Persistent Pain Physiotherapy London — Specialist Treatment for Pain That Hasn’t Responded to Conventional Care

For people whose scans are clear but the pain isn’t. We go beyond the area of pain to assess the body, nervous system and mindset — finding what is actually driving it, and addressing all three simultaneously.

Alessio Barone BSc MSc HCPC-Reg CSP · Persistent Pain Specialist · London Bridge SE1 · 55–80% average pain reduction across completed patients

Book Your Special Assessment

Alessio Barone specialist persistent pain physiotherapist performing manual therapy at Hito Holistic Health London Bridge

The Chartered Society of Physiotherapy - Hito

We hear you

You are not making this up. And you are not running out of options.

You have been in pain for longer than anyone said you would be. The scans came back clear. You have heard “nothing structurally wrong” — which felt like being told you were imagining something that has changed the texture of your days. You have done the right things: physiotherapy, specialists, perhaps a pain clinic referral. Things helped, briefly. Nothing has held.

That is what we are here to change. Alessio’s assessment does not start with the area of pain — it starts with why the nervous system is generating pain there, at that volume, for this long. For people who have been doing the right things without lasting results, this distinction is usually the difference.

Book Free Discovery Call

Patient at Hito Holistic Health during persistent pain physiotherapy session, London Bridge

Why most persistent pain treatment reaches a ceiling

Standard physiotherapy is built for structural problems — muscle weakness, joint restriction, tissue damage. For acute injury, this works. For persistent pain, it treats the output without touching what is generating it.

The mechanism is called central sensitisation: the nervous system itself becomes sensitised, generating pain more readily, at lower thresholds, sometimes without ongoing tissue damage. This is not imagined pain. It is a measurable neurological change — and it cannot be resolved by treating the area of pain alone.

Most clinical settings do not have the capacity to address the nervous system or the mindset patterns that maintain it. This is why you plateau. Why you relapse after every course of treatment.

At Hito, we assess whether the driver is structural, neurological, or both — and address all three dimensions simultaneously. For presentations with co-occurring symptoms (gut, fatigue, sleep, anxiety), this is often the first time all the threads have been seen together.

55–80% average pain reduction across completed patients. 100% report clinically significant improvement across all three dimensions. First meaningful shift typically by weeks 4–6.

If you have been doing the right things without lasting results, it is usually because one dimension has been missed. That is what we are here to find.

The Hito Method

Three dimensions. One joined-up approach.

Persistent pain rarely has a single cause. It lives at the intersection of physical, neurological, and psychological factors — which is why addressing only one produces incomplete results. We assess and treat all three simultaneously.

01

Physical

The body and its structures

Persistent pain involves changes in how the nervous system processes pain signals — not simply damage at the site of pain. Standard treatment often targets the area of pain without asking why the nervous system is generating amplified signals from that area.

Alessio’s specialist assessment evaluates the physical structures contributing to your pain, identifies whether movement patterns or sensitisation are maintaining factors, and applies manual therapy — myofascial release, craniosacral techniques, visceral therapy — where indicated.

The crucial first question: is the primary driver structural, sensitised, or both? This distinction determines the entire treatment approach.

02

Nervous System

The system amplifying the signal

For many people with persistent pain, the nervous system has been in a chronic threat state long enough to become structurally sensitised — pain is no longer proportional to tissue damage. Stress, burnout, adverse life events, and sustained high-pressure living all prime the nervous system and lower the pain threshold.

In many cases, the nervous system dysregulation preceded the pain — creating conditions in which pain arrived and could not leave. Julie’s sessions address autonomic regulation directly, through breath-based practices, nervous system education, and a personalised daily toolkit.

This is the dimension most clinical settings do not address. It is also often the reason physical treatment alone has not held.

03

Mindset

The patterns maintaining it

Living with persistent pain changes how you relate to your body. Fear-avoidance — avoiding movement because of anticipated pain — is one of the most significant maintaining factors in chronic pain. Hypervigilance to sensation, catastrophising about what symptoms mean, and an identity gradually reorganised around limitations are intelligent adaptations to a difficult experience. But they become part of the clinical picture.

