Transcript

Bart Van Buchem (00:01.536)
Hello, and welcome to the Le Pub Scientifique Pain Podcast. My name is Bart van Buijum. I'm a pain specialist physiotherapist, and I'm here with good friend and expert in residence, Timmy Beams. Good on. So Tim is founder of Le Pub and he's a very experienced clinician as well. And we're going to talk about acceptance today in the context of chronic pain, which is a...

Tim Beames (00:15.892)
You know what?

Bart Van Buchem (00:31.604)
Interesting subject. think it's, there are many, many, many sides of this coin that we can discuss. let's, let's dive straight into it because my, my experience in the clinic, Tim, is that if we talk about acceptance, it's many times it's believed to be a passive action, if you like, I'm going to give up. And this is what I hear back from my patients and I'm,

Tim Beames (00:57.016)
yet.

Bart Van Buchem (01:01.29)
keen to sort of tackle that experience or that notion of that you give up is not what I mean, but the word acceptance does provoke some of those thoughts. And I was wondering, where does it come from?

Tim Beames (01:18.968)
The idea of acceptance. mean, I'm thinking that...

Bart Van Buchem (01:20.767)
Yes.

Tim Beames (01:24.824)
Buddhism and yeah, I'm thinking that probably is a large part of it, but then I'm just sort of racking my brains around different spiritual beliefs. And I think that that's also a part of Daoist philosophy and Stoicism. I should imagine I don't know well enough everything out there, but I think that yeah, this is a concept that is a...

part of many spiritual and religious philosophies and beliefs and now or and has been a part of particularly psychological therapies relating to pain. So when you think about acceptance, I mean the first thing I'm thinking of immediately from a pain point of view is

act and psychological flexibilities and things like that. So that's where my mind goes when I start applying it to pain. I'm like the what I'm thinking of is exactly like you is when you speak to people who have been experiencing pain for you know varying lengths of time the notion of accepting it does feel like giving up.

You know, that's what does this mean? It means I've got it forever. And there's a. mean, even just even just hearing that, even saying that to me sounds quite, you know, disheartening and and and you can understand the disillusionment that would come with the concept of hearing that or or thinking it and being told to work in that.

So yeah, the sort cold-faced practicalities of working someone and suggesting that acceptance is where to go is you can understand that it might be met with resistance.

Bart Van Buchem (03:26.506)
Yeah. And, and so you referred to, to certain cultural beliefs, guess, I guess that there will be different ways of understanding acceptance. So, so how would you, in the context of pain and the doctor would say you have to accept your pain because it's there for a long time, but it does seem to be more acceptable, accepted that acceptance is accepted in the, in the terms of

short-term pain. So you have to accept what's happening right now and then so what the result will be. I'm not sure what is meant to be there, but I guess it depends on the context, right?

Tim Beames (04:04.78)
Yeah, that's it. I think like, so, yeah, putting some meat to the bones, what I'm hearing from you and what I think is a part of the piece is the rhetoric and the socio-cultural beliefs embedded around pain and chronic pain and the notion that when you have pain, you've got to fight it and get rid of it. And it's an enemy and you're at war with it. And the notion of giving up.

surrendering to it goes against that cultural belief and that standpoint. So yes, you can absolutely see how that's problematic.

Bart Van Buchem (04:47.134)
Yes, I said that like ontology is like referring the different meanings of the same word depending on the context of it, but it's. Yeah.

Tim Beames (04:54.958)
Totally. Yeah. Yeah. Yeah. So, so, so I think that, and this is something that I actually work with many of my patients with is, just the bare bones of them understanding what pain really is to them. And, and, and we do talk about, and, and I, and we have exercises around it of checking in and noticing how you are.

in pain and what we often experience when we're in pain is we experience resistance in our bodies don't we? We experience some tensing up and frustration and annoyance and anger and upset and what have you.

Bart Van Buchem (05:33.044)
Hmm.

Bart Van Buchem (05:37.824)
So let's start here. think we could sort of map this up, this session with by first having like some agreement on this definition. So what do you, what we use consider to be helpful in the terms of understanding the definition of acceptance in working with patient and managing chronic pain.

So let's start from there and we can see if we can get some to some exercises and some ideas, but I think we just have to map out what is it by definition you mean by acceptance in the context of treating chronic pain.

Tim Beames (06:14.668)
Yeah, yeah, I think and that God, that's a big question even there. Yeah. I, I, to me, acceptance is the recognition of being present. And what being present is for me is that

Bart Van Buchem (06:22.888)
I know, but it's happening in the first session, right? So if people would refer it, like accepting it, wow, this is.

