Transcript

Tim Beames (00:01)
Hello, and welcome to The Pain Podcast. I’m your host, Tim Beames, and today I’m joined by Bart van Buchem. We’re both specialist pain physiotherapists, and we’re going to explore a topic that often comes up in the clinic: how to achieve lasting change. We’re particularly interested in empowering people on their pain recovery journeys.

Bart van Buchem (00:28)
It’s an interesting area, isn’t it?

Tim Beames (00:30)
Yes, I’ve been thinking about this from both a personal and clinical perspective. For example, at the start of a new year, many of us decide to change our diet or start exercising. We begin with good intentions, but often we only last a couple of weeks, or maybe a month or two. It’s a common experience—many people drop off quickly, myself included. I’ve found that a strong motivating factor is crucial for sticking with change over time, and this is something I’ve applied in my work with clients, especially when considering behaviour change and habit formation.

Bart van Buchem (01:50)
It’s a bit like practising what you preach, right?

Tim Beames (01:53)
Exactly! I’ve committed to changing the way I eat, including what I eat and how I prepare food. There are a lot of elements involved, like making sure healthy options are visible and easy to access. It’s made a big difference for me, and I apply similar strategies with my clients. Reflecting on whether these changes have had an impact is an important part of the process.

Bart van Buchem (03:11)
Yes, it’s interesting how sometimes even when we know what’s right for us, it can still be hard to maintain that behaviour. At some point, it starts to feel more normal, like when your body begins to ask for exercise instead of it feeling like a chore. That’s a big shift.

Tim Beames (04:30)
Absolutely. When patients ask if they need to do certain exercises or focus on their posture all the time, it’s about finding when those behaviours become the new normal. It’s not an easy question to answer, but it often happens when patients realise they haven’t been paying attention to it anymore, yet it feels fine.

Bart van Buchem (05:06)
Yes, it’s a sign of progress when people notice they’re not as conscious of their movements because they’ve become more natural. It’s something we can facilitate in clinic through reflective practices and encouraging self-awareness.

Tim Beames (07:16)
Reflection is a key skill, but it’s not always something people are naturally good at. In clinic, we might encourage journaling or use mindfulness techniques to help build this capacity. It’s about helping people learn to notice their needs and respond to them.

Bart van Buchem (09:42)
Exactly. We often use tools like goal setting, asking reflective questions, or even recording movements so that patients can see themselves from a different perspective. It’s about developing that third-person view of their own behaviour, which can be very enlightening.

Tim Beames (11:21)
Some people find journaling helpful, but for others, it can be tricky if they’re focused on their pain every day. In those cases, I suggest a practice called "The Three Gifts," where instead of journaling about pain, they write about three positive moments from the day. It shifts the focus and can help balance the perspective.

Bart van Buchem (12:24)
That’s a great idea, but it requires a level of trust between clinician and patient. You need to introduce these exercises carefully, making sure it doesn’t come across as dismissing their pain.

Tim Beames (13:54)
Yes, timing is important. We often have to build that trust before suggesting such exercises. It’s about finding the right moment to introduce new perspectives and help patients recognise positive experiences, even if they’re small.

Bart van Buchem (17:41)
Absolutely. Chronic pain often involves being stuck in certain patterns. Disrupting those patterns can be necessary for change, but it needs to be done carefully to avoid overwhelming the patient.

Tim Beames (18:36)
Yes, it’s about striking the right balance. Sometimes, we need to broaden the lens and look at progress over a longer period—weeks or even months—instead of checking in daily. This helps to avoid focusing too much on day-to-day fluctuations, which can be discouraging.

Bart van Buchem (20:24)
I agree. Setting small, achievable goals that focus on building skills rather than just reducing pain can be more effective. It’s about creating positive, practical targets that patients can integrate into their daily lives.

Tim Beames (24:23)
Yes, and these goals need to be meaningful for the individual. It’s not just about reducing pain but about improving overall well-being. Over time, as these changes become habits, they can help create the conditions for better health and quality of life.

Bart van Buchem (29:21)
That’s where the focus on meaningful activities comes in. Sometimes, it’s about helping patients find new hobbies or experiences that bring joy and purpose, rather than trying to go back to their old routines.

Tim Beames (31:14)
Yes, it’s about creating an environment where change is possible and encouraging patients to notice even small shifts in their experience. This builds the foundation for lasting change.

Bart van Buchem (32:48)
Disruption, when done thoughtfully, can be key to breaking through the patterns of chronic pain. It’s a delicate balance, though—we need enough change to make a difference without overwhelming the patient.

Tim Beames (36:56)
Exactly. We’ve covered a lot today about self-reflection, goal setting, and creating lasting change. It’s clear there’s much more to explore in future episodes.

Bart van Buchem (37:21)
Yes, there’s so much more to discuss. If you’re interested in learning more, please visit our website at [thepubscientifique.com](thepubscientifique.com). We’d love to hear your feedback and suggestions for future topics. Just drop us a message.

Tim Beames (38:23)
Thanks for listening. See you next time.

Bart van Buchem (38:26)
See you next time. Bye.