Fibromyalgia Specialist in New York City, NY

It can come on in the middle of the workday, or keep you from even getting out of bed. It can cause such intense pain, body stiffness, and muscular tenderness that you find it hard to move your joints. It can resolve and return at will - and nobody knows exactly why.

Fibromyalgia is a chronic condition with an elusive cause.

We do know that it's stimulated by chronic muscle shortening. Fibromyalgia predominantly affects women between the ages of 35 and 55, but can also occur in men and children who also feel pain in response to stimuli that don't usually cause it. People who suffer from fibromyalgia also tend to be struggling with chronic fatigue syndrome (CFS).

Why this chronic muscle shortening? There are numerous theories, which may all be correct. Some researchers blame the nerve chemical signals in the spinal fluid of fibromyalgia patients. Others theorize it may be explosive synchronization (ES) that causes the hyperactive brain networks and pain of fibromyalgia.

Dr. Borenstein is fascinated by these questions as he continually reads up on the latest research. In the meantime, whatever triggered your fibromyalgia flare, he and his team are ready to help you manage it - in a way that works for your body, age, genetic make-up, and lifestyle.

At Manhattan Integrative Medicine we understand your 'on again off again' relationship with fibromyalgia. For years, we've doggedly targeted every trigger and watched patients' quality of life improve dramatically. We'd like to do the same for you. Call us for a discrete consultation at ☎ (212) 262-2412 or contact us here.

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Fibromyalgia Symptoms

Pain is the universal symptom of fibromyalgia. It comes and goes at random times and at varying levels of intensity throughout the day. Other symptoms include:

• stiff muscles
• back pain that moves around
• recurring infections
• insomnia & restless or disturbed sleep
• brain fog & forgetfulness
• depression
• anxiety
• chronic fatigue
• irregular bowel function
• weight gain
• low libido

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Sister syndromes: CFS and Fibromyalgia

A number of people who suffer from fibromyalgia may also have chronic fatigue syndrome (CFS). These sister conditions share several symptoms, which can make the diagnosis more confusing.

The key symptom of CFS is excessive fatigue that is not relieved, even with rest, while the key symptom of fibromyalgia is extensive pain and stiffness - to debilitating degrees.

Although some people have fatigue without pain, whereas others have pain without fatigue, for most of our patients CFS and FM are the same illness.

At Manhattan Integrative Medicine, we've had years of experience treating patients with these intricately intertwined conditions. Our success rate can be attributed to our training in the SHINE® protocol, developed by Dr. Jacob Teitelbaum, who has struggled with these conditions and healed himself 30 years ago with his proven treatment for fibromyalgia.

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S.H.I.N.E® Protocol for fibromyalgia

In a peer-reviewed, double-blind placebo-controlled study, 91% of fibromyalgia patients who strictly followed the S.H.I.N.E® protocol improved, reporting an average 75% increase in quality of life at 99 days, and a 91% increase two years later. Meanwhile, the placebo group saw minimal improvement.

This proves that fibromyalgia is treatable and that anyone who is still claiming these illnesses are "all in your head" is wrong.

Fibromyalgia patients have trouble sleeping deeply, so their immune system dysfunctions and causes pain. If your muscles don't have enough energy, they'll get stuck in the shortened position and you will feel pain. This energy drain can be caused by any of a number of infections, hormonal imbalances, stresses, or injuries.

Dr. Borenstein realizes that this "energy crisis" presents differently in