The mindset dimension at Hito addresses these patterns specifically — not through positive thinking, but through identifying the cognitive and behavioural habits that sustain the nervous system’s pain output. The activities avoided and the world quietly shrunk reinforce the brain’s assessment that these things are dangerous. Working with that assessment, progressively, is part of what makes recovery hold.

Is this right for you

This may be right for you if…

The Hito Programme is designed for people whose pain has persisted beyond the point where conventional treatment has been able to help. If any of the following resonate, a discovery call is the right next step.

✓ You have been in pain for more than six months — often much longer — and it has become part of how you plan your life.

✓ Your scans and blood tests have come back normal, or show findings that don’t fully explain the level of pain you experience.

✓ You have seen GPs, physiotherapists, specialists, or pain clinics — with partial or temporary relief at best, and no lasting resolution.

✓ You are high-functioning and have been pushing through — but the cost is increasing and something needs to change.

✓ You suspect stress, emotional factors, or life history may be involved, but haven’t found a clinician who takes this seriously alongside the physical picture.

✓ You have been told your pain is “functional,” “non-specific,” or “psychosomatic” — and found that explanation dismissive rather than helpful.

Chronic low back pain • Fibromyalgia • Central sensitisation syndrome • Chronic widespread pain • Chronic neck pain • Persistent sciatica / nerve pain • Post-surgical persistent pain • Post-viral pain and fatigue • Unexplained musculoskeletal pain • Chronic pelvic pain • Pain with co-occurring gut / fatigue symptoms • Burnout with physical pain

Not sure whether your condition fits? A free 30-minute discovery call will give you an honest answer. Book here

What treatment involves

Evidence-based treatment, then complementary practices

Clinical physiotherapy is the foundation of every Hito Programme. Complementary practices — acupuncture, breathwork, sound therapy, mindset coaching — are offered alongside it, patient-led and paced to what is appropriate at each stage.

Evidence-based physiotherapy (core treatment)

Complementary wellbeing practices (optional, patient-led)

With Alessio

Acupuncture

Fine needles placed at specific points in the jaw, neck, and cranial muscles to release tension, calm the nervous system, and reduce the pain signals that keep jaw muscles in a state of chronic guarding.

Craniosacral Therapy

Very gentle touch applied to the skull, jaw, and base of the spine to release deeply held tension — particularly helpful when TMJ symptoms include a sense of pressure in the head, ear fullness, or tinnitus.

Sound Therapy

Immersive sound sessions using gongs, Tibetan bowls, and crystal bowls. The vibration and resonance of these instruments create a deeply relaxing state that is difficult to achieve through conventional relaxation alone — allowing the nervous system to genuinely down-regulate.

With julie

Breathwork & Meditation

Guided breathwork and meditation practices that shift the body out of a stress state — slowing the nervous system, reducing jaw and shoulder tension, and creating the internal conditions that allow physical treatment to land and hold.

Psychosomatics

An exploration of the mind-body connection — understanding how emotional experiences, stored stress, and unprocessed tension show up as physical symptoms in the jaw, neck, and body. Psychosomatic awareness helps you recognise the signals your body is sending before they escalate into pain.

Mindset Coaching

One-to-one sessions with Julie that identify the thought patterns, stress responses, and emotional habits that are maintaining your symptoms. Coaching gives you a practical language for what is happening — and concrete tools to interrupt the cycle.

Habit Tracking

Simple, sustainable tracking of the daily factors that most influence jaw tension — sleep quality, stress load, jaw awareness, movement, and breathing. Used not as a productivity tool, but as a way to help you notice what makes things better and what triggers a flare.

The Hito Programme combines HCPC-registered physiotherapy with optional complementary practices. Physiotherapy treatment follows HCPC and CSP professional standards. Complementary practices are patient-led, used to support wellbeing and nervous system regulation — not as diagnosis or medical treatment.

Patient Story

“For the first time in years, I used the foam roller at home and had no pain.”

