Trevor (Chronic Pain): Chapter 3 - Trevor's main learnings and advice

Episode 3: Chapter 3 - Trevor Barker - Recovery from chronic/persistent back pain (Chronic pain) - Trevor's main learnings and advice.

In this third episode we meet Trevor Barker, a former electrician and now support coordinator from north eastern Victoria who following a minor workplace injury, developed and lived with debilitating chronic lower back pain for over 20 years. His eventual recovery came swiftly through education and he now works with some of the world's leading pain scientists and educators to share his story and encourage others to learn more and make meaningful change in their own lives. Trevor has appeared on SBS’s Insight program, as well as contributing to various podcasts, radio and print media and continues to share and champion recovery from persistent pain.

In this chapter Trevor describes his key learnings and recommendations for others who might still be living with chronic or persistent pain.

Full transcripts and show notes are available for each chapter on the podcast website: storiesofrecovery.buzzsprout.com

Shownotes:

• ^00:32 - Trevor talks about a few things which together were incredibly important and beneficial for his recovery: 
  • ^00:53 - Trevor's discovery at the persistent pain service (when he realised he 'could' hold his arms up from playing the flute) helped him to see that he had ability in his arms because he uses them. He does it for himself. It is an 'active' strategy. Trevor recommends trying to look for and apply 'active' strategies (things you drive and do yourself), rather than 'passive' (where someone else does something to/for you),
  • ^03:14 - Learning that 'pain is not an accurate measure of tissue damage', 
  • ^04:29 - Learning that pain is affected by social, psychological and biological factors and that there is a treatment which focuses on the social and psychological aspects:  DIM-SIM therapy (Danger In Me - Safety In Me). This tool helps you identify the things in your life which contribute to your pain so you can reduce your exposure and interaction with them, whilst at the same time increasing thought processes and participation in activities which reduce your pain experience and start to dial down your overprotective pain system,
• ^07:30 - Find a medical professional who is trained in pain science, who can safely assess what you are 'safe' to do, and can work with you to understand pain and recover,
• ^14:11 - Trevor recommends two great videos by David Butler and Lorimer Moseley, 
• ^15:34 - Read Alison Sim's book Pain Heroes. Trevor refers to it as 'painful stories' in the interview which is another good book by Lorimer Moseley,
• ^15:58 - Trevor's greatest investment during his recovery: Having the courage to try new things, new approaches and to "give things a go", such as getting into a loving and caring relationship again in Trevor's case,
• 17:30 - It's important to be exposed to and open to consider 'a different perspective',
• ^18:23 - Trevor suggests 'we're in the change business'. If we get stuck on one road and we're not prepared to look at a different road, nothing will change. If we want things to be different, then ask yourself 'what can change?', 'what do I need to change?',
• ^19:23 - Be wary of anyone who is trying to treat your chronic pain with only a 'Biomedical' approach,

^Trevor's main tips

Transcript

Note: Time stamps for the chapter episodes are based on the full episode recording.

Robbie Frawley  
Welcome to chapter 3. In this chapter Trevor describes his main recovery learnings.

Robbie Frawley  53:36  
Looking back now, what would you say were the most beneficial elements to your recovery?

Trevor Barker  53:44  
Yeah, that that really is a good question, Robbie. Probably three or four really key points that together really helped me take a different approach. And, and the first thing was the example of me holding my arms up and just discovering for myself that me getting into doing things for myself is really a good thing. So that I have ability in my arms because I'm using them. Whereas I don't have ability in the rest of my body because I was lying down and protecting myself. There's a difference between active and passive treatments. Yes. And passive treatments are those treatments that people are doing things to me. So you know, massage and physio were long on a table, car, practice my therapy, all of that. It pretty much pills, injections, those sorts of treatments are all passive is when something's someone's doing something to me, as opposed to active which is scientific truth, you're strong, you're capable, get moving. Motion is lotion. And when you're involved in that space, of being active rather than passive, you're moving forward. And it's making a difference to your health and well being. And it's making a difference to your pain. So that was one concept so

Robbie Frawley  55:24  
active with you meaning using active strategies rather than passive strategies. Absolutely. Yep. Yeah, looking for things that are being offered or that you can do where you're the driver of them. That's

