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FIBROMYALGIA!
3 EXPERT TALK TRANSCRIPTS
from
HEALTHMEANS
LET’S “TALK” ABOUT
CONTENTS
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Fibromyalgia: Diagnosis Is
Half the Cure
David Brady, ND, DC, CCN, DACBN
with Michael J. Schneider, PhD, DC
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Fatigue, Fibromyalgia,
Autoimmune Illness
and Pain
Donna Gates, MEd, ABAAHP with
Jacob Teitelbaum, MD
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Fibromyalgia: A Food and
Lifestyle-Based Recovery
David Brady, ND, DC, CCN, DACBN
with Deidre Rawlings, ND, PhD
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Fibromyalgia: Diagnosis
Is Half the Cure
David Brady, ND, DC, CCN, DACBN with
Michael J. Schneider, PhD, DC
Click here to watch this interview!
The purpose of this presentation is to convey information. It is not intended to
diagnose, treat, or cure your condition or to be a substitute for advice from your
physician or other healthcare professional.
peer reviewed medical journals,
in medical textbooks, and lay
publications as well. There is like
I said up front, there is a very few
people if any who are respected
knowledge in this topic more than
Dr. Schneider. So thanks for being
with me, Mike.
Dr. Schneider:
Okay, great. My
pleasure.
Dr. Brady:
Well, we’ve been through
some of these topics around for
upwards of 25 years at this point
And sometimes we, I think we felt
like we were howling into the wind.
And I think both of us had a similar
epiphany way back in our careers
with this thing we call fibromyalgia
and correct me if I’m wrong, if I’m
speaking for you in a way that’s not
accurate, but I know that I got to the
point very soon after my training
was completed, at least my initial
training as a chiropractic physician.
You had much more experience
than me by that point but, I
realized that I was not prepared for
treating patients with fibromyalgia
and that I knew little about it. I
just didn’t really understand it.
And once I started learning more
about it, partly thanks to you,
I started realizing that nobody
else knew much about it either.
The healthcare practitioners
were confused, the patients
were confused. The healthcare
practitioners were confusing the
patients even more.
So we set out on a journey to try to
educate healthcare providers more
about this disorder. And we did
that for many, many years. And this
latest project with the summit and
the upcoming book
The Fibro-Fix
is
really about taking this message
directly to the people who have
been told they have fibromyalgia
who may have it, who may not
have it.
So, just a start sort of from 30,000
feet, your perspective on this thing
we call fibromyalgia and how you’ve
had to deal with it in your career,
any just opening thoughts about it
for the listeners?
Dr. Schneider:
Yeah sure. That was
a nice little summary. I mean for
me, as you started talking about
my little bio there, I was always
interested as a chiropractor in
people who had pain.
Dr. Brady:
Right.
Dr. Schneider:
And since I focused
on soft tissue pain in my practice, I
did a lot of trigger point therapy.
Dr. Brady:
Right.
Dr. Schneider:
So, I remember
1990 when the first article came out
about fibromyalgia. The very first
article, 1990, my first impression
was, “Oh, this research, they just
got it wrong. They’re saying tender
points that’s trigger points. What’s
the big deal? This is all the same
thing.” And then after a couple of
Dr. Brady:
Hi, this is Dr. David
Brady. And welcome to The Fibro-
Fix Summit. We’re here with one
of our esteemed experts, a good
friend of mine, and a very respected
colleague. And one of the most
knowledgeable people I know in
this topic of fibromyalgia and that’s
Dr. Michael Schneider.
Dr. Schneider graduated from The
Palmer College of Chiropractic in
1982 and then went on to obtain
his PhD in rehabilitation science
from The University of Pittsburgh
in 2008. He’s currently an associate
professor at The University of
Pittsburgh in the school of health
and rehabilitative sciences.
He’s been seeing patients as a
chiropractor for over 30 years,
specialized in the treatment of
muscular and myofascial pain
including patients that came in
with a diagnosis or a label of
fibromyalgia. At The University of
Pittsburgh he sees patients at the
Center for Integrative Medicine,
where he collaborates with other
integrative practitioners and other
approaches including naturopathic
medicine, massage therapy,
yoga, mindfulness meditation,
tai- chi, and others to combine a
comprehensive treatment plan for
fibromyalgia patients.
Dr. Schneider has published
and lectured with me on many
occasions. We have many co-
author papers together in the
years I started realizing, oh, I see
what they’re talking about.