Tim Beames (06:42.944)
you are accepting of this is how I am now and I can't force that, I can't turn back time, I can't jump to the future, I've got to be here now. I think that's a part of it. There are many other parts of it as well but I think that the ability to be present with pain

And actually there's a skill there and I know you've already said this, like we're coming back to some exercise and things there. But the interesting thing about being able to be present is to notice that things do change over time as well. So being able to sit in pain is a skill. It could be an exercise and to notice you and your responses to the experience or the sensation or the feeling or

Bart Van Buchem (07:22.336)
you

Tim Beames (07:37.314)
however you want to describe it, of pain itself can be quite revealing and helpful.

Bart Van Buchem (07:45.088)
So let's move on from there. So if we have this definition, how would you communicate this with your patient?

Tim Beames (07:52.086)
Yeah, yeah, I think I'm just putting myself back into like the last week of speaking to people. And it's the word I use so, so often, validation. Because it's important for me to demonstrate that I am listening to that person, that I am able to

essentially bond with them, to connect with them, to be with them in that experience and not to be against them. And that's a big part of the acceptance as well, think. The acceptance piece is to be with your pain. In other words, you're seeing it as a companion instead of an enemy and a combatant.

something that's against you.

Bart Van Buchem (08:53.3)
Yeah. So, so how would you identify a person who's fighting their pain instead of accepting it in terms of what we just discussed by definition? So what we'll be typically saying, yeah, what's fighting means and how do you recognize that?

Tim Beames (09:03.852)
Yeah.

Tim Beames (09:08.194)
these are great questions, Bart. I feel like I'm in an exam at the moment. But these are great questions. Well, think, if you're doing a good job of listening and being open and curious, you're going to hear various different descriptions. And it will be descriptions that suggest that this person is in a battle, is fighting, is trying to push away and get rid of.

Bart Van Buchem (09:12.438)
I'm just curious.

Tim Beames (09:36.746)
and you'll hear notions of wanting to have a fix and a quick fix and things like that. And probably when you're hearing some of the history, the history is littered with examples of someone pursuing quite understandable actions relating to the fix or the getting rid of or the finding the cause.

So, so littered with multiple investigations of trying out many different therapies, expecting there to be a solution that they can find. So you might find that just in the actions that person's been taking. But then you hear it as well in the language that they use around pain as well. It's like something that's done to them and it's, yeah, and there will be there will be lots of

There will be lots of examples of that as you're listening to their story.

Bart Van Buchem (10:39.434)
Yeah. So what will you see? Because I think you, you, you, you nicely got like, this is what you hear. This is what their behavior has been over the past. And that's very much like interviewing, but what will be typically you would expect to see from someone who's fighting the pain.

Tim Beames (10:50.423)
Yeah.

Tim Beames (10:57.614)
Yeah, again, that's a really good question. I guess we're looking at different things, aren't we? So visibly looking at someone, we see the anguish and frustration and we hear that in their comments and their voice. We see it displayed through their body language as well. Some irritation, some tension, etc.

and we see it played through the way that they behave and move and what have you as you're going through your clinical exam as well with someone. So yeah, there are many different things that we might see.

Bart Van Buchem (11:38.91)
Yeah. Yeah. You would see something like anticipation on the pain, for example, think, and bracing type of, yeah. Yeah. It's interesting.

Tim Beames (11:48.014)
Yeah, and it makes sense as well. I don't see that as wrong. It's what someone has done based on their knowledge and understanding and beliefs around pain at that time. if you, let's say you had back pain and you're to bend forward and your experiences of bending forward mean I'm going to be in pain.

Bart Van Buchem (12:06.621)
Mm.

Tim Beames (12:11.65)
but you found that bracing might change that, then why not brace? Like, great, I'll protect my back because I think pain might mean I'm damaging it. So why don't I protect it by bracing? Awesome strategy. So for someone, and then for someone to say, have you, have you thought of just relaxing into this movement? Albeit that might be an interesting thing to try, could be really quite threatening.

Bart Van Buchem (12:23.358)
Hmm. Yeah. So what?

Bart Van Buchem (12:42.142)
totally. Yeah. Yeah. Yeah. And is there any way you could sort of demonstrate that with your patient just to get that notion of that? What is going, you, you probably have your own conclusions from what you observed, what you've been hearing so far. Is that something you basically going to address and feedback on, or do you have

a specific strategy that comes with understanding that the notion of what do you mean by definition with acceptance and how you go along with this through the treatment, for example, because my feeling sometimes is just, you can't say you have to, this is what I mean and just go for it. It's, it's, it's a process, right? So do you, in the back of your mind, you've got something like having a strategy that's helpful or for you in your treatment approach?