Trevor Barker  55:38  
right. Yeah, that I can incorporate into every day. So, you know, we've talked about doing crossing the midline, above shoulder height, that's a agnate. thing. Going for walk to the post office, stretching, they're all active things going to water aerobics, and incorporating, incorporating movement into my life. Sure. So changing my focus from people doing things to me, to me doing things for myself, was really a very important change, that the other key concept that really is important to think about is how when you're in chronic pain, patients pain is not an accurate measure of tissue damage. Yes. And I thought that because I'm in so much damn pain is got to be something catastrophic going on in my body. Yes. And then when pain goes up a pig, oh, my goodness, my condition is worsening on degenerate domande, a degenerative condition, I'm going to be in serious trouble here. Whereas what's really pertinent for people to grasp is that pain is not an accurate measure of tissue damage is not a direct relationship there. That's a really important concept is to get a really good grasp, started to understand that I could move more, even if my pain went up, it didn't mean that I was, it didn't actually mean you tissue damage here.

Robbie Frawley  57:24  
And that was a concept we picked up from, from Aubrey, and with the pain revolution. Okay, so as you know, powerful

Trevor Barker  57:32  
that that was really important. Another important concept is that our pain, chronic pain is about psychological, social and medical issues. And that there's a treatment out there that focuses in on the social and psychological treatments. It's called dim sim therapy. So, and dim sim stands for danger in me, safety in me. And it really talks about the relationship between all the stress that's in our life, as compared to all of the active, fun, enjoyable, safe things we can do for ourselves. So if we have, if we change that balance between barebone lots of stress to lower stress, and no self care, no fun enjoyment to more fun enjoyment, self care, safety stuff, then we are going to alter the relationship between the s protecting nature, which we're on high alert all the time. And we're going to calm our state down to the point that we're also calming down not only to our psychological distress, we're calming down pain.

Robbie Frawley  58:51  
And just to clarify, so DIM-SIM, it's an acronym used by pain revolution. So DIM is

Trevor Barker  58:58  
'danger in me'. Yes. And SIM is 'safety in me'. 

Robbie Frawley  59:01  
And what's the idea behind that? 

Trevor Barker  59:03  
So the the idea is really to help people think about what elements in their life create stress, danger, time type, thinking and beliefs.

Robbie Frawley  59:15  
Okay, so not literal danger, but sort of the perception of danger.

Trevor Barker  59:21  
Yes, yes. Now, it could be actual danger of in domestic violence relationship, for example, then there'd be a lot of stress, there'd be a lot of danger going on. And that doesn't just impact on your personal safety, but it impacts on your mindset and your psychological well being and your relationships. So the dim sim therapy is about helping people to think about what elements in their life are creating stress and danger. Yep, thinking. And then. And for people with chronic pain, most of that's easy too. Understand what are some examples of example might be, for me. Movement was avoided, I lie down all the time with hot water bottles on my back. I wanted to avoid flare ups. Yes, the thinking was if I move, I'm going to hurt and injure myself, I'm going to be in more pain. So there was a real danger in me about moving. Sure. And using my back bending, twisting, lifting. Whenever I had pain in my back, it was because I've bent too far, or I hadn't been lying down for long

Robbie Frawley  1:00:34  
enough in the day. So how do you convert that into

Trevor Barker  1:00:37  
what I did was I understood or got some help. And I understood that moving was a good thing for me that there was a safe thing for me or wasn't going to do tissue damage, that I could pace myself and slowly increase the level of activity, which is a reasonable way of starting to go from zero to hero doing a whole lot more than what I was doing. So I could slowly increase activity. Understand that even if my pain did increase, or wasn't causing tissue damage, so

Robbie Frawley  1:01:16  
And how did you like have that? Where did you get that confidence from? That it wasn't causing tissue?

Trevor Barker  1:01:21  
From a good assessment from a physio therapist who explained that? No, your back's fine, strong, be capable? Yes, it's okay. You're safe to move in. In fact, when you move your joints to lubricate they get. Yeah, motion is lotion.