M.R. · London · Chronic back pain, sciatica, migraines and heart palpitations · 10-year history · Completed 12-week Hito Programme · January–April 2026

What G.D. came in with

Everything arrived at once

Daily left-sided lower back pain (7–8/10) radiating down the left leg to the foot — altering the way she walked
Migraines and recurrent headaches
Frequent heart palpitations, including a recent A&E visit during a stress episode
Sleep disruption — waking most nights, unable to return to sleep easily
Scoliosis diagnosis (2015) — multiple physiotherapists and chiropractors seen over ten years, without lasting resolution
Pain that reliably escalated with stress, grief, and difficult emotional periods

What Alessio found

The picture after one assessment

Left-sided musculoskeletal pattern with SIJ dysfunction and lumbar shift — physical, but maintained by chronic tension
Reduced sensation in the left leg and foot — evidence of sustained nervous system involvement
Postural compensation patterns throughout — eyes, feet, and jaw all influencing spinal alignment
The nervous system chronically activated — stress and unresolved grief from her father’s loss (2004) were not background factors but primary drivers of the physical pattern
Holding patterns in the jaw and intraoral muscles (notable emotional releasing during treatment)

Programme & Outcome

12 weeks with Alessio + Julie

Weeks 1–3: Myofascial and sacral treatment — leg radiation reduced; no more constant discomfort
Weeks 4–6: Acupuncture, breathwork with Julie — migraines resolved; heart palpitations resolved; sleep improving
Weeks 7–8: Returned to Pilates (ability 10/10, from 5/10 at start)
Weeks 9–12: Deeper identity and nervous system work — emotional release in multiple sessions; tools embedded
Discharge: Walking 10/10 (from 7–8/10); back pain rare, settles in 1–2 days; “a completely different relationship with my body, my emotions, and my ability to take care of myself”

“I had tried so many approaches over the years — physios, chiropractors — and the pain always came back. At Hito, for the first time, someone looked at the whole picture. A completely different relationship with my body, my emotions, and my ability to take care of myself.”

M.R. · Completed the Hito Programme · April 2026

* Patient’s words used with permission. Details anonymised. Individual outcomes vary. This case is representative of the type of presentation the Hito Programme is designed for — persistent pain with a significant nervous system and emotional component.

Finding the right fit

We match you to the right clinician — you don’t have to decide

At Hito, your clinician is matched to your presentation — not the other way around. After a short discovery call, we will tell you which pathway is clinically appropriate for your history, symptoms, and insurance cover.

Not sure which applies to you?

Book a free 30-minute discovery call. We will listen to your history and give you an honest recommendation — with no obligation to book.

Book FREE Discovery Call

HCPC-registered physiotherapy team · acute & structural TMJ

The Hito Team

All therapists BSc HCPC-Reg CSP · session-based · flexible booking

Our team of HCPC-registered physiotherapists specialise in vestibular and musculoskeletal conditions. For TMJ presentations that are recent in onset, structurally clear, or triggered by a specific event — dental work, injury, or posture change — session-based treatment provides targeted, evidence-based care that resolves the problem efficiently, with flexible booking and insurance cover through most major providers.

✓ Recent onset — symptoms present for less than 6 months

✓ Identifiable structural trigger — dental work, jaw injury, posture

✓ No significant co-occurring symptoms (tinnitus, headaches, dizziness)

✓ Covered by most major health insurers — BUPA, AXA Health, Aviva and others

✓ Flexible booking — no long-term commitment required

Insurance: BUPA · AXA Health · Aviva and others · Pre-authorisation required

Book a Session

Specialist clinical director · complex & chronic TMJ

Alessio Barone

BSc MSc HCPC-Reg CSP · TMJ & Nervous System Specialist

Alessio is Hito’s specialist for complex, chronic, and treatment-resistant TMJ. Where standard approaches have plateaued, or where the nervous system is clearly a driver — bruxism worsened by stress, symptoms that reset after every course of treatment — Alessio’s 12-week programme addresses all three dimensions simultaneously: the joint, the cervical spine, and the autonomic state maintaining the pattern.

