not always present. The NHS migraine guide explains these features. A headache on one side, or one that changes with neck movement, does not by itself establish a neck-related cause. Assessment includes how the headache began, its frequency, associated symptoms and whether neck movement changes the familiar pain. The International Headache Society criteria require evidence of a neck disorder capable of causing headache and evidence that the two are linked, with other explanations considered. For example, the headache may have begun with a neck problem and improve as that problem improves. Restricted movement or tenderness alone is insufficient. Changes seen on a neck scan are also common in people without headaches, so an imaging finding alone does not prove the cause. The upper back, shoulders and daily activities Assessment may include the upper back, shoulders and the activities or positions that affect your symptoms. Stiffness or muscle tenderness in these areas does not, by itself, establish the cause of a headache. Advice may include comfortable movement, breaks from prolonged positions and an individual exercise plan. Discuss which activities matter most to you, rather than aiming for a single ‘perfect’ posture. Keep a useful headache diary For headaches being assessed as possible migraine or another primary headache disorder, NICE CG150 suggests recording a diary for at least eight weeks. Note: When headaches happen, how long they last and how severe they feel. Other symptoms and possible triggers. All prescribed and over-the-counter headache medicines, with the days taken. Any relationship to periods, if relevant. Also record effects on sleep, work and usual activities. Bring the diary to your assessment and use it to judge progress. Do not delay medical assessment or urgent care while completing it. Could frequent painkiller use be contributing? In NICE’s guidance on medication overuse headache, a warning pattern is headache that develops or worsens during at least 3 months of taking triptans, opioids, ergots or combination painkillers on 10 or more days a month, or paracetamol, aspirin or non-steroidal anti-inflammatory painkillers (alone or combined) on 15 or more days a month. These are warning thresholds, not recommended allowances. If you need headache medicine often, ask your GP or pharmacist to review it and agree a plan. Do not abruptly stop a prescribed opioid without medical advice. Treatment options and the evidence Where assessment supports a neck-related headache and osteopathic care is suitable, we can discuss an individual plan. Options may include exercises, advice about activity and appropriate manual techniques. I will explain the expected benefits, limitations, risks and alternatives, and obtain your consent before treatment. Improvement or prevention of future headaches cannot be guaranteed. A 2022 systematic review by Bini and colleagues found that manual and exercise therapy may help cervicogenic headache, but most included trials had a high risk of bias. Results from the lower-risk trials suggested smaller benefits. This supports realistic expectations and review of your response; it does not establish a cure or apply to every headache type. NICE CG150 guides care for migraine, tension-type, cluster and medication overuse headaches; the treatment evidence above comes from research on cervicogenic headache. If migraine is suspected, your GP can discuss suitable acute and preventive treatment. The GOsC consent standards require discussion of benefits, risks and alternatives. Ask about exercise-based care or other suitable techniques if you prefer to avoid neck manipulation; you can decline any proposed technique. Agree how progress will be reviewed Useful goals include fewer headache days, improved sleep or easier everyday movement. Agree when to review the plan and what would prompt referral. GOsC’s safe-care standards require treatment response to be monitored and care changed or stopped when it is ineffective or no longer in your interests. Relevant shoulder or jaw symptoms may also be considered during assessment. Persistent, worsening or changing headaches may need medical review. You can also read about neck pain assessment before arranging an appointment. Sources and further information NHS: headaches and when to seek urgent help NHS: migraine symptoms and treatment NICE CG150: headache assessment, diaries and medication overuse International Headache Society: ICHD-3 cervicogenic headache criteria Bini and colleagues (2022): systematic review of manual and exercise therapy (PubMed) GOsC: communication, care choices and consent (standards A3–A4) GOsC: assessment, review and referral (standard C1) Sources checked: 15 October 2026. Clinical guidance, research evidence and professional standards serve different purposes; the links above identify each source. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. This general information supports, and does not replace, an individual assessment. Browse all patient guides.