Robbie Frawley  1:01:38  
Is that something like, given the fact you'd seen a lot of specialists and medical professionals prior and you obviously hadn't got that message? But then, in the old resetting, you were getting, I guess, the right message about

what you were safe to do. And that movement is good. Is that difficult to find, I guess, medical people who are trained in this and that are going to give you the right messages to give you safety in me. If and I guess to know that you're safe to move,

Trevor Barker  1:02:09  
I think this is a fundamental flaw with the medical profession, in that they are problem focused. What is wrong with this person in front of me? Rather than what are they capable of? what's working well. And the thought that they're telling me they're in a lot of pain, so there's got to be something wrong. There's something wrong might be, there could be a whole lot of stress. So look, it's worthwhile doing a proper thorough assessment to make sure that, you know, we all the red flags, yes. off the table. And that being the case, then the medical profession, if it continues to go down with offering pills and more investigations like that they did for me, then that's not going to resolve the social and psychological aspects to this pain that's going on. Yeah. So that is the risk. At the moment, most people that go to their doctor will get a biomedical focus, rather than a more holistic approach that also looks at the social and emotional. And that's an issue with the Proficient. It's an issue with Taiwan. And it takes time to hear someone's story and context, and unpack everything else that's going on and contributing factors. So when you sit down in front of a doctor, it very quickly goes, What's wrong? What can I do? Yes, rather than let's talk about your whole life.

Robbie Frawley  1:03:50  
So for anyone listening, I don't know, how do they how would they find someone who? I don't know, he's gonna provide, I guess, the advice and

Trevor Barker  1:04:01  
different approach. Yeah, yeah. So it's worthwhile asking around. You know, my first approach is, do you know any friends that have had a different type of experience? Where did they go? Who did they talk to? Now, we're not talking about trying to find the guru that's going to fix you? Because there are plenty of people out there that say, oh, go to this person or go to that person. To me, it's more about the approach. Because the approach has to be bringing me back to a self management perspective. What can you do, Trevor to help yourself? Yes. If anybody is saying to you, I will fix you and you've got chronic pain. Then run away because the fixes within yourself. If they're saying to you, I will help you understand what's going on and give you some sense strategies that you can apply to your life to improve your situation, then that's the right person. Yeah. So you can very quickly work that out when you're talking to someone, if they say, tell us about your injury, show us your X rays, or you are first starting to suggest that we get another x ray, another MRI or a CT scan, then they're looking for issues with tissues, if you've had long standing pine, and it's very unlikely that it's going to be issues with tissues, yes, my approach now is to deal with this have a look at the social and psychological aspects to my life, and work on those and see how that shifts pain.

Robbie Frawley  1:05:51  
Yeah. And that's, that's a, I guess, the view that's been formed and been learnt from, you know, these people that are at the forefront of pain science globally by the sounds of

Trevor Barker  1:06:06  
it is, it's also not being dismissive of issues with tissues. Yeah. I mean, it's important to have a good understanding that, okay, I don't have a broken bone here, or, yeah, but we know that bones heal in six weeks. So if you've had pain for 20 years, it's not about a broken pain, or broken bone. So it really is just having an accurate understanding of the fact that tissues have healed. And if that's the case, then let's find people that can offer really good social and psychological support. Now that comes in the form of an occupational therapist, for example, who has a really good understanding of the stuff. physio therapists that might have pain accreditation, yep. A psychologist that has, you know, training in this space with iron sights. And how you find those people is really talking to friends, family, others that have experienced a different approach.

Robbie Frawley  1:07:15  
Yep. If you did encounter someone who was, I guess, in a similar space to you? Is there any? Are there any books you would recommend to them? Videos, you'd suggest that they watch to, I guess, help them along on their journey?

Trevor Barker  1:07:29  
Yeah, well, you know, I've mentioned Dave Butler and Lorimer Moseley a few times, and why I like them is that they're very good at it at explaining very complex concepts. In a way that makes sense to me. Yeah. And if it makes sense to me, it'll make sense to anyone. Yeah. And that's really important. We don't want to scare people off with big words. We don't want to have them being thinking that we're at the end of the world. We want people to really be able to step through what's going on, and what can I do to make a difference to that? Yes. So almost anything that David Butler or Lorimer, Moseley do online? Is some very good lectures available there. If people Google MSK, Australia, then there's two lectures online there that are professionally filmed. Both have one from Dave Butler, one from Laura, mostly. That's a good starting point. Okay. Yep. How long can I get for better now? I can have Cora. Yeah. And then Alison Sims wrote a book painful stories. That's a series of stories about people that have had long term chronic pain, and, and what they've done to help trigger. Yes. And it's quite informative, and a very good book.

Robbie Frawley  1:09:00  
Okay. Yep. Beautiful. What do you think was the most worthwhile investment you made for your recovery? And that could be an investment of time, investment, money, effort, anything?

