Welcome to Episode #4 of the Healing Pain Podcast with Dr. David Brady!
The combination of fatigue and body-wide chronic pain, often called “fibromyalgia”, remains mysterious and confusing. An alarming 66% rate of those sufferers are misdiagnosed. Leading naturopathic medical doctor and nutritionist Dr. David Brady joins the Healing Pain Podcast to answer your questions about Fibromyalgia. For more than twenty-three years, Dr. Brady has treated many thousands of patients seeking relief for what they consider a mystery illness—chronic global pain—and has devised a protocol to help patients determine if in fact, they are suffering from fibromyalgia— or from one of the several syndromes commonly misdiagnosed as fibromyalgia.
In This Healing Pain Podcast You Will Learn:
- What Fibromyalgia is and what it is not.
- How Fibromyalgia is different than Chronic Fatigue Syndrome.
- How to properly diagnose and treat fibromyalgia.
- How to differentiate Fibromyalgia from other pain syndromes.
- Why so many clinicians mistake other pain syndromes for Fibromyalgia.
- An outline for the modern Fibro-Fix!
Welcome to the healing pain podcast. I am your host, Dr.Joe Tatta. It’s great to have you here today. The topic of today’s podcast is fibromyalgia. I have an excellent, incredible guest that joined me today. His name is Dr.David Brady. He is a naturopathic physician based out of Connecticut. He had also studied integrative and functional medicines, so he brings a really well rounded approach to the condition of fibromyalgia. On the podcast today you’re going to learn exactly what fibromyalgia is, and what it’s not. Oftentimes it’s misdiagnosed with things like myofascial pain syndrome, lyme disease, or even autoimmune thyroiditis. So he’s going to go into that in detail, and give you a really good framework of what fibromyalgia is and how you can get over it. Or if you’re a practitioner and you want to know exactly and accurately how to diagnose fibromyalgia, this is the podcast for you. So stay tuned and enjoy the podcast, and let’s welcome Dr.David Brady.
Dr.David Brady, thank you for accepting my invitation to be on the healing pain podcast. It’s great to have you here today.
Hey, thank you Joe. I really appreciate it. I always love talking to you, and I look forward to another great discussion.
So we’re going to be talking about fibromyalgia today, which obviously is a really really important topic, and I know one that you’re going to provide a lot of clarity around. So as a physical therapist, if I could count the number of prescriptions that I’ve received that fibromyalgia across it … They’re so numerous. So tell us exactly what fibromyalgia is because I know you’re going to later define what it’s not.
Yeah. It’s pretty well defined at this point as far as what the current diagnostic criteria is, and what I’m going to tell you is according to the American College of Rheumatology, which has the most current diagnostic criteria which was published originally in 1990, it was modified in 2010, or re-released in 2010, updated, and then it was modified again very quickly in 2011, but basically it is a condition where someone, and these are generally women … Not exclusively, but almost exclusively women, who experience body wide achiness or pain. So by body wide or global, I mean it can’t be in one place or two places, or even three places. It can’t be regionalized or localized. So it really has to be this pervasive achiness and pain that’s perceived in the softer tissues. Not in the joints, but in the muscles, and fascia, tendons, and the softer compliant tissues.
That’s where the name comes from. Fibromyalgia. The fibrous, soft, pliable tissues, not the bones, not the joints. And algia just means pain. So the pain has to be basically in the upper body, lower body, left side, right side, along the midline of the body, out in the periphery, but it’s really much more than just pain. A true classic fibromyalgia has with it a conglomeration of symptoms that we associate with something called central sensitivity. And we’re going to talk more about how this disorder is really a disorder deep within the central nervous system. So therefore, it has other symptoms related to things that the central nervous system controls.
So you see a lot of pervasive, persistent fatigue for instance, going along with that pain. But also things like depression. Things like anxiety. Even panic attack. Inability to get refreshed sleep. So people have specific sleep dysfunctions where they may sleep … They may actually sleep 12, 14, 16, hours but they get up and felt like they never slept, and they’re unrefreshed. And then the final component that’s extremely common is the kind of symptoms that most doctors would classify as irritable bowel syndrome. So bloating, gassiness, constipation and/or diarrhea, or alternating between the two, abdominal distension, and just general abdominal and gastrointestinal discomfort that’s never diagnosed as any discreet disease process.
So those things are generally all clumping together in someone who truly has fibromyalgia, what we will refer to in this discussion as classic fibromyalgia, and that will be distinctly different from the majority of people who come in with that prescription sent to you, who usually have other, real things wrong with them, they’re not making them up, but they’re not really classic fibromyalgia.