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 15 October 2026. Benign paroxysmal positional vertigo (BPPV) is an inner-ear condition that causes short episodes of spinning with particular head movements. This page explains the symptom pattern and when to seek help. A separate guide covers BPPV assessment and the Epley manoeuvre in Eastbourne. Dizziness that needs urgent help Call 999 or go to A&E if vertigo comes with double vision or loss of vision, hearing loss, trouble speaking, or weakness, numbness or tingling in an arm or leg. Do not drive yourself. Sudden, ongoing vertigo with new difficulty walking also needs emergency assessment via 999 or A&E. Do not wait for a routine BPPV appointment. See NICE’s guidance on sudden-onset dizziness. Seek an urgent GP appointment or NHS 111 help for vertigo with a severe headache, marked nausea or vomiting, or a high temperature or shivering. New symptoms should not be assumed to be a recurrence of BPPV. These urgent-care symptoms are based on NHS guidance on vertigo. What does BPPV usually feel like? A brief spinning sensation may occur when rolling in bed, lying back or looking upwards. The spinning commonly lasts less than a minute, although nausea or a sense of imbalance can linger afterwards. BPPV is different from simply feeling faint on standing. Continuous severe dizziness, new hearing changes, blackouts or other new symptoms need a broader medical assessment. Vestibular migraine is another possible cause. NICE NG127 highlights episodes lasting between five minutes and 72 hours in people with recurrent headaches. Duration alone does not establish the diagnosis. “Benign” describes the condition; it does not mean the symptoms are trivial. BPPV can affect confidence, sleep, walking and the risk of falling. What to tell the clinician Describe whether you feel spinning, unsteadiness or faintness, and how long each episode lasts. Note the movements that bring it on, any falls, and whether you feel well between episodes. Mention hearing changes, headaches, recent injury or illness, and all medicines you take. What happens in the inner ear? Tiny calcium-carbonate crystals normally sit in one part of the balance organ, the utricle. If they enter a semicircular canal, changes in head position can trigger an inappropriate balance signal and spinning. Often there is no obvious reason. BPPV can also follow a head injury or another inner-ear problem. Similar dizziness can have other causes, including migraine, medicines and other balance disorders. How is the cause checked? Assessment combines your history and examination. NICE recommends a Hallpike test by a trained healthcare professional for brief spinning triggered by head movement. During supported changes of position, the clinician watches for a characteristic involuntary eye movement called nystagmus. Unclear findings may need another positional test or referral. The specialist BPPV guideline explains why assessment matters before choosing a manoeuvre. Epley and other repositioning manoeuvres are designed for particular patterns of BPPV. They are not general treatments for every kind of dizziness. Do not copy a home manoeuvre for unexplained symptoms without checking that it is appropriate. Staying safer while dizzy Sit down when spinning begins. Get up carefully, use suitable support if unsteady and keep routes around the home clear. Good lighting at night and help with steps can reduce avoidable difficulty. Avoid driving, ladders and machinery while dizzy. Ask for individual advice about returning to these activities. GOV.UK guidance says you must tell DVLA about dizziness that is sudden, disabling or recurrent. If symptoms persist or come back Arrange assessment if vertigo does not settle or keeps returning. If a previous manoeuvre helped but the symptoms recur, reassessment can check whether the same problem is present; a changed symptom pattern deserves particular attention. Choosing the next step A GP can assess unexplained dizziness and arrange further care where needed. At Eastbourne Osteopathy, Andy offers BPPV assessment and repositioning where appropriate. The GOsC standards on knowledge and competence require osteopaths to work within their training and skills and consider referral when another professional’s assessment is needed. Read what to expect before, during and after an Epley appointment, or contact the clinic to discuss whether this is the right starting point. Sources and further information NHS: vertigo and urgent warning signs NICE NG127: dizziness, BPPV assessment and referral (section 1.2) Royal Berkshire NHS: Dix-Hallpike and Epley manoeuvres (patient leaflet, 2024) AAO-HNSF: clinical practice guideline for BPPV (2017; PubMed) GOV.UK: dizziness or vertigo and driving GOsC: knowledge, skills and limits of competence (standards B1–B2) Sources checked: 15 October 2026. General patient information; assessment and care depend on your individual circumstances. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Browse all patient guides.