Introducing Our Pain and Perception CPD Weekend at Core Clapton: An Interview with the Course Leaders
Why does pain sometimes persist long after the body has healed? What makes some patients feel stuck in their symptoms, while others find ways to move forward? In the lead-up to our upcoming CPD weekend, Pain and Perception (20–21 September 2025 at Core Clapton), we spoke with one of the course leaders Josh Fein-Brown to delve into these important questions.
In this interview, he share his experiences of working with patients living with persistent pain and explains how predictive processing and embodied cognition can transform the way osteopaths understand and treat it. From challenging common misconceptions about pain, to rethinking the role of attention, beliefs, and language in clinical practice, his insights point towards a more compassionate and effective approach to care.
This course is more than theory — it’s about learning to listen deeply, building safety, and empowering patients through a fresh understanding of how pain works.
👉 Book your place now and join us at Core Clapton for this transformative weekend of learning and practice.
1. Have you ever felt stuck trying to help a patient with persistent pain?
Josh Fein-Brown: Yes. Absolutely. I recall a patient I was working with, who had been waiting a long time for their appointment. We had agreed to work through some exercises to help them get stronger. They had had a previous surgery on their knee, and it hadn't been followed up sufficiently with the rehab team. After the operation, their pain had become worse, the knee had begun to give way on stairs, and significantly limited their ability to walk.This meant that they had to change their job role, taking a pay cut. This was affecting their mood; they were becoming quite depressed, to the point where they were saying that they wanted to end their life if this continued as it was. We started to go through some simple exercises to strengthen the knees.During this, it was clear to me they were hyper focusing on the knee and all the clicks and sounds it was making. I tried to normalise this, but they felt thatI was being dismissive and not taking it seriously. They kept catastrophising and saying things that indicated they believed it would never recover. This then made them visibly depressed, and all the while, the pain and tensionaround the knee increased. From my perspective I could see clearly that this pain was impacting this persons life, they were interpreting the pain as damage, this meant that they were going to lose their job, their relationship was going to deteriorate because they couldn't keep up with the mortgage, they weren't able to be present for their children because their mood was so low. All this significantly amplified their focus on the pain and the belief that if this pain went away, then they would get their life back. I couldn't promise that, and tried too quickly to challenge their beliefs by trying to highlight how their mind was thinking about the pain. The session ended with them walking out on me, very frustrated. I never saw them again.
I have done a lot of reflection on this interaction. At the time, a lot was going on in my life, which was resulting in some compassion fatigue. I was finding myself frustrated with the interaction; I felt I wasn't being listened to. In reality, my capacity to actively listen, to really put myself in their shoes, was compromised. This resulted in them not feeling validated or understood. I guarantee that if your patients don't feel understood, then they won't trust you as much. If they don't trust you, then they won't believe you or take on your advice. This is where I failed, as for this individual, so much of their suffering was built on the meaning they were making from their pain.With chronic pain, so much of the suffering is about how it impacts mood, capacity to work, and social relationships. A lot of this is in the mind, and this must be addressed with sincere compassion, understanding, and deep listening. This requires a lot of energy from us as practitioners. If we are not taking care of ourselves, it is very hard to work with these very complex patients.
2. What if pain is more about protection than damage?
Josh Fein-Brown: There is no 'what if'. Pain is about protection from damage.Always. So, how come we have pain when we are damaged? You may ask. Well, the pain once we have tissue damage is still trying to protect us. Damaged tissues, or tissues that are stressed, need much more protection than strong, healthy tissues. Pain acts to communicate this vulnerability to our conscious awareness in order to motivate us to heal. More than that, it is trying to actively coordinate both protection and healing in a myriad of very complex mechanisms.Many of which we will go though in our upcoming courses.
3. Could understanding predictive processing change the way you practise osteopathy?
Josh Fein-Brown: Absolutely! It is a unified theory of conscious perception. I think the big eureka moment came when I started to look at Active Inference, which is the idea that our perceptions, like sight, pain, mental objects etc.come with physiological change. What does this mean? Well, if you imagine a bright light, then your pupils will constrict. If you remember a stressful memory, your heart rate will increase (as well as your sympathetic arousal generally). What this means is that the mind and the body are never separated.All perceptions contain actions. You cannot have one without the other. So simply changing the joints, muscles, fluid dynamics, blood flow, etc., is not enough if it doesn't also change the individual's perceptions. Especially when it comes to pain. We know all too well that pain is a perception, so we cannot expect to make deep, long-lasting change to people's pain experiences if we don't understand how we form perceptions in the first place. I now focus much more on listening to what my patients say, watching out for their underlying beliefs, and listening to how they have made meaning out of their situation. I engage them much more in the treatment; they are rarely 'passive' in my sessions. I am very careful with my language and use questions to direct their attention inwards. I am also much more playful and try to encourage curiosity in all my patients.
4. Is pain there if we cannot feel it?
Josh Fein-Brown: No. Pain is always a subjective conscious experience and cannot be present if we don't feel it.
5. Can changing your patient conversations improve outcomes for chronic pain?
Josh Fein-Brown: Yes, certainly. We are still so stuck in the idea that if I can fix my body, then my pain will go away. We have also somehow created the idea in society that to be pain-free is normal. This is categorically not true.Everyone has pain every single day. If they didn't, many people would be dead.Pain is essential for life, and we need to stop chasing the ideal of being 'pain-free'. It is not ideal! Pain is wonderful. Pain is the reason you fidget in your chair, the reason you are driven to go exercise, the reason you stop before you injure yourself, the reason you still have hands and feet that are intact and not ulcerated, the reason that you care about your own physical wellbeing! It is the foundation for the caring relationship you have with yourself. Without it, why would you care about your body? The people who are born without pain certainly don't care about their bodies, and a vast majority die very young. There is a story of a little girl who felt no pain. She chewed the ends of her fingers off so she could draw in red paint on her mum's wall, smiling and content as ever. We need to begin to appreciate pain and respect it.