Tim Beames (13:38.348)
Yeah, yeah, yeah. I know it's probably quite similar to yours already, I think, is that I'll be asking them some questions. I'll be getting them to reflect. I've noticed that you said this. What does that mean? What are your thoughts around pain at the moment? How has that served you? You know, those sorts of questions. So instead of me trying to guess.

Bart Van Buchem (14:02.102)
Hmm.

Tim Beames (14:02.624)
I'd like them to reflect and to make sense and understand and so that both of us are on the same page then as well.

Bart Van Buchem (14:11.712)
Yeah. Yeah. So, so what will be the difference if a person is making that, let's say that shift from fighting their pain to what we call accepting their pain. What will be typically your observation? What will you expect that would happen? Or maybe an example, an example, that has, has happened in your clinic.

Tim Beames (14:39.488)
Yeah, okay. look, I've got a guy I'm treating at the moment and so we spoke to each other a couple of days ago. So I think there's an interesting piece here is that pain seems to have fairly variable association with what he's doing, know, day to day, when he does a lot of a particular

movement on one day, it might make things worse or seemingly be associated with things worsening, but do lots of similar movement on another day. And actually there's no such change. And actually the ability to just take yourself out from there, because it's, you know, it's understandable if you're in pain, you check in on yourself every day, don't you? And the sort of step for him noticing that

this session to the previous session was he's able to step back instead of constantly probe and go, but was it this that caused it to be worse? Is the ability to say, well, I've noticed that on some days there does seem to be some association, but actually not every day. So it's like the ability to come back out and be open to possibilities that...

that that might not be the case and that there might be other things at play and and for him our discussions sort of broadened as a result of it. So I think just coming back to that. So the previous session would have been very much like more like a focus on but what if you know, but what is causing my pain kind of thing? And I think that's a familiar.

topic for many clinicians to have, isn't it? The ability to then come out and say, you know, it could be a number of things, opens up that cognitive flexibility we're talking about, doesn't it, of saying actually there might be a number of other possibilities here, given what you're experiencing. And that in itself, like the opening up to other possibilities is a really interesting thing. But it also

Bart Van Buchem (16:43.38)
Yeah.

Tim Beames (16:55.394)
by taking yourself away from that sort of focus in, focus in, there must be something wrong to coming back out, you can immediately sense a sense of lightning. It's like a lightness, a load taking away from them as well. So if you want the threat value of the pain can just reduce a little bit.

doesn't mean that you don't want the pain to go. You don't have to go, I'm all right about being in pain. But the ability to be able to sit and make friends with it and see it as it is, whatever that is for that person. Because I have conversations about this for everybody and it means different things, but I'd love to get to the point where

instead of seeing it as a foe, we could see it as a friend, or we could see it as a guide, or we could see it as a helper or a companion. And if you can switch that stance around what pain means to that person, that is massively liberating.

Bart Van Buchem (18:14.216)
Yeah, so it's that skill being able to do so. which you can see.

Tim Beames (18:16.887)
I think so.

Tim Beames (18:20.77)
I think so. there's ways of pulling that skill out. And it doesn't mean they're having to learn something new. It's just being able to tap into the knowledge that they already have.

Bart Van Buchem (18:32.65)
Yeah, because I can see people and I can definitely foresee some of the trouble that using framing pain as a friend. could be highly problematic without knowing whether it's threatening itself. People say, well, I don't want my pain to be my friend because it's, hate it or it makes me different person. even companion and all the sort of similar...

similar wording would be, would be, well, I would think of doing that. So I'm not mentioning the, the friend word or anything like that. So how would you think of like preparing that? Is that before going into that section, you like, what is required to, get in, get into this, is this like doing exercises or is this a, like a psychologically treating, like a psychological treatment approach that, that would

Tim Beames (19:12.654)
So that's what.

Tim Beames (19:17.645)
Yeah.

Bart Van Buchem (19:30.506)
be required to get to that phase.

Tim Beames (19:33.174)
Yeah, yeah, yeah, yeah, that's it. Look, and the you know, just answering your observations are absolutely right. Like some people, they are not the right words, which is why I've given a few other words like a helper or guide. And because because I like my belief around pain is is that actually the inability to experience pain is catastrophic. That is terrible.

Bart Van Buchem (19:37.973)
you

Tim Beames (20:02.078)
So why want to get, why want to be rid of something that is so potentially useful and helpful for us? So being able to see the value in pain as an experience in our lives is something that I'll spend some time talking to people about. And there are absolutely times when we really need to listen.