✓ Chronic or recurring symptoms — 6+ months, or returning after previous treatment

✓ Standard treatment has plateaued — partial improvement that doesn’t hold

✓ Nervous system component — bruxism driven by stress, worse after difficult periods

✓ Co-occurring symptoms — headaches, tinnitus, ear fullness, dizziness

✓ Three-dimension programme — body, nervous system, and mindset addressed together

✓ Results designed to hold — not require indefinite maintenance

Self-pay: from £1,997 · 12 weeks all-inclusive
Insurance: WPA · Cigna · Healix · Pre-authorisation required

Book Alessio's Assessment

Have BUPA, AXA Health or Aviva — but think your presentation is complex?

Contact us before booking. Some insurers allow referral to a specialist clinician for complex or treatment-resistant cases — we will check your cover and advise on the most appropriate route, including self-pay options for the programme if that makes sense for you.

THE HITO METHOD

A structured programme — not more appointments

WEEKS 1 – 4

Phase 1 — Foundations

Comprehensive assessment across Body, Nervous System and Mindset — hands-on treatment begins in session one
Journey mapping with Julie — understanding your specific pattern before it became pain
Daily check-in form introduced from week one to track patterns and progress
First breathwork techniques for downregulating the nervous system between sessions
Foundation movement and exercise strategies calibrated to your sensitisation level

WEEKS 5 – 8

Phase 2 — Progressive Treatment

Clinical work deepens as the full picture emerges and response to treatment is established
Manual therapy and movement rehabilitation advance progressively
Nervous system states explored in depth — the stress container model and what fills it
Personalised breathwork and regulation toolkit built and embedded
Mindset patterns addressed directly — fear-avoidance, hypervigilance, identity work

WEEKS 9 – 12

Phase 3 — Consolidate & Exit

Consolidation of gains across all three dimensions
Gradual transition to confident self-management
Long-term toolkit embedded and owned by the patient — not dependent on ongoing sessions
Graded re-engagement with avoided activities, exercise, and situations
Exit assessment and written 12-week progress report

What to expect

Programme vs session-by-session — what the evidence shows

Persistent pain responds better to a structured programme than to isolated sessions. The table below reflects outcomes from completed Hito Programme patients.

What Changes

Progress

Typical timing

Pain reduction (primary site)

70% 70%

Weeks 4-12

Return to exercise / sport

80% 80%

Weeks 6-10

Sleep quality

55% 55%

Weeks 3-7

Secondary symptoms (fatigue, gut, anxiety)

85% 85%

Weeks 5-12

Self-regulation tools embedded

70% 70%

By Week 12

Fear-avoidance / movement confidence

50% 50%

Weeks 6–12

Outcomes data from completed Hito Programme patients, 2025–2026. Individual outcomes vary based on history, chronicity, and presentation. Data on file.

Your clinicians

HCPC-registered. Specialist-led. Transparent credentials.

Every clinician at Hito is HCPC-registered and CSP-affiliated. Alessio holds a specialist postgraduate qualification in persistent and complex pain. All credentials are publicly verifiable.

Senior Physiotherapist & Clinical Director

Alessio Barone

BSc Physiotherapy · MSc · HCPC-Reg · CSP Member

Alessio founded Hito in 2017 with a specialist focus on complex, chronic musculoskeletal and neurological presentations — particularly TMJ dysfunction, vestibular disorders, and persistent pain. His BSc and MSc training in physiotherapy underpins a practice that integrates regulated clinical techniques with evidence-informed approaches to nervous system regulation.

Alessio’s approach to TMJ is built on comprehensive assessment of the whole system — jaw, cervical spine, cranial base, breathing pattern, and autonomic state — rather than the joint in isolation. Most patients he sees have already tried conventional approaches; his role is to identify what has been missed.

