Episode 75: When Everything Hurts: Exploring Predictive Processing in Fibromyalgia

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.