Bart Van Buchem (20:23.541)
Yeah.

Tim Beames (20:31.99)
you know, that is telling us some very important information about what's going on in ourselves, in our lives. Can we be open and listen to it instead of push it away? And that's a big part of an acceptance piece, you know. Is there a message there that we can gather, we can receive from this?

Bart Van Buchem (20:49.962)
Yeah.

Bart Van Buchem (20:58.272)
So how would you see pain relief versus acceptance as a, as a competitor? So treatment is not necessarily about pain relief, like you said, but it's about acceptance. It's not finding the pain. It's not about the pain go away. It's about sort of finding, building a new relationship with that feeling, if you like. But I can see my clinic with some people.

There will be a struggle. is it, it doesn't mean you cannot use any pain relief like using how does, well, let's put it like this. If people have, they have been seeking pain relief for, for a decade and they're going to transition to like sort of sort of an acceptance process. How would that, what would that mean for the pain relief? Let's say strategies and options.

Tim Beames (21:50.53)
Yep. Great. Brilliant question. I personally think that it can all coexist and needs to as well. You know, that there are and we have, look, we've got, we've got sufficient evidence, albeit the evidence is saying you are going to get mind-bendingly brilliant results doing this treatment, but you've got, you've got, you've got evidence that's

says that if someone understands and knows about their pain, that it can help to reduce things like the burdensomeness of pain and the disability relating to pain and to a degree as well the intensity of pain that they experience. you know we can work on education that might be the piece and there might be other interventions like certain medication that will have a role there that can coexist with this process as well. I suppose the

The great thing about getting to the point of acceptance is that we can also reduce things like the amount of suffering that goes with the experience of pain. It can reduce the threat. It can give us a little bit of relief in terms of the body's response in

when you're in pain as well. So perhaps it can liberate a bit of energy for you to be able to do other things in your life and open up to engage towards life activities and towards those valued life activities instead of engaging in the pushing away, getting rid of, stopping and limiting life. So I don't know whether I've answered it, but I believe that the two need to coexist actually.

think they go.

Bart Van Buchem (23:47.434)
Yeah, it somehow feels like when you were on the road for lexical acceptance and you're focusing on, on participant in life and values and so on, that it may, and this is just my observation and conflict. Sometimes people feel like, all right, I just, this today is so bad. I need to take this oxycodone, for example. They basically go back to the strategies that would you recommend or would you feel like that's, that's a risk of

let's say success, because if we're thinking about like long-term, like long-term results, then you would ask people to stick with the acceptance and perhaps preventing themselves to, to re relapse by, by getting back to meds or passive treatments or only short-term relief types of, of, of actions.

Tim Beames (24:45.422)
Yeah, and this is an interesting point here because you're not saying, I want you to love pain or I want you to love being in pain or you're not saying that, but to just be able to acknowledge the presence of pain and if it's possible without judgment or with less judgment.

Bart Van Buchem (24:46.419)
So

Tim Beames (25:12.098)
Particularly what we find is that there's judgment to self and berating of self and that I think can be really, really unhelpful, wishing you hadn't have done that and, God, I can't believe I did that the other day. I was so stupid. I knew it was going to make me worse. So there's so much judgment that we have on us. then there can be such an excessive

time, effort, when I say excessive, I don't mean that that isn't, you know, that is really admirable. Like people put so much effort into trying to get rid of pain and trying to be pain free. You cannot fault them for the effort that they put in. But sometimes that, that's just too, you know, it's too much. It's not sustainable over a period of time. And we talked about it.

Bart Van Buchem (25:57.024)
Hmm.

Tim Beames (26:10.22)
having rest, haven't we, in the past. So being able to just lighten that a little bit, be less judgmental on yourself, acknowledge the present. We can't force things. We can only control our own actions in those moments, in the moment to moment, in the present.

Bart Van Buchem (26:18.698)
Yeah.

Bart Van Buchem (26:30.804)
Yeah, I like that because I think it's very helpful. and how is the research on this topic? There's been a lot of work being done on, on acceptance, commitment, therapeutic approaches, which basically sort of hold this whole concept of acceptance in the way we're talking about this today. By my knowledge, it seems to be quite successful, but the long-term effect seems to move away a bit.

So people tend to sort of like I said before, you captured it nicely by saying, probably have to, it's a lot, it's a long-term process as well. So it's not like switching, switching the knot in his, and you'll be done and ready for it. But it's like having an ongoing, being challenged all constantly, right? You've been challenging in life in different situation and context. So,

I was thinking any recommendations on, say getting a little dive in research, where would you start reading to get a better understanding about acceptance? Yeah.