So that’s a great introduction. I think what’s really interesting about your intro is that you take in fibromyalgia, and you have just created a framework for it being a disease that’s much more than just a chronic pain disease then.
Absolutely. It’s way more than just chronic pain. And you know there’s a chronic pain epidemic as you are well aware of, and opioid addiction problems. So chronic pain is affecting between 40 and 50% of Americans on an ongoing basis with almost 20% of them having significant life disability because of chronic pain. Certainly there’s a much larger group of chronic pain patients than fibromyalgia patients, but fibromyalgia patients are still a large group of chronic pain patients, and it’s in the tens of millions in the United States alone. And I think these are probably the group of chronic pain sufferers that are the most mismanaged, underserved, and in our current medical system I find them not only mismanaged, but at times almost abused. I hate to use that word but they’re dismissed. Their sincerity is doubted. They’re made to feel like they’re making it all up and it’s all in their head. And that is generally not the case.
Yeah, and I think it’s really great to point out that obviously if you have chronic pain, most people are caught within this web of trying to find a solution. They see multiple providers, practitioners, healers, therapists, everyone. So I appreciate you being on the podcast to give some clarity around the topic of fibromyalgia. There are two symptoms that you mentioned. The first one was fatigue. And I want to talk about that first, and later I want to come back to the gut a little bit, but as far as fatigue goes a lot of times you’ll actually see on prescriptions … It’ll say “Fibromyalgia/Chronic fatigue syndrome”. Are those the same things? And is there a way to differentiate the two?
Well they’re not the same thing when it comes down to the diagnostic criteria for fibromyalgia vs. chronic fatigue syndrome they’re definitely distinctly different things, but traditionally when you go back in the literature 5, 10, 15, even 20 years ago, they were always clumped together. You always had that chronic fatigue/fibromyalgia, fibromyalgia/chronic fatigue. But in reality, fibromyalgia is primarily a sensory perception disorder deep in the nervous system, and the primary symptom is this global pain phenomenon. But it is true that virtually 100% of those people also have a persistent level of fatigue or lack of vitality. However, in chronic fatigue syndrome the primary symptom is unrelenting fatigue, and they do not necessarily have global pain or pain syndromes at all. And in many cases they don’t have a lot of these other central sensitivity symptoms like the gut issues, like the depression, anxiety, panic attack, un-refreshed sleep. They may, but they don’t necessarily.
So they are very different things. Chronic fatigue syndrome is often a persistent fatigue after someone has had an infectious event. Classically people will say, “Well I had a really bad flu,” or “I had a really bad viral type of infection, and I’ve never quite … I got better overtly, but I never quite got my energy back, and I’ve never been the same person.” Where that’s not really the history in fibromyalgia. It’s not really something that comes on classically after an infection, or a cold, or a flu, but it can come on after highly stressful or traumatic event, and maybe we can talk about that at some point during the podcast.
So there’s a practitioner out there, and they want the one answer to how you would separate fibromyalgia from chronic fatigue syndrome, what symptoms would those be exactly?
Well if the condition seemed to come on historically after a viral type illness, and the main complaint is fatigue, and there’s not a significant body wide pain, body wide achiness component, and particularly if there’s none of those other central, psychological type of issues like depression, anxiety, panic attack, then you’re not dealing with classic … You’re not dealing with fibromyalgia. You may very well be dealing with chronic fatigue syndrome. But just because the fibromyalgia is fatigued, and chronically, does not mean that they actually have the entity we call chronic fatigue syndrome. So they really should be separated. They should not be clumped together with a slash, or a dash. It’s really old-school thinking and we’re trying to move practitioners away from it, but you know once something sets in, it’s really hard to kill.
It’s true. It’s kind of like just a reaction. People just put them on the … And we got to really clarify things for a patient.
Even the name fibromyalgia, if the researches had a do-over they would get rid of it tomorrow because fibromyalgia, like I said pain in the soft, compliant tissues … In reality, true fibromyalgia there’s nothing wrong in the tissues, in the muscles, in the fascia, at least that we are able to determine definitively at this point. The problem is really central in the brain. It’s in how the central nervous system, and the brain, and the spinal cord is behaving as it’s interpreting all of this data coming into the system, and the problem isn’t down in the periphery. So fibromyalgia implies pain in muscles. It’s only a perception of pain in the muscles, the pain is not actually in the muscles.