Specialties: TMJ dysfunction, vestibular disorders, persistent pain, nervous system dysregulation, myofascial induction therapy, craniosacral therapy, acupuncture

BSc Physiotherapy · HCPC-Reg · CSP Member

Lucy Monson

BSc Physiotherapy · HCPC-Reg · CSP Member

Lucy is a senior physiotherapist specialising in vestibular and musculoskeletal conditions. For TMJ presentations that are recent, structurally driven, or straightforward in complexity, Lucy provides evidence-based physiotherapy within a traditional session-based model — and is covered by BUPA, AXA Health, and Aviva.

Lucy’s training and approach are grounded in traditional physiotherapy evidence — assessment, manual therapy, exercise prescription, and patient education — delivered within the same warm, patient-centred environment as Alessio’s work.

Specialties: Vestibular physiotherapy, musculoskeletal physiotherapy, TMJ (recent or straightforward presentations), BUPA/AXA/Aviva insured patients

Physiotherapist · Joining the team

Coming soon

HCPC-Reg · CSP Member

We are expanding our team of specialist physiotherapists. All Hito clinicians are HCPC-registered and CSP members, selected for their specialism in the conditions we treat. If you are interested in joining the team, get in touch.

This card will be replaced with a full clinician profile when the new team member joins.

✓ All Hito physiotherapists are registered with the Health and Care Professions Council (HCPC) and members of the Chartered Society of Physiotherapy (CSP). HCPC registration can be verified at hcpc-uk.org/check-the-register. Alessio Barone’s registration number is PH101329.

Not sure which is right for your situation?

Book a free 30-minute discovery call and we’ll help you decide which
approach will serve you best.

Book Your TMJ Specialist Assessment

Common questions

Things people wonder before booking

"I've tried physiotherapy before. Why would this be different?"

Standard physiotherapy addresses structural problems. For persistent pain, this treats the output — not what is generating it. If your nervous system is sensitised, treating the area of pain is like turning down one speaker while the amplifier stays on full. At Hito, the assessment explicitly identifies whether structural, nervous system, or mindset factors are driving your pain — and treatment addresses all three in the right proportion. Most patients who come to us have already had good physiotherapy. The difference is the dimension that was missing.

"My scans are clear — surely there's nothing to treat?"

Scans look for structural damage, inflammation, or disease. What they cannot show is how your nervous system is processing pain signals. Persistent pain frequently involves central sensitisation — a measurable neurological change in which the nervous system generates pain more readily, at lower thresholds, sometimes without ongoing tissue damage. Normal results do not mean your pain is imagined. They mean the explanation lies somewhere a scan cannot reach. At Hito, this is precisely where our assessment begins.

""I've been told I just need to learn to manage it.?"

Pain management and pain resolution are different goals. Managing pain means accommodating it — pacing, avoiding, adapting. Resolving it means addressing the patterns that are sustaining it. The evidence base for biopsychosocial treatment — addressing body, nervous system, and mindset simultaneously — consistently shows that persistent pain can genuinely improve, not just be managed. 55–80% average pain reduction across completed Hito patients. 100% report clinically significant improvement. The question is not whether improvement is possible. It is whether you have found the right approach.

"Is the biopsychosocial approach actually evidence-based"

Yes. The biopsychosocial model of pain is the current standard framework in pain science — endorsed by NICE, the British Pain Society, and the Chartered Society of Physiotherapy. Pain neuroscience education (PNE) and nervous system-informed physiotherapy are among the most evidence-supported interventions for persistent pain. What is less common is a clinic that has genuinely built its entire treatment model around this evidence base. At Hito, the three-dimension approach is not an add-on — it is the core of everything we do.

"Can pain really resolve after this long?"

Yes — and the evidence is clear on this. The nervous system is plastic: sensitisation states can and do change when the right inputs are consistently applied. The duration of your pain does not determine whether it can improve — but it does influence which approach is most likely to work. For pain that has persisted for months or years, a structured 12-week programme consistently outperforms isolated sessions. The patients who benefit most from Hito’s programme are often those who have been managing for the longest — because they are finally addressing all three dimensions at once.

"Is a 12-week commitment the right fit for me right now?"

