Transcript

Bart Van Buchem (00:00)
Hello, and welcome back to a new episode of The Pain Podcast! I’m Bart Van Buchem, a specialist pain physiotherapist from the Netherlands. Thanks for joining us again. Today, we have an exciting announcement: Yoni's will be joining us for a science session in January. This episode serves as a bit of a prelude.

Joining me is Tim Beames, a good friend and founder of Le Pub Scientifique. Today, we’ll share our thoughts on nociplastic pain, particularly its classification and the terminology around it, which continues to spark debate. It’s a complex topic, but it’s important for clinicians and patients alike. Tim, welcome back to the podcast!

Tim Beames (01:08)
Thanks, Bart. Happy to be here.

Bart Van Buchem (01:26)
To give some context: nociplastic pain was introduced by the IASP in 2017 as the third mechanistic pain descriptor, alongside nociceptive and neuropathic pain. It’s defined as pain arising from altered nociception, without clear evidence of tissue damage or a lesion in the somatosensory system.

This definition matters because it pushes us to look beyond traditional causes of pain. Having Jo Nijs in the January science session is exciting—he’s been working on clinical criteria for nociplastic pain alongside Eva Kosek and others. These criteria will impact clinicians and patients alike.

Tim, what are your initial thoughts on nociplastic pain?

Tim Beames (03:10)
It’s an important step forward. Before this definition, we viewed pain more mechanistically, focusing on nociceptive (tissue damage) or neuropathic (nerve-related) pain. Nociplastic pain broadens that understanding, highlighting central contributions and changes in the nervous system.

However, it’s not without challenges. Diagnosing nociplastic pain can be tricky because it often overlaps with other pain types. In the clinic, things are rarely clear-cut, which makes these classifications both useful and limiting.

Bart Van Buchem (07:09)
I agree. Clinical presentations are often messy, and strict classifications don’t always align with patient experiences. But clearer definitions could help clinicians diagnose and treat pain more effectively.

Tim Beames (08:19)
Exactly. A good classification can validate a patient’s experience and guide tailored treatments. But it’s crucial to remain flexible—pain is highly individual, and we can’t treat every case the same way.

Bart Van Buchem (09:45)
Absolutely. My question is: how does classification drive treatment decisions? Does it really change the way we approach pain management, or is it just a diagnostic tool?

Tim Beames (10:03)
It definitely influences my clinical practice. Learning about nociceptive and neuropathic pain transformed my understanding of pain and shaped how I treat patients. But I also try to avoid letting a diagnosis box me in. Instead, I work collaboratively with patients to explore their unique experiences.

Bart Van Buchem (12:05)
That’s a great approach. Patients often use terms like "chronic pain" or "central sensitization," but these don’t fully capture their experiences. We need terms that resonate with patients while also guiding effective treatments.

Tim Beames (13:17)
Agreed. Diagnoses like “nociplastic pain” can validate patients’ experiences, but the terminology should be culturally sensitive and relevant. For example, research in Australia found that patients preferred terms like “pain system hypersensitivity.”

Bart Van Buchem (17:31)
Exactly. We must involve patients in these discussions to find terminology that helps them feel understood and acknowledged.

Tim Beames (18:26)
Ultimately, our goal is to treat the whole person. Many patients experience overlapping symptoms across multiple systems—headaches, pelvic pain, IBS, and so on. This complexity highlights the need for broader perspectives in diagnosis and treatment.

Bart Van Buchem (21:00)
I agree. Nociplastic pain often overlaps with nociceptive and neuropathic pain, making it difficult to classify. But this descriptor encourages clinicians to move beyond a purely mechanical view of pain and consider factors like psychological well-being.

Tim Beames (24:49)
Absolutely. Expanding our scope can help us avoid sticking to ineffective treatments. For example, I’ve seen patients stuck in cycles of antibiotics or neuropathic pain medication for years, without exploring other options.

Bart Van Buchem (26:28)
Yes, broadening our understanding allows us to offer more holistic care, which is often what patients need. It’s not just about treating pain but understanding its broader impact on mental health, relationships, and daily life.

Tim Beames (28:51)
Totally. A strong therapeutic relationship and patient-centered approach can make a huge difference in outcomes.

Bart Van Buchem (29:10)
Looking ahead to January’s session, I think Jo Nijs will bring a well-balanced perspective. He’s done integral work in this area, and I’m excited to hear his thoughts.

Tim Beames (29:37)
Same here. Jo Nijs research and consumer-focused approach will spark important discussions.

Bart Van Buchem (32:30)
For those interested, the science session is on January 23rd at 7:30 PM UK time (8:30 PM Amsterdam). Join us—it’s going to be a great session!

Thanks for tuning in, and don’t forget to check out our website, Le Pub Scientifique, for free guides and resources. See you next time!

Tim Beames (32:56)
Thanks for listening!