Therefore, therapy directed at the muscles, like physical medicine, PT, chiro, massage, body work, in many of these classic fibromyalgia patients it doesn’t work with any kind of lasting benefit because that’s really not where the problem resides. And if it does work, and it commonly does in patients who are diagnosed or labeled as fibromyalgia, usually that patient didn’t have classic fibromyalgia. They actually had myofascial pain syndrome, trigger points, true problems out in the somatic tissues or in the body peripherally, and that’s where physical medicine providers are just wonderful at being able to treat those things. But often times the providers themselves think, “Hey. I treated that fibromyalgia patient with these type of therapies, and they got better. Therefore I fixed fibromyalgia,” not realizing that they fixed myofascial pain syndrome, or they fixed some other orthopedic, neurological, musculoskeletal type of situation and really not a central pain processing disorder.
So the other symptom that you mentioned earlier on in the podcast was that, yes irritable bowel syndrome, and obviously gut issues. And if you’ve studied functional medicine, or integrated medicine, you realize that there’s a direct connection between the gut and the brain, but can you clarify how important that connection is and what that connection is specifically with fibromyalgia patients.
Yeah. It’s very interesting, I wrote a whole textbook chapter in a medical textbook called Integrative Gastroenterology that what published out of Johns Hopkins, that was meant to try to train medical students better on fibromyalgia, and I was asked to write the chapter specifically on the linkage between fibromyalgia and gut issues. Particularly two, which is irritable bowel syndrome, and something called small intestinal bacterial overgrowth. Some people call it SIBO, SIBO. I’ve heard it pronounced both ways, and nobody knows what’s right, so either way you’re good. The comorbidity and what that means is the instance of two things existing together, with fibromyalgia and irritable bowel syndrome, is approaching 100%. So most people, the vast majority of subjects that truly have class fibromyalgia, have some level of what we would classify irritable bowel syndrome.
And the reason for that is very simple. It’s that the dysfunctions that we’ve been able to define in the central nervous system associated with fibromyalgia and this pain disorder, things like low serotonin, elevated substance P, alterations in other key neurotransmitters are the same things that are going on in the enteric nervous system, which is the nervous system of the intestines. The intestines are the only system or organ of the body that have its own independently operating nervous system. It’s influenced by the master, or the central nervous system, but it doesn’t need the central nervous system to do it’s basic jobs, or basic housekeeping. So the enteric nervous system dysfunction that is analogous to the central nervous system dysfunction in fibromyalgia produces things like irritable bowel syndrome. So it makes sense that they, they’re comorbid.
There’s some really interesting new information also that some people can get central sensitization, or at least hyper perception to pain, because they have aberrant growth of bacteria in the gut, the wrong kinds of microbes, or an imbalanced population of microbes. And if they have this overgrowth, it’s called dysbiosis, these microbes can produce metabolic toxic chemicals. They can express certain proteins on their surface. They can express certain, what we call lipopolysaccharides, and these things can translate through the gut, and they can actually go through the gut brain access as you called it … There’s some postulation that they’re traveling via the vagus nerve, which is one of the cranial nerves, and that they can find their way to the brain. And in the brain they can activate the immune system of the brain which is called the microglial apparatus, or the microglial cells, and they can cause a micro inflammatory type of scenario where the brain deep inside can be inflamed and sort of on fire, if you will.
So you can get this deep seated brain pain, which may explain some people’s global pain, although that model has not held out as being the unifying, or sort of modelithic reason for fibromyalgia as we know it, because it really does not explain things like why there’s an extreme female predominance, why there’s such an extreme connection to previous and particularly early life, and childhood, stress, trauma, feelings of being unsafe or threatened, or even abused scenarios. In many cases, not all certainly. And it does not explain some other aspects of depression, anxiety, and mood disorder. We may make those connections, but right now there’s also patients who have fibromyalgia who have this classic pain processing disorder, but they don’t have the gut dysfunction. There are some that when you test them, even when you detailed DNA molecular analysis of their gi microbiome, they don’t have this overgrowth type of pattern. So it’s not a unifying a cause, but it could be yet another confusion point on who’s who. Who really has fibromyalgia in the classic sense, and who may have something else that’s causing the same mixed bag of symptoms.
Excellent. I mean, that’s a ton of information for everyone. I want to go back a couple of phrases there because you mentioned serotonin, and I think it’s important to talk about this. [inaudible 00:16:03] really articulate the gut brain connection because practitioners know this, but for patients they can really understand this and empower themselves. When they hear serotonin they think “Oh, I’ve heard that. That’s a chemical in your brain that can make you feel good. I was even put,” let’s say, “On an SSRI, selective serotonin reuptake inhibitor …”
Like prozac, or something people may have heard of like that.
Yeah. So they’ve been put on these drugs to help elevate their mood, and in effect help their fibromyalgia. But how does the gut effect serotonin? How deeply is that connection?