You and I call it classic fibromyalgia
patient. That’s not trigger points.
That’s something else. And I didn’t
know what that was at that time.
But then as the years went by, I
started seeing there were patients
that had truly muscular or joint
pain, and then there are people
who don’t and fit this sort of classic
profile.
And then there are people that
are just completely mislabeled in
the first place on neither one. And
that was sort of the beginning of it.
And I think you and I then started
going down that road trying to sort
people out into these different
categories.
Dr. Brady:
Right, because you
know, the term fibromyalgia just
means pain in the fibrous tissue,
you know the softer tissues not the
hard tissue like bone to joints but
the muscles, tendons, ligament,
fascia. But it’s very nebulous, right?
It just means pain there but
when we started really digging
into the literature and what the
rheumatologist and all were talking
about, was really that the pain
was not in those soft tissues. The
pain was just perceived in those
soft tissues in this classic model of
fibromyalgia, which is really this
centralized pain processing disorder
where there are things that are
going wrong in how we process
information coming into the brain
itself. That the problem is not in the
muscles or in those soft tissues, it’s
just felt there.
So, that was what we called classic
fibromyalgia and all the classic
presentations of what the literature
was talking about of these central
sensitization disorder. So it had
the depression, and the anxiety,
and the unrefreshed sleep, and
the IBS, and all these other things
where what we were seeing as
chiropractors often and we were
successfully treating are these
patients that had a lot of pain but
they really actually had problems in
the muscles out in those tissues.
And they had these things we call
trigger points and we treated them
with various ways. And they got
better. But then there are these
other patients who seem to be
complaining of pain all over. But
when you go and examine them
and touch them and palpate them,
they didn’t have those trigger
points, and they didn’t respond to
the kind of treatments that we were
used to giving. So that was where
we decided, hey, we need to start
really understanding this and we
need to start writing about this.
And I think initially our intent
was to try to educate our fellow
chiropractors at that time, but then
we got more ambitious than that
somewhere along the line I think.
Dr. Schneider:
That’s true. And
you make a good point there that
one of the things I learned early on
was with this classic fibromyalgia
patients, they hurt everywhere.
And that there was like a real
hypersensitivity that we didn’t see
with the trigger points application.
That it wasn’t a localized regional
sort of pain. They literally hurt all
over their body.
And then as chiropractors being a
little bit more holistically oriented,
we started realizing, they weren’t
just sensitive to the physical touch,
they were sensitive to sounds, they
had multiple chemical sensitivities,
multiple food sensitivities. And it
started leading towards this idea
that maybe their central nerve
system is just sensitized overall.
Dr. Brady:
Right, and then
that’s what the literature started
uncovering as well, that they had
sort of irritable everything right?
And it goes with irritable bowel,
irritable bladder, all the sort of
what they call the hyper vigilance
right? Their nervous system is in the
state of emergency all the time, like
they’re always waiting for the next
shoe to drop and the next bad thing
to come along.
So they’re primed in a way to expect
a catastrophic type of event if you
will. But instead of being in that
mode temporarily when there is a
legitimate threat or stressor, their
nervous system is seen to somehow
get stuck in this pattern perpetually.
Do you think that’s an accurate way
to describe that?
Dr. Schneider:
Yeah I mean, you’re
right. There’s a whole emerging
area of literature now showing that
these patients what we call the
classic fibromyalgia patient they
tend to have irritable everything.
And the way I describe it to patients
is it’s like the volume has been
turned up on everything. They’re
still having the same input like we’re
trying to get the volume here or
mic set so that their volume is way,
way up. So even the slightest little
whisper in their brain becomes like
you’re shouting. And to me that’s
a good analogy of this, whether
that input is coming from the skin,
or muscles, or inputs coming from
their stomach, or inputs coming
from other parts of their body.
Everything is ramped up.
Dr. Brady:
That is interesting how
that correlates with this issue of a
lot of these patients who go on to
develop fibromyalgia in adulthood.
You know, they’re generally
females, not exclusively but the
large preponderance of them are.
And many of them in their histories
– and I never really realized this
until I really paid attention to it and
did very good histories on these
patients – that they have histories
of sort of previous stress trauma,
even abuse.
A lot of times they were brought
up in a household with maybe the
abusive, yelling, alcoholic father, or
something. Or they got the mother
who is being abused by the father.