Trevor Barker  1:09:16  
Yeah, having the courage to try new stuff, and doing it. So, you know, instead of being fixated on a particular path, and a particular way of doing something, being prepared to change that approach, and having the courage to do something different. A prime example of that really came when I was prepared to drop my thinking that being in relationship would be danger and and have the courage to try again, and discover that being in a loving caring supportive relationship is the best thing I could possibly do to treat my pain. It's might sound a bit strange, but really having the security of a secure loving relationship does change the balance of danger in me, and safety unmade. So my safety in May is really at a very high level, because of being prepared to make that change and get into a loving relationship and be part of that.

Robbie Frawley  1:10:34  
And David's comments had kind of instigated some thought,

Trevor Barker  1:10:37  
yeah, a different perspective. Yes, someone else's comments had provided a different perspective, just like my friend making comments about the programme gave a different perspective. Yes. Which opened me up to the possibility that things might be different. Yep. That it doesn't have to be on that I'm not on a railway track headed down a particular road, I can choose to do things differently. And that creates change. Yes. And so, you know, that's, that's really, what all of that did was changed my thinking in perspective. Okay. Now, when you're living alone, and you're isolated, and you're not talking to people, you don't have that perspective. You see things, how you see them? Yeah.

Robbie Frawley  1:11:28  
Do you have? Or have you had any particular mantras or quotes, which you found particularly helpful on your journey?

Trevor Barker  1:11:35  
Yeah, I think the main thing really is that we're in the change business. If we get stuck on one road, and we're not prepared to look at a different road, then we're just gonna keep experiencing more of the same. So it's not a major as such, but really just continually thinking, What can I change? What needs to change? And, and that, to me is really important, just accepted things. If we want things to be different, then let's have the courage to try something different. And give it a go. And if it doesn't work out, we've given it a go, we'll find out some more information and try something different next door,

Robbie Frawley  1:12:25  
like are there any bad recommendations or advice you've heard or that you've received during your experience?

Trevor Barker  1:12:34  
So the over arching period of my life has been, you know, 20 years of trying a particular approach that had a whole lot of advice that was just wrong, okay. And it comes from the industry that believes that because someone's in pain, there's something wrong was the body his issues with tissues? And, and even like today, that advice will continue to roll out every day in doctors rooms around the world, that if someone's in pain, we give them a pill, we send them off for an x ray or a CT scan or an MRI scan, we inject them with this, we do that. So the bad advice comes from that belief that chronic pain is a biomedical approach. And you know, doctors and physios have red flags. And those red flags will be a series of questions they ask themselves when I meet someone for the first time, to establish that there's not an underlying condition that if it's treated in a particular way, is going to cause more damage. Because we're helping Bogle and for me, patients can have their own red flag. So instead of looking at one piece of advice, that's bad advice, we can ask yourself one question. And that question is, is the doctor or the physio or whoever was saying, looking at my situation as a biomedical problem? And how we work that out is, are they saying, You need a new pill? You need a bigger pill. You need an X ray, you need an MRI scan or an ultrasound. Or I'm going to do something to you to treat your pain. That's a biomedical thing and if so, okay, if they're offering that to you, and you've got chronic pain, that's bad. Yeah. That's a red flag for me. That gives me permission to run out the door and not come back.

Robbie Frawley  1:15:00  
Okay. And that sounds pretty standard.

Trevor Barker  1:15:03  
That's yeah. Which is the sad, sad thing, that in 95% of the cases, that's what's going to be dished up to you. Yes. So the bad bit of advice would be, do not go. Do not keep seeking advice from a biomedical focus because it won't resolve pain at all.

Robbie Frawley  1:15:26  
Yeah. And when it's just the term bio, medical focus, what does that mean? And what is the bio sosu? What the other one you described?

Trevor Barker  1:15:35  
Yeah. So look, what this generally accepted. Model or framework for looking at chronic, or persisting pain, yes, which has three elements to a biological, which is what's going on with our bodies, social stuff, which is our relationships, and psychological well being as thought processes, how we feel about ourselves. And so if we apply that thinking, and somebody is only offering one element, then it's not a complete picture to it stuck missing. Yeah. And so for me, what happened to me was I continually sought answers from the doctors who continually dished up a bio medical treatment system that failed to explain that psychological and social factors also contribute to pain. Yeah. And failed to help me develop an approach to help myself. Had they done that, or wouldn't have had 20 years of chronic pain? Yes. Yeah.

Robbie Frawley  
That's the end of chapter 3. In the final chapter Trevor talks about his life now and his day to day practices.