Well, as you said people tend to think of serotonin as a brain chemical, and it is, but it’s really a body wide chemical. And in fact, about 90 to 95%, at least by estimates I’ve read, of your total serotonin in your body is actually located within the enteric nervous system. It’s the main neurotransmitter talk chemical in the gut nervous system. So in fact, the drugs that are meant … Many of the drugs to treat, let’s say irritable bowel syndrome, are selective serotonin receptor agonists that are only acting on serotonin receptors in the intestinal area and not in the brain. For instance, like a prozac would. Conversely, many … There’s three approved drugs right now for fibromyalgia for that specific use by FDA, and two of them are actually recycled, or repurposed, renamed, new again, antidepressant drugs, and they’re in the SNRI class. So they’re selective serotonin and norepinephrine reuptake inhibitors. And norepinephrine of course, is a catecholamine neurotransmitter related to stress and many other things that we can maybe get into.
So the two … Two of the three drugs are anti-depressant drugs, and the other one is actually a repurposed, renamed, recycled if you will, antiepileptic drug in the Alpha 2 Delta Ligand class I believe. And so none of these drugs were really developed from the ground up to treat fibromyalgia. They were, “Oh, when we give people these, we notice their fibromyalgia gets better,” and they went through drug approval process that way, but they’re not the answer. I mean they can be useful in some patients who truly have classic fibromyalgia, not ones that have other stuff that are misdiagnosed. Some of these meds can be helpful in some symptomatic modulation, but Rand did a big study showing that even those diagnosed directly with classic fibromyalgia, only less than 25% had a significantly or statistically significant benefit functionally from any of these medications. In fact it was 22%. That’s less than a coin flip. That’s less than placebo technically. Usually.
And the other thing is that those who did benefit, the 22% that benefited, the majority of those lost that benefit while continuing to take the drug over a series of months. So they ended up downstream being right back where they started, but now they’re taking a drug that cost money and cause the side effects commonly like, fatigue, making you feel zombied out, or non-clarity of mind, and that’s the last thing you need when you have fibromyalgia. So we do use those medications very strategically and very selectively some of the time to see who’s a responder and who’s a non responder, and if they have persistence of the response. But they’re not the panacea. You have to turn to other things to get these people recovered. It’s not a drug fix.
Excellent. So as an expert on fibromyalgia, how do you diagnose it? Because obviously there’s a problem with the diagnosing or differentially diagnosing it, but how could a physician or a practitioner go about diagnosing fibromyalgia correctly?
Well I’ve written about this extensively in many peer reviewed medical papers, and we’ve actually created diagnostic algorithms to guide someone through the full differential diagnosis, and it looks at, and it respects the American College of Rheumatology’s diagnostic criteria, but it gets more granular in what the clinician actually needs to do. For instance, the American College of Rheumatology criteria just simply states one of the requirements is that you cannot have any other medical disorder that may be causing the symptoms, and they leave it at that. But they don’t say, how do you go through ruling out all those other medical disorders. Okay?
So we kind of went there if you will. And I do that in the book too, The Fibro Fix, and the book is not written for doctors per se, or healthcare providers, although generally if they read it they will learn a lot about it. More than they usually know at this point. But it was written in a way that people who have it, or may think they have it, or have a family member that has it, can understand the process that your healthcare provider should go through before they ever give you that diagnosis. And part of it is when they come in like any patient with any kind of potential complaint, it all starts with the history. Right? I mean we were all trained in school that 90% of your diagnosis is in a good history or consult. And that’s usually the case.
So with these patients, like I said, usually they’re a woman and middle-aged. And by that … Or even middle-aged, maybe not quite middle-age, but generally most of them are women between 30 and 60, let’s say. Okay? If it’s a guy, I’m very leery that it’s fibromyalgia until I really prove it to myself. Okay? But usually they’re a woman, and then the history needs to line up. They need pain perceived in the soft tissues, not in the joints. It needs to be perceived everywhere, so I ask them “Where do you feel your pain? Is it in your joints? Is it in your soft tissues? Is it everywhere in the body? Or just a few places?” If they say “Oh it’s in my knees and in my hip,” probably not fibromyalgia. I’m starting to look for autoimmune, inflammatory arthritities, or degenerative joint disease, or some other kind of orthopedic injury.
Also the more they click boxes in the classic history like, “I have anxiety. I have panic attack. I have some level of depression. I can get to sleep eventually but when I sleep I wake up and I feel like I never slept. Like I have not rejuvenation. I’ve a lot of vague gut problems. Gas, bloating, distension, constipation,” the more that they hit, the more I’m going this may be fibromyalgia. The less they hit those things, the less I’m leaning that way. And then finally I actually asked them, “What was your upbringing like? What was your childhood like? What was your relationship like with your parents? Your siblings? Did anyone else live in your household? Grandparents, aunts, uncles. What was the relationship like with them? Was there any abuse going on? Was there any loud yelling? Was there alcoholic … Raging alcoholic dad for instance.” If that stuff’s there, very dominant parental, authoritative, usually it’s the male figure like the father or the father figure … High demands, expectations that can never be met. Those are common histories, they’re not universally there, but common.