Tim Beames (27:40.014)
I mean I suppose I mean I always like going back to sort of the roots, so someone like Lance McCracken's work and god you've put me on the spot now I want to say Stephen Haynes and people like that but yeah

would probably go back to their work originally. My understanding of the more recent research around ACT in particular is yes it can be effective to a degree and we had Lance speak for the pub actually didn't we where he was saying

The next steps is to say what part of that acceptance piece for that individual was the meaningful thing. that really he was interested in how we then personalize the approach. so, yeah, I don't know to dive into for that specific sort of updated piece. The other thing is that there is a movement of

Bart Van Buchem (28:46.751)
Yeah.

Tim Beames (28:50.99)
living well with pain, living well alongside your pain or living well despite pain. And Bronnie Thompson for instance spoke to us a couple of years ago, wasn't it?

Bart Van Buchem (29:09.29)
Yeah, that's still available. that, that, that session is still there. I think it's massively relevant. Yeah.

Tim Beames (29:14.062)
Totally, massively relevant. It's really good. She does a brilliant job here. This is not a one-off event. This is becoming a part of your lives. How do we thread this into your being? I think that's an important...

an important piece. I suppose somewhere we haven't gone yet, which might be helpful to go, is I cannot guarantee you the experience of pain that you bring to this moment, I cannot guarantee that it will be gone forever. I would say it's unlikely.

that that can be the case if you've had pain for a very long time. Now I don't mean that the pain can go away so that you don't notice it there, but that it might come at a point in the future when you've had time without it for instance, but it's not something that's easily predictable. But what I can guarantee is it and your relationship to it will change over time.

Bart Van Buchem (30:20.566)
Hmm

Tim Beames (30:30.38)
That is an absolute given. So, and in that, you you have the ability to be able to create new possibilities, create a new you and, you know, however you want to see that, construct your life so that you are living, you know, your best life, even if that means you're living alongside pain to live your best life.

Bart Van Buchem (31:00.788)
Yeah. I like the way you summed it really nicely, how you would basically communicate this, right? And people are stuck and they want, they want to, they need definitely, it's clear they need something else to lose, to break free from their habits, from the patterns of thinking, the patterns of, because they haven't resulted in any long-term, well, solutions for life or even for pain.

Which is a nice, I think just let me to sum up what we've been talking through. So we talked about definition that it's clearly a challenge because there are different definitions and for people who will see it as stop or giving up. And you have to prevent that. Whether whatever the word you're going to use for pain or be fronting it or an accompaniment, it's finding a matching it with the person's

a person on a, let's say on an individual level to make sure that people can move with that idea. And it's a process where you do experiments, you do all types, which is what we refer to acts therapy, acceptance commitment therapy. We mentioned, Stephen Hayes work in the early, nineties, I guess, when he started to write about this, as well as Lance McCracken.

And I think our clinical confidence series with Laura Redbone probably will also touch on the, on the notion and the things that we talked about acceptance and Bronnie Thompson session is also in the library. So if you're a LAPUP member, you will be able to see these videos or these sessions, which are great because there's so helpful and so much insight for.

And we talked about like pain relief versus acceptance, the challenges that come across. I think we should, so probably going to touch more on this because this is very clinically relevant. I can see this day by day when this is absolutely where you can sort of lose connection with people on this top of, or where you can flip the whole.

Bart Van Buchem (33:19.658)
the coin where everything started to become different. And this is my experience when people are making the switches. It's lovely to work before that it's hard work, but once it's there, it's, you're starting to build a whole new relationship and the role as a, clinician will even change in this particular consultation. So, yeah, thank you, Timmy. I think it was lovely. I've been sort of.

Tim Beames (33:41.998)
I wanted to finish off on one thing because I feel like if you feel pain is being done to you, pain is the driver in everything and the acceptance piece is empowering. know, actually you're taking your own control here and that to me offers hope.

Bart Van Buchem (33:52.768)
Hmm.

Bart Van Buchem (34:07.7)
Absolutely. Yeah. Yeah. And that's, that's the process where you into so, so, yeah, that was, was a great addition to this and, we'll, definitely get back to the subject. So you're interested, just hang in with us and, sign up for whatever, follow this podcast. So you make sure you'll get notifications for the new episode. so you've been listening to the Le Pub Scientifique Pain Podcast. My name is Bart van Buuren.

We've here with co-founder of LePub Scientific, Tim Beams. We have talked all things about acceptance in chronic pain. our goal is to give you the tools that help your clients to take charge of their pain journey. So until next time, keep empowering your patients and thanks for listening.

Tim Beames (35:05.518)
Thanks very much.