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 15 October 2026. This guide explains a BPPV appointment at Eastbourne Osteopathy: preparation, testing, treatment choices and follow-up. For the usual symptom pattern and other causes of dizziness, see BPPV and dizziness: when to seek help. When routine assessment is not the right route Vertigo with double vision or loss of vision, hearing loss, speech difficulty, or arm or leg weakness, numbness or tingling needs 999 or A&E. Do not drive yourself. Severe headache, marked nausea or vomiting, or fever with vertigo needs urgent GP or NHS 111 advice. A previous BPPV diagnosis does not explain every later episode. Sudden, ongoing vertigo with new difficulty walking needs emergency assessment via 999 or A&E. See NHS urgent advice and NICE guidance on dizziness. Before the appointment Mention dizziness or BPPV when contacting the clinic so the appropriate appointment can be discussed. Bring a current medicine list and details of previous dizziness assessment or treatment. Tell Andy about neck or back difficulties, recent operations, circulation problems, stroke, pregnancy or anything that makes lying back or turning difficult. Wear comfortable clothing that allows supported changes of position. Consider bringing someone who can help you travel home. Do not plan to drive immediately after a manoeuvre or while dizzy. There are three entrance steps and one internal step at the clinic. Please call first if balance or access is a concern. See location and fees. History, examination and consent Andy will ask when dizziness occurs, how long it lasts, what triggers it and whether there are hearing, headache, fainting or neurological symptoms. Medical assessment or referral may be the appropriate next step. The Dix-Hallpike manoeuvre is a diagnostic test; Epley is a treatment. Testing uses supported changes in head and body position while eye movements are observed to help identify the affected ear and canal. If testing is inconclusive, Andy will explain whether further testing or referral is appropriate. Testing can briefly bring on spinning or nausea. The procedure and alternatives will be explained; you can ask questions, decline or ask to stop. Positioning may need modification, or testing may be unsuitable. NICE recommends repositioning by a trained practitioner when BPPV is confirmed. People with unstable cervical spine disease need referral through an appropriate pathway. See NICE NG127, recommendation 1.2.6. The GOsC consent standards require an explanation of likely benefits, material risks and alternatives, with ongoing consent. You can decide not to proceed or withdraw consent during the appointment. What the Epley manoeuvre does Epley uses a sequence of positions to move displaced crystals out of the posterior semicircular canal, a common location for BPPV. Another canal or diagnosis may need a different approach. Some people improve after one treatment; others need further assessment or treatment. Improvement and the number of appointments cannot be guaranteed. This is a repositioning procedure for a particular inner-ear problem, not a treatment for all dizziness. Treatment choices and possible unwanted effects Observation with planned follow-up is an option for some people. Medicines do not reposition the crystals, and the specialist BPPV guideline advises against routine use of vestibular-suppressant medicines for BPPV. Discuss prescribed medicines with your prescriber before changing them. Testing and treatment may briefly provoke spinning or nausea. Occasionally crystals move into another canal, requiring a different approach. The Royal Berkshire NHS leaflet explains possible complications, including very rare serious events. Suitability and risks need to be discussed in the context of your health and mobility. Aftercare and returning to activity Allow time to feel steady before leaving. Temporary nausea or imbalance can occur. Arrange help with travel and avoid driving, ladders or machinery until it is safe to resume them. The AAO-HNSF BPPV guideline advises against routine restrictions on sleeping position or head movement after repositioning for posterior-canal BPPV. Individual advice may still be needed for another medical reason or fall risk. Only use home repositioning exercises after a clinician has confirmed the relevant side and pattern, checked suitability and shown you the technique. Do not repeatedly copy an online manoeuvre for unexplained or changing symptoms. Reviewing the result Agree a review plan before leaving. The specialist BPPV guideline recommends reassessment within one month, sooner if symptoms persist or make daily activities unsafe. Persistent symptoms may reflect unresolved BPPV, another affected canal or a different balance disorder. Further assessment may lead to a different manoeuvre, balance rehabilitation or referral rather than simply repeating Epley. Seek medical review for new or changed symptoms, and follow the urgent advice above. Continuing repeated manoeuvres without reassessment is not the answer when the pattern is unclear. Andy Duckmanton BOst (Hons) is a GOsC-registered osteopath, qualified since 2007. To discuss a BPPV appointment, call 01323 335052 or use online booking, mentioning BPPV. Read your first appointment for general consent and appointment information. Sources and further information NICE NG127: trained assessment, repositioning and referral (recommendation 1.2.6) Royal Berkshire NHS: testing, suitability and possible complications (2024 leaflet) AAO-HNSF: BPPV clinical practice guideline — aftercare, medicines and review (2017; PubMed) NHS: vertigo and urgent symptoms GOsC: care choices and valid consent (standards A3–A4) Sources checked: 15 October 2026. General patient information; assessment and care depend on your individual circumstances. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Browse all patient guides.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 15 October 2026. Neuralgia means pain associated with an irritated or damaged nerve. It may feel burning, shooting or like an electric shock. Different types have different causes and need different approaches to assessment and treatment. This article explains facial nerve pain and pain after shingles; for pain travelling down the leg, see our sciatica guide. Pain after shingles (post-herpetic neuralgia) After chickenpox, the virus can remain inactive in the body and reactivate as shingles. Shingles usually causes a painful rash on one side, and can affect the trunk or face. Pain that continues after the rash has healed is called post-herpetic neuralgia. The skin may remain sensitive enough for clothing or light touch to hurt. Not everyone who has shingles develops lasting nerve pain. Speak to your GP if pain in the affected area is not improving. Treatment may include prescribed nerve-pain medicines or referral to a pain specialist. See the NHS advice on post-herpetic neuralgia. Trigeminal Neuralgia The trigeminal nerve carries sensation from the face to the brain. Trigeminal neuralgia is often associated with a blood vessel pressing on the nerve near the brainstem, although other causes are possible and sometimes no cause is identified. It needs medical assessment; it is not an ordinary trapped nerve that can be released with hands-on treatment. Trigeminal neuralgia typically causes brief attacks of severe pain on one side of the face, often around the jaw, teeth or gums. The area affected varies and is not a fixed fraction of the face. Washing, eating, brushing teeth or light touch can trigger an attack. See a GP for frequent or persistent facial pain, especially once dental causes have been excluded. When to seek prompt help If you think you have shingles, contact a pharmacist or NHS 111 promptly; treatment works best when started early. Seek an urgent GP appointment or NHS 111 advice for a rash on the eye or nose, changes to vision, or a severely weakened immune system. See the NHS shingles guidance for other situations requiring urgent advice. Managing Nerve Pain Management depends on the diagnosis. Trigeminal neuralgia treatment usually starts with prescription medicine; some people need specialist treatment. Persistent pain after shingles also needs a medical management plan. Osteopathy cannot replace this medical care or remove the underlying cause. For back-related leg pain such as sciatica, an osteopathic assessment can help establish whether musculoskeletal care is appropriate or medical referral is needed. Any care plan should be based on the findings and your goals, without promising to resolve nerve pain. Repeatedly touching a painful facial area to try to increase its tolerance is not advice this article recommends. Sources and further information NHS: post-herpetic neuralgia NHS: shingles NHS: trigeminal neuralgia treatment Reference links checked: 13 October 2026. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. This general information supports, and does not replace, an individual assessment. Browse all patient guides.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 15 October 2026. Piriformis syndrome is a term used for symptoms attributed to irritation of the sciatic nerve near the piriformis muscle, deep in the buttock. It is one possible explanation for buttock and leg pain. Similar symptoms can come from the lower back, hip or other structures, so muscle tightness alone does not establish the diagnosis. Causes and Symptoms Symptoms may be aggravated by prolonged sitting or activities involving the hip. An assessment considers recent changes in activity, any injury and other possible causes. Symptoms that may be reported include: Pain in the buttock, sometimes extending down the back of the thigh or leg. Tingling or numbness in the affected leg. Discomfort that changes with sitting, walking or other activities. These symptoms are not specific to piriformis syndrome. New or worsening weakness, including difficulty lifting the foot, needs prompt medical assessment rather than being assumed to come from a tight muscle. Similar symptoms can result from irritation of a nerve root in the lower back. The history and examination help guide which possibilities need further assessment; a pain diagram cannot distinguish them reliably. Diagnosing Piriformis Syndrome Assessment includes your symptom history and an examination of the back, hip and leg. Strength, sensation and reflexes may be checked where relevant. Movement tests may help reproduce familiar symptoms, but no single simple test proves that the piriformis is the cause. Further medical assessment may be needed to investigate other explanations. Management Management depends on the assessment and may include adjusting aggravating activities, a gradual exercise programme and suitable hands-on care. The aim is to help you manage symptoms and improve function. Treatment does not guarantee that pressure on a nerve has been removed or that symptoms will resolve. Advice and exercises should be tailored to your abilities and reviewed as symptoms change. Seek further assessment if symptoms worsen or do not improve. For broader information about pain travelling down the leg, see our sciatica guide. Go to A&E or call 999 if back or leg symptoms include sciatica on both sides, severe or worsening weakness or numbness in both legs, numbness around the genitals or bottom, or new difficulty controlling or passing urine or controlling bowel movements. These can be signs of a serious spinal problem. See the NHS sciatica guidance for details. Do not wait for a routine appointment. Sources and further information NHS: sciatica, overlapping symptoms and urgent warning signs GOsC: what to expect from an osteopathic assessment Reference links checked: 13 October 2026. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. This general information supports, and does not replace, an individual assessment. Browse all patient guides.

By Andy Duckmanton, BOst (Hons), GOsC registered osteopath. Editorial update: 15 October 2026. A comfortable computer setup should help you do your work and change position easily. It does not need to hold you in one supposedly perfect posture all day. These ten checks are starting points to adapt to your body, tasks and equipment. Start by noticing which task is difficult: sustained typing, looking between screens or using a laptop at a low table. Try one or two changes that address that task. Consider adjustments to equipment you already have before buying more. 1. Adjust the chair to the task Choose a height that lets you use the keyboard without repeatedly lifting your shoulders. Use the backrest if it is comfortable and change your position during the day. If the chair cannot adjust enough, discuss suitable equipment with your employer. 2. Support your feet Aim for comfortable foot support. A footrest may help if raising the chair for the desk leaves your feet unsupported. Leave enough room beneath the desk to move your legs. 3. Make the screen easy to see Place the main screen in front of you at a distance and height that lets you read comfortably. Increase text size before repeatedly leaning towards the display. Your glasses and the task may affect the most comfortable position. 4. Keep frequently used items nearby Bring the keyboard, mouse and other items you use often within easy reach. Allow space to support the hands or forearms if that feels comfortable, and avoid pressing against a hard desk edge. 5. Adapt a laptop for longer sessions For sustained work, a separate keyboard and mouse can allow you to raise the laptop screen independently. A separate monitor is another option. A laptop balanced on your knees may be convenient briefly but offers fewer adjustment choices. 6. Position extra screens around the task Keep the screen you use most directly in front of you. If you use two equally, arrange them so you can turn comfortably between them. Move documents closer to the screen when frequent reading makes you twist repeatedly. 7. Reduce glare Adjust the screen position, blinds and lighting if reflections make you lean or squint. Set brightness and text size for comfortable viewing. Persistent visual difficulty is a reason to seek appropriate eye-care advice. 8. Avoid holding a phone with your shoulder A headset or speakerphone, where appropriate, can make long calls easier while keeping your hands free. Choose an arrangement that suits privacy requirements and the work you need to do. 9. Change activity regularly HSE recommends short, frequent breaks or changes of task for display-screen work. A pause may involve standing, walking or doing another task, rather than staying seated and switching to your phone. The timing should suit the work and your needs. A standing desk offers another position, but standing still for hours is not a solution for everyone. If you use one, vary sitting and standing according to comfort and the task; there is no fixed ratio you need to achieve. 10. Review what actually helps Change one or two things, then see whether work feels easier. If you are covered by workplace display-screen requirements, ask for a workstation assessment. Persistent discomfort should not simply be blamed on posture or treated as proof of damage. Consider the rest of the day too, including your commute, caring responsibilities and unfamiliar activity. A workstation adjustment can be useful without explaining or resolving every symptom. Seek clinical advice if pain continues, affects sleep or function, or comes with persistent tingling, numbness or weakness. New or rapidly worsening neurological symptoms need prompt medical assessment. Read the neck pain guide or low back pain guide for symptom-specific advice. Getting active offers ideas for movement outside desk work. Sources and further information HSE: working safely with display screen equipment HSE: breaks and changes of activity HSE: DSE workstation checklist HSE: workstation assessment Sources checked: 13 October 2026. These examples support, and do not replace, a workplace assessment where needed. Patient information from Eastbourne Osteopathy. About Andy Duckmanton, BOst (Hons), GOsC registered osteopath. This general information supports, and does not replace, an individual assessment. Browse all patient guides.