Then from there we move to the examination. And the examination is very simple. Even though the new diagnostic criteria took away this, what we call, tender point examination, what I simply do is I take these hands right here and I start squeezing large muscle groups. Okay? And not enough pain that would make the average person … Or not enough pressure that would make the average person feel pain, only enough pressure that would make the average person feel pressure. Like I was squeezing the muscle. But if you stay in the large muscle groups, then it really shouldn’t be painful to just moderate squeezing pressure. So I do that in the calves, and the large muscles of the legs, the gluteal muscles, the trapezius muscles, muscles of the upper arm, and the forearm, and I’m trying to gauge “Is this person unduly painful? Do they perceive pain to the kind of pressure that would not normally be painful? And if they do, is it pretty much everywhere not just one or two places?”
If they pass that test, and the history lines up, wow. Now we’re getting somewhere. But then I still have to do the medical rule outs. I still have to do basic blood chemistry, CBC’s, thyroid panels, exclamatory markers, to make sure they don’t have some organic medical disease where organs are failing. They don’t have overt anemia and hypothyroidism. Or they don’t have some other reason … They don’t have kidney failure and they’re building up nitrogenous waste, and they azotemia and they can’t think, and they’re icky, and they’re fatigued. And I mean that can happen very, very easily. So we need to rule out that stuff.
And then as a functional or integrative medicine doctor, we generally don’t stop there. I’m going to look at the thyroid much more granularly than the average doc would because I know that that’s one of the top three masqueraders of fibromyalgia. An undetected, underappreciated, sub-optimal thyroid function. It could cause fatigue, brain fog, slow bowels, constipation, bloating, gas, and ickiness. Fatigue. The other thing is we’ll often do something called an organic acid test, and we’ll look for how someone’s individual, unique biochemistry performing. Are they for instance having trouble making ATP or energy at the level of the mitochondria, sort of these powerhouse furnaces of the cell? If that’s wrong, and they’re not making energy, they will go into what we call anaerobic metabolism on an ongoing basis. They will be achey in the muscles, just like you do when you over exercise and you can’t deliver enough oxygen. They will be tired. They won’t think straight. And if they’re a woman in their middle-age, middle-age kind of years, they’re likely to get an erroneous diagnosis of fibromyalgia for mitochondrial dysfunction.
And then when I’m doing that examination hands-on, I’m looking for things like muscle tightness, muscle spasms, trigger points of myofascial pain syndrome, and if they have a lot of that where they’re complaining of pain, then I’m thinking “Wait. This might be a structural, musculoskeletal issue, not a pain perception issue,” particularly if they’re not anxious, depressed, and have IBS. So it’s really a lot of years of dealing with a lot of these patients, and really being able to think … Multitask, and think, and put it all together with all of those things, and when you get comfortable doing that, it’s not very hard.
It’s really not that hard, but this is something that really confuses a lot of practitioners because we’re not really trained through this kind of thought process. And these are patients that they’re not sure what to do. They generally don’t get good results with. They shuttle them off to another specialist. The person gets … Sees six specialists, gets put on six different drugs. So they’re a point of frustration for a lot of healthcare providers, and part of the mission of the book and the summit is to help people who may be afflicted with this become their own self-advocate. So they’re knowledgeable about it so they can navigate this minefield of this healthcare system. And if they can actually help their provider along the way, if they’re dealing with a provider who’s not very versed and skilled in this.
So I give things to bring to the doctor. I give questionnaires that the patient can go through, and gateways for them to answer for themselves “Hey, do I have this thing called classic fibromyalgia? Or am in one of these other buckets that get me an erroneous diagnosis? And then what do I do about it based on where did I land in those different categories?”
What’s interesting to me is when you’re diagnosing fibromyalgia, you spent a whole lot of time on the actual history taking.
Most important part.
You know, it’s fascinating because in our environment of healthcare a lot of practitioners don’t have time to really spend … Maybe that might take, let’s say 20 minutes, to go through really thorough history and really talk to the patient about what they’ve been through, what are they currently feeling, what symptoms do they have or they don’t have … Really their entire medical history from … You’re really taking them from their [inaudible 00:28:25], their past surgical history, medications, tests, but also what they’ve been through on an emotional, spiritual level.
