The Pain Podcast

Tim and Bart tackle one of physiotherapy's most divisive topics: touch and manual therapy. They explore when hands-on treatment genuinely helps, when it quietly does harm, and why the answer changes depending on the nervous system in front of you. Real cases anchor the conversation, from a functional neurological disorder patient who regained a sense of agency the instant touch was applied, to a complex regional pain syndrome case where a similar intention triggered a dramatic adverse response. They close with the predictable pattern behind manual therapy dependency and the single justification for touch that Bart would keep above all others. Full show notes and blog at lepubscientifique.com.

This episode, we turn the lens around. After five episodes building a framework for treating persistent pain, Tim and Bart ask: who's looking after the person delivering that framework?

In their most personal conversation yet, they share what burnout looks like in pain care, why failed connection drains you more than heavy stories, and what happens when you're the lone wolf in a team that doesn't think the way you do. They talk openly about their own experiences with vulnerability and fatigue, and explore how the same principles they teach their patients (dosing, sweet zones, not working at a hundred percent every time) apply to clinicians too.

An honest, important conversation for any clinician who's ever wondered whether they're the only one finding it hard. You're not.

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How much is enough? How do you know when to push and when to back off? When does consistency matter more than novelty? And when do you stop?

In this episode, Bart van Buchem and Tim Beames explore the clinical judgment behind dosing in persistent pain; from exercise to enrichment to life itself. Tim shares his cost-benefit framework and a walking case study that illustrates why erring on the side of caution builds more momentum than pushing too hard. Bart introduces the tides metaphor from a patient whose fluctuating symptoms needed flexible dosing, not a fixed protocol.

They also discuss preparation and recovery (the Usain Bolt principle), widening the dosing lens beyond reps and sets, using embodied cues as guides, and why the last rep should never be the worst. This is the fourth instalment in a series covering agency, affordances, playfulness, and now dosing — together forming a practical framework for persistent pain rehabilitation.

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Rehabilitation for persistent pain often defaults to structure — sets, reps, progressions. But what happens when the people in front of you have already tried all of that? In this episode, Bart van Buchem and Tim Beames make the case for playfulness, creativity, variability, and abundance as genuine therapeutic tools.

They share practical clinical examples including constraint-based learning, metaphorical movement, and using distraction to unlock different movement strategies. They explore when patients need structured programmes and when they need permission to let go, why more control doesn't always mean better outcomes, and how small shifts in context can dramatically change someone's experience — drawing on Charles Spence's perceptual experiments as a vivid example. A hands-on, clinically grounded conversation for therapists ready to move beyond the exercise sheet.

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Description: Persistent pain doesn't just hurt — it shrinks your world. Less movement, fewer social connections, reduced spontaneity, and a narrowing field of what feels possible. In this episode, Bart van Buchem and Tim Beames explore environmental enrichment as a clinical framework for reopening that world.

Drawing on affordance theory and ecological psychology, they discuss how to reframe exercise as lived experience, why small and consistent wins beat dramatic interventions, and how shifting a patient's state of mind can unlock new possibilities. They share practical approaches including constraint-based learning, playful exploration, and co-constructing enrichment plans rather than prescribing them. The episode closes with key questions clinicians can use to discover what brings their patients joy, curiosity, and energy — and what they've stopped doing that they miss.

A grounded, practical conversation for therapists who want to move beyond protocols and into person-centred care.

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What happens when persistent symptoms start calling the shots? In this episode, Bart van Buchem and Tim Beames dig into the concepts of agency and body ownership in persistent pain — how they differ, how they're disrupted, and what clinicians can do about it.

They discuss the clinical reality of patients wanting to disconnect from painful body parts, the role of hypervigilance and suggestibility, and why uncertainty can fuel the cycle. The conversation then moves into practical territory: mirror therapy, graded motor imagery, visual feedback, and how to introduce experiential techniques in a way that feels safe and meaningful. They also touch on the exciting potential of VR and AI in rehabilitation.

A clinically grounded conversation for therapists working with people in long-term pain.

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Pain has no objective test — so people depend on language to share what they're experiencing. In this episode, Tim Beames and Bart van Buchem unpack how clinicians can become better listeners, why patient metaphors matter far more than we might think, and how the language therapists use can either bridge or widen the gap between clinician and patient.

They cover the skill of balancing open and directed questioning, how to work with chaotic or contradictory stories, and the difference between descriptive metaphors (sharp, electric), body perception metaphors (my head feels huge), and conceptual metaphors (fighting, war). Bart and Tim also explore the risks of layering on clinician-preferred metaphors and why your go-to explanations probably reflect your treatment bias.

A practical, reflective conversation for therapists who want to sharpen their communication skills.

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In this episode of The Le Pub Scientifique Podcast, Tim Beames and Bart van Buchem tackle a phrase many clinicians fear saying out loud: “I don’t know.”

Working in pain care means working with complexity, variability, and uncertainty — yet clinicians often feel pressure to provide certainty, predictions, and clear answers. In this conversation, Tim and Bart explore why false certainty can quietly erode trust, and how learning to work honestly and skilfully with uncertainty can actually strengthen the therapeutic relationship.

They discuss:

Why uncertainty is inevitable in pain — and not a sign of incompetence

The difference between confidence and certainty

How over-explaining or overselling treatment can backfire

When “I don’t know” builds trust — and when it doesn’t

Reframing patient questions like “What’s wrong with me?” into deeper needs such as safety, support, and direction

How curiosity, exploration, and experience help both clinicians and patients live better with uncertainty

This episode is the first in a series exploring uncertainty, trust, and flexibility in clinical practice — especially relevant for clinicians working with persistent and complex pain.

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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

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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