What happens when we try to apply predictive processing models to fibromyalgia? In this exploratory conversation, Tim Beames and Bart Van Buckem work through the clinical implications of understanding fibromyalgia through the lens of prediction, uncertainty, and sensitivity to difference.

They discuss why unpredictability is so costly in fibromyalgia, why "healthy activity" can backfire, and how systems become sensitized to even tiny changes. The conversation explores concepts like entropy, allostasis, expectation violations, and the challenge of creating difference without creating threat.

Bart brings healthy skepticism throughout, questioning the risks of mechanistic language and whether these models truly help in the clinic. Tim responds by translating theory into practical approaches: micro-variability, building baselines of safety, and pacing at a different timescale.

This is thinking-out-loud science. Two clinicians trying to bridge theoretical models with clinical complexity in fibromyalgia—a condition where traditional approaches often fall short.

Featuring: Tim Beames & Bart Van Buckem Duration: 39 minutes Level: All clinicians working with chronic pain

Note: This episode is followed by a refinement piece where Tim reflects on the limitations of this approach.

In this episode of The Pain Podcast, Tim Beames and Bart van Buchem explore a deceptively simple question: can assessment itself be therapeutic?

Drawing on clinical experience from both in-person and online practice, they unpack how physical examinations are never neutral acts. Every question asked, every movement explored, and every test performed can shape expectations, build trust, reduce threat — or sometimes unintentionally increase it.

Rather than viewing assessment as a box-ticking exercise, Tim and Bart discuss assessment as a shared process of sense-making. They explore:

• How validation, reassurance, and curiosity can emerge before any treatment begins

• The difference between testing and exploring

• Why over-testing can sometimes increase uncertainty or fear

• How assessments can update internal models and predictions about the body

• The role of safety, trust, and co-creation in early clinical encounters

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In this episode of The Pain Podcast, Tim Beames and Bart van Buchem take on a big, often buzzword-y topic: neuroplasticity in pain recovery.

Starting from a real patient encounter (“I think this is about my neuroplasticity…”), they explore what this term actually means, where it comes from, and how to use it in a way that supports – rather than scares or blames – people living with persistent pain.

You’ll hear them discuss:

• Neuroplasticity as ongoing adaptation and change, not just “brain rewiring”.

• The shift from a narrow neuro focus to a broader bioplasticity lens across multiple systems.

• The problem with “maladaptive plasticity” and “broken pathways” language – and how it can reinforce a sense of defectiveness.

• How difference and context (holidays, relationships, movement, meditation, therapy, altered states) create new embodied experiences that can open the door to change.

• The role of salience, reward and emotional tone in determining whether change is large enough – and meaningful enough – to stick.

• Why recovery often shows up first as better participation, connection and quality of life, even when pain scores don’t shift dramatically.

Tim and Bart also reflect on popular “rewire your brain” narratives, highlighting where the metaphor can be helpful and where it risks oversimplifying complex science.

This episode is for you if:

• You’re a clinician trying to talk about neuroplasticity without slipping into hype or hopelessness.

• You work with people whose pain has become the “status quo” and are looking for ways to create safe, meaningful difference.

• You live with persistent pain and want a validating, nuanced explanation that doesn’t blame your brain or your beliefs.

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