Yeah. And you know, there’s been multiple studies done, and they come up with a little bit of different data, but they’re pretty close that the average actual doctor patient contact time in an ambulatory care environment in the US healthcare system, is somewhere between 6 and 8 minutes. So it’s really not a system meant to deal with complex chronic patients like these, it’s meant for real quick “Oh yeah, you have strep throat. Here’s your antibiotic. Or you have this. Take this.” It’s really not meant to deal with these complex, chronic issues. And of course many times now the person’s not even seeing a physician, they’re seeing an assistant or a physician extender. Many of those are great clinicians, but that’s not always the case, but then again the physician’s not always a great physician so I don’t know if that’s a good thing or a bad thing really.
But it just … It complicates it even more because then the next time they’re coming in, they’re not seeing that same doctor like they used to, maybe they’re seeing another physician extender and it’s a different one because someone else is on shift today. It’s hard to have coordinated care in a complex chronic case like this when you’re doing it on that basis. It’s part and parcel of this issue. We have an acute care designed healthcare system, and we have a chronic disease epidemic. The two don’t mix very well because acute care medicine doesn’t address chronic illness and people who are really good at chronic care illness are not necessarily great emergency room physicians. So the door swings both ways.
Listen, if I’m, god forbid, in a traumatic motor vehicle accident on the way home, I want to be with top flight trauma surgeons in a very orthodox conventional hospital. I don’t want to be brought to my functional medicine doctor. Okay? But if I have a chronic complex disease, I don’t want to go anywhere near the acute care system. I want to go to the people who know how to deal with that.
That’s a great point to articulate the difference between the two. And obviously they both have a integral role in our healthcare system, but for fibromyalgia it is more of a chronic disease and you need someone who can really go to bat for you and give you the care and the time that you need.
And that’s … I tell people all the time is “How do I find a doctor like you if I can’t come to Connecticut or whatever,” and in the book I give resources on finding people who are trained in functional and integrative medicine models and the like, but I tell them also “Trust your instincts, and trust your gut.” If you have a physician or a healthcare provider of some sort, even if they don’t know everything about this, if they’re there with you on the journey and they’re open minded, and they’re open to what you may suggest to them, not that they will necessarily do everything that you tell them to do, but that they’re open and they’re trying to help you with all sincerity, then that’s a very good thing. That’s a very valuable thing. And if you get a vibe that’s not good, that they’re not cooperative, that they’re full of their own ego and they just can’t get over it, go find someone else.
Yeah. I think it’s also really interesting that the rheumatologists who traditionally have really seen most of the fibromyalgia patients, although we now know that fibromyalgia really is not a rheumatologic disorder, correct?
No, it’s not a classic … When you think of a rheumatologist you’re thinking of rheumatoid arthritis, and autoimmune diseases that are overtly inflammatory. And fibromyalgia is not an overtly inflammatory disorder. For instance, for any of the doctors listening, it wouldn’t have a elevated C reactive protein or a sed rate or something like that. Now there is some evidence of micro inflammation deep in the brain that we talked about, but that’s not going to show up on normal gross inflammatory panels like you would see in inflammatory connective tissue disorder, and autoimmune disorder. So it is not a classic rheumatology disorder, although they’ve become the specialist of choice just because there is nowhere else it seems to send these folks.
What I wanted to point out, there was a large study done by Fitz Charles and his group, and he’s a rheumatologist that’s a world renown specialist in fibromyalgia. One of the giants, actually. He did a study looking at people who were diagnosed with fibromyalgia by either their family physician and internal medicine doctor, and a rheumatologist. So they were mixed together. So there was a smattering of all of them, but they were all diagnosed by physicians. And then those … That same group of people were sent to an expert panel of rheumatologists with specialized training in fibromyalgia and they worked them up as a group. And what they found was two thirds of the patients diagnosed by physicians with fibromyalgia, did not have fibromyalgia. That’s 66% error rate of diagnosis.
And can you imagine now you add in all those people that come in and say they have fibromyalgia because they think they do from looking at WebMD. Or their neighbor told them they have fibromyalgia. Or some other pathway to it, and you can only imagine how dirty this diagnosis is and people call it a wastebasket diagnosis. And sometimes that has negative connotations meaning it doesn’t really exist so everyone’s just calling anything they don’t know what it is that. That’s not the case. Classic fibromyalgia absolutely exists, and it can be diagnosed well, but that’s not happening in clinical medicine so a lot of stuff that’s not it is being thrown on the pile. Therefore a lot of the research can’t be trusted because the researchers are also not great all the time at picking out who’s who, so you get studies that will show certain therapies might be effective in fibromyalgia patients when in reality you look back on them and it seems they’re really looking at patients, let’s say, with myofascial pain syndrome. Or they’re looking at patients with other disorders.