Or they witnessed something
horrific. Or there was something
going on that made them feel
fundamentally threatened or unsafe
while they were young, while their
nervous system was developing,
learning how to cope with the world
and sort of what we would call this
neuroplastic state.
And maybe they sort of took on
this pattern if you will of looking at
their world in a way that they may
not have if they were not in that
kind of environment when they
were young. What do you think
about that theory that previous
trauma imprinting, sort of the body
remembers the pain, the trauma,
and maybe even the abuse itself?
Dr. Schneider:
Yeah, well, since
you mentioned this, there’s actually
quite a bit of literature in this area.
We know for a fact that again, what
we call a classic fibromyalgia patient
that there’s much, much higher
prevalence of physical, sexual,
verbal abuse. This is pretty much
becoming an emerging fact.
What the interesting part is, is
that some patients are subjected
to abuse and they don’t develop
these symptoms, which had lead
now to the idea that maybe this
is partly a genetic issue. That
some people are genetically sort
of predisposed, if you will, to
potentially develop fibromyalgia
or a central sensitization disorder.
If they’re not subjected to abuse
in their lifetime and they have the
genetic predisposition, it’s never
expressed. So the genotype does
not become a phenotype if you will
in medical terms.
Dr. Brady:
Right and I discussed
it in the book and actually shows
some of the literature there that the
higher prevalence of fibromyalgia
and classic fibromyalgia running in
families. There is clustering that’s
passed on through family genetics.
But it has to be paired up with the
right environment right?
The right environmental
circumstances, and that’s how most
things work.
There are some things that are
really hardwired genetically. But
most things are – you have a higher
likelihood of developing that if all of
the things line up.
Dr. Schneider:
Sure, and we
know just without even going to
fibromyalgia literature, we could talk
about it’s pretty well-known that if
you have a family five people, one or
two of those family members might
be very sensitive kind of people and
one or two may not be. In those
sort of sensitive type of people that
are the ones that tend to develop
fibromyalgia type symptoms
when they’re exposed to multiple
prolonged stress.
That’s what we’re talking about
here, not just a single incidence
typically. It’s typically, it could be
a low level of stress over a long
period of time. Or it could be one
really, really terrible thing that
happened.
Dr. Brady:
Right, and it seems to
be that even people who may be
sort of harbor this sensitivity or this
susceptibility, if they have an event
like that as an adult, let’s say they’re
abused or they have some sort of
traumatic scenario. This seem less
likely to go on to develop things like
fibromyalgia and IBS than if they
were exposed over long periods of
time with two significant stressors
or abuse when they were young
and growing and their nervous
system was sort of learning. Do you
put much credence in that?
Dr. Schneider:
Oh for sure. Again,
it’s not just for credence if there’s
a lot of evidence to show that the
younger, the more malleable your
nervous system is when trauma
occurs the more ingrained it
becomes into your nervous system,
that harder it is to change that
later on.
Dr. Brady:
And it’s interesting that
some of the same neurotransmitter
abnormalities, you know the
tendency toward lower serotonin
and high substance P, and high
catecholamines, and all these
things that we’ve written about
extensively. They correlate with
other things such as posttraumatic
stress disorder or even below the
actual diagnostic criteria of PTSD,
things that some researchers have
called distressing life events.
Some people talk about ACEs,
various childhood experiences and
the like. That same kind of similar
constellation of neurotransmitter
abnormalities exists in all of these
types of disorders that involve this
sort of traumatic experience.
Dr. Schneider:
Yes, and again how
much of that is genetic? We don’t
know yet.
Dr. Brady:
Right, and it’s also
interesting that we had worked on
a textbook chapter in Gerard Mullin
from John Hopkins’ book about
fibromyalgia and the association
with irritable bowel syndrome, and
other kind of gut problems.
Where the dysfunction in the gut’s
nervous system, the enteric nervous
system in IBS seems to mirror the
dysfunction in the central nervous
system in disorders like classic
fibromyalgia. And in fact, many
of the same neurotransmitters
or neurochemicals are actually
involved.
So it’s really not a surprise that
something like irritable bowel
syndrome has in some cases
almost 80% maybe to even 100%
comorbidity depending on what you
look at with fibromyalgia.
Dr. Schneider:
Yeah, I mean that’s
another great example. As we know,
there’s something with patients with

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