A structured programme is not right for every situation or every moment. If your pain is recent, structurally clear, or you need flexibility, session-based treatment with the Hito Team may be the better starting point. The discovery call is specifically designed to help you work this out — we will give you an honest recommendation based on your history, not a sales conversation. If you are not yet ready for the programme, we will tell you clearly, and suggest what is.

COMMON QUESTIONS

Frequently Asked Questions

View All FAQs

Hito Holistic Health Physiotherapy London Bridge

What is the difference between persistent pain and chronic pain?

The two terms are often used interchangeably. “Persistent pain” is now preferred in clinical practice because “chronic” can carry an unhelpful implication of permanence — as if nothing can be done. At Hito, we use “persistent pain” deliberately, because the clinical picture is rarely as fixed as that word suggests. With the right approach, the patterns driving persistent pain can and do change.

Why do my scans and blood tests show nothing wrong if I am clearly in pain?

This is one of the most frustrating — and important — experiences for people living with persistent pain. Scans and blood tests look for structural damage, inflammation, or disease. What they cannot show is how your nervous system is processing pain signals. Persistent pain often involves central sensitisation — the nervous system generating pain more readily, at lower thresholds, regardless of whether there is ongoing tissue damage. The absence of findings on a scan does not mean your pain is imaginary. It means the explanation lies somewhere a scan cannot reach.

What is central sensitisation and how does it relate to my symptoms?

Central sensitisation is a change in how the central nervous system processes information. In a sensitised state, pain is generated more readily, at lower thresholds, and sometimes in the absence of any clear physical stimulus. It can cause pain to spread beyond the original site, become disproportionate to what triggered it, or persist long after injury has resolved. It is not a character flaw or a sign of weakness. It is a measurable neurological change that develops when the nervous system has been under sustained load — through stress, sleep disruption, adverse life events, or prolonged high-pressure living.

Why has physiotherapy not worked for me so far?

Standard physiotherapy is designed primarily to address structural problems — muscle weakness, joint restriction, tissue injury. For pain with a significant nervous system component, this approach addresses the output without addressing the driver. If your nervous system is sensitised, treating the area of pain is like turning down one speaker while the amplifier stays on full. This is not a reflection on the quality of the treatment you received — it is a mismatch between approach and cause. At Hito, we assess whether structural, nervous system, or mindset factors are primary, and address them in the right proportion for your specific presentation.

Can persistent pain actually get better, or is it just about management?

Yes — persistent pain can genuinely improve, and for many patients it resolves to a degree that significantly changes their quality of life. The key distinction is between managing pain and addressing the patterns that sustain it. These are different goals and require different approaches. The evidence base for biopsychosocial treatment — addressing body, nervous system, and mindset simultaneously — is strong and growing. Across completed Hito Programme patients, average pain reduction is 55–80%. 100% report clinically significant improvement across all three dimensions.

How does stress affect chronic pain?

Stress activates the threat-response system and keeps the nervous system in a state of heightened reactivity — lowering the pain threshold and amplifying signals. This is why many people notice pain reliably worsens during high-pressure periods, even when nothing has physically changed. The relationship runs in both directions: stress amplifies pain, and persistent pain is itself a significant stressor that keeps the nervous system activated. Breaking this cycle requires addressing both dimensions — not just one.

Is persistent pain physiotherapy available on the NHS, and how is Hito different?

The NHS does offer physiotherapy and some pain management services, typically through GP referral, with variable wait times. NHS persistent pain services often provide group-based or time-limited interventions. At Hito, you work with a specialist from your first session, and the approach is highly individualised — your assessment, treatment, and exit plan are specific to your history and your three-dimension profile. The Hito Programme is a structured 12-week intervention that addresses the nervous system and mindset dimensions most clinical settings do not have the capacity to work with. We work with self-pay patients and those insured with WPA, Cigna, and Healix.

Ready to understand what’s actually driving your pain?

We know that choosing where to go for help — after years of trying things and perhaps being let down — is a significant decision. The discovery call is free, with no obligation. We will tell you honestly whether we think we can help, and what that would involve.

Book Your Free Discovery Call

No referral needed · No obligation · By video call