Yeah. So my question for you is, obviously there are clinicians and patients watching and listening to this podcast, once they receive a proper diagnosis for fibromyalgia, how long can someone expect before they start to see a turn around in their symptoms? And what members of an integrated team, an integrated healthcare team, might they need on their side to really help them through this course?
That’s a great question, and there’s not a stock answer because there are what I call different levels of imprinting on people’s nervous systems. And fundamentally with true classic fibromyalgia, it seems to be an aberrant learned response of the brain to previously adapted to events. And oftentimes, like I said, it’s young females being in very tumultuous environments when their nervous system is still neuroplastic and learning how to deal with it’s environments. And if that’s the case, deep centers of the brain such as the limbic system, which we call the emotional brain, and you can imagine if they’re in an emotional, traumatic, scenario it’s the emotional part of the brain that gets affected.
Where they learn how to process information differently because they’re in a constant state of what we call hypervigilance. They’re always on guard if you will at the neurological level. So imagine if we step off a curb and we turn and we see a bus coming at us, what does our nervous system do? It’s in freakout mode, right? It’s ready to do something. But if we get out of the way, and we calm down, everything goes back to normal. These patients nervous systems, maybe not that dramatic, but they’re stuck in this sort of hypervigilance response, sort of waiting for the next threat. The next shoe to drop. They’re always in defensive posture if you will. So they tend to have personalities that align with that. They tend to be always worrywarts about everyone around them, they’re very much caretakers, they’re worried about their kids, they’re spouse, if something bad is going to happen to them how do I take care of them. And they’re all about facilitating and protecting everyone else and they don’t take care of themselves essentially. And eventually it all comes crashing down.
But that’s why they have anxiety, and panic. They’re always waiting for the worst to happen. They tend to be very fastidious and very neat. They need everything in it’s place, they want order, they hate chaos. So you look for those kind of constitutional things. And basically some people have that imprinting more than others. So it takes longer to turn them around. So because that’s the case, we do have to treat them from a biochemical standpoint. So we test their neurotransmitters. We’ll use things like serotonin precursor therapy like 5-hydroxytryptophan. We’ll use melatonin especially, it’s a sustained release version, to drive them into deeper refreshed sleep so they can recover. We’ll use things like gabba. We’ll use calming botanicals that are not stimulating adaptogens, that are calming adaptogens, like aswaghanda, or [thaniasamnathera 00:37:38]. We’ll use German chamomile. We’ll use [inaudible 00:37:43], Melissa, things like that. Very very commonly … Eltheeni. Things that are calming. Phosphatidylserine.
But biochemically, you’re only going to get so far. You have to also deal neurologically with the person, and that’s where we use cognitive behavioral therapies. So we will intensively work with them with techniques like brain mapping, EEG directed biofeedback, to get them trained into getting their brain into different states that are more calming. We’ll use heart rate variability in office, but then send them home with phone apps that trains them with heart rate variability. But then we often go very low tech with them as well. We want them doing things like meditation, or yoga, or guided imagery, or progressive relaxation, prayer. It could be tai chi, chi gung. We try to find something that resonates with them that’s a daily calming, resetting the stress meter practice. That’s very important.
We really look to circadian rhythm and sleep hygiene. We have to get them sleeping predictably. We have to get them into deeper stages of sleep. So we have to get them away from blue light after about seven to eight o’clock at night. Off iPads, laptops, or they need at a minimum get the software apps installed that change the screens dynamics to orange and pull out the white blue light. We get them going to sleep by about ten o’clock at night. Getting up no later than 7:00, 7:30 in the morning. On the weekends and weekdays. No variability. It’s got to be on a circadian rhythm. Sometimes we’ll use blue blocking lenses with patients who can not get out of the light at night.
So we do that along with getting them moving again. And the book goes over all of these things and how to safely implement them. So to get people to get flexibility again, and range of motion and mobility is exceedingly important. But they’re afraid to do it because as you know a lot of times they’ve gone and tried to do traditional exercise, or go to the gym and they crash and burn and they can’t get out of bed for three days. So we walk them through how to do that safely. How to address the biochemical side if they have classic fibromyalgia. How to do the mindfulness things. And at firm we do sort of a 21 day metabolic reset with a little bit of detoxification. Get them less inflammatory. That can help anybody essentially.
But then if we find out through the book that they’re in one of these other buckets. Let’s say we think they really have maybe a thyroid issue, or an adrenal stress specific issue, or they have a mitochondrial energy dysfunction, or they have some sort of other musculoskeletal problem, then we give very specific regiments on things to do to address those specific concerns. So we’re trying to find what it is this person as a unique individual, what is their root cause, and what are some comprehensive, more holistic, engaged … Having the patient engaged in their own recovery, things that they can do to put together a complete recovery plan.
Great. So I think the take home message from that is obviously there is hope. And the way out of your fibromyalgia diagnosis. And at times I don’t even like giving people the diagnosis of fibromyalgia because even that can be … It can wind someone’s nervous system up and make them hypervigilant as you said.
Yeah. Or it can actually become a life raft for them if they’re used to being chronically ill. It’s sort of “Oh. Finally I have my name. My diagnosis. So I am fibromyalgic.” And when you take that mentality, and it’s a humanly, predictable thing to do, so I’m not assigning any blame for doing that, but it’s an observed phenomenon of chronic illness, therefore the patient doesn’t want you to take their life raft away. Right? So they’re reluctant at a subconscious level even to let go of the fibromyalgia and to fully recover. So those are dynamics that when you get very used to working with these patients, you can work through those things with a lot of understanding and compassion, but yet motivating the patient and not letting them stick in that spot.
Excellent. So it’s been a pleasure speaking with Dr.David Brady today on the Healing Pain podcast. He’s a naturopathic physician in Connecticut, not too far from where I am in New York City. David, can you share with us some amazing things you have happening around the topic of fibromyalgia. I really think you’re going to change the way this is diagnosed and treated.
Yeah. Well thank you Dr.Tatta. Basically I spent years of my career publishing to my peers. Right? In medical journals, and textbooks, and trying to change their behaviors, and their thought patterns, and hopefully some of that’s been accomplished and more will happen in the future. But with my new book, The Fibro Fix, after many years of contemplating doing this and not doing it for various reasons, I finally did and in a couple years of labor of love, but about 25 years of experience went into it, it’s bringing the story to the people. Basically grass roots effort. Right? I needed to empower the people who are afflicted by these conditions, and this label, and this diagnosis to better understand their disorder, to advocate for themselves, to find routes to recovery, to find the right kind of healthcare providers.
So the book is called The Fibro Fix. It comes out July 12th. It is available for pre-order. If you order it before the book actually comes out, it’s like 40% off or something like that at all the big book vendors. But you can learn more at the website for the book which is just fibrofix, f-i-b-r-o-f-i-x.com, and you even get a bunch of extra goodies and bonuses if you pre-purchase the book on any of the vendors and then come back and put in your receipt code. I give you all kinds of videos and cool stuff.
But the other thing is The Fibro Fix summit. This is … And you’re one of my experts. I interviewed over 35 experts, people who are my most respected colleagues that I thought had something really special and unique to share with patients about fibromyalgia. So some are experts and researchers in fibromyalgia. Some are experts in things that are misdiagnosed as fibromyalgia. So I have adrenal and stress experts. I have depression and anxiety experts. I have sleep experts. I have gut experts. And some of these people are from Johns Hopkins, and NYU, and major academic centers. So it’s all free. You can sign up. It runs from June 20th to the 27th. And it unlocks and you can watch it as it goes. Watch just the talks you want. Watch them all. And you can learn more about it, you can learn how you can actually have that content if you want it, all the videos, all the transcripts, everything on the summit’s site. And that’s just fibrofixsummit.com, or if you go to fibrofix.com on the bottom there’s a link to the summit.
Excellent. So I want to thank Dr.David Brady again for being here, and please go right to Amazon and check out his book The Fibro Fix, and look for him online at The Fibro Fix summit. He’s got tons of great information for you, so if you have fibromyalgia, if you think you have it, if you’ve been misdiagnosed, if you are a practitioner interested in learning more please check it out. And without further ado, I’ll see you next week on the Healing Pain podcast.
About Dr. David Brady
Dr. David M. Brady has over 25-years of experience as an integrative practitioner and academic. He is a licensed naturopathic medical physician in Connecticut and Vermont and a board certified clinical nutritionist. Dr. Brady is also a prolific author of medical papers and research articles on fibromyalgia and has dedicated a large part of his professional career to helping people recover from this mysterious disorder. He currently serves as the Vice Provost for the Division of Health Sciences, Director of the Human Nutrition Institute, and Associate Professor of Clinical Sciences at the University of Bridgeport in Connecticut. He maintains a private practice, Whole Body Medicine, in Fairfield, CT and is also the Chief Medical Officer for Designs for Health, Inc. and Diagnostic Solutions Labs, LLC. He is an internationally sought-after presenter on nutritional, functional and integrative medicine and has appeared on the speaking panel of the largest and most prestigious conferences in the field. Dr. Brady is a highly dedicated champion and advocate for patients suffering with a fibromyalgia diagnosis. He is the author of the upcoming book The Fibro-Fix from Rodale, Inc. and will be hosting the informative online Fibro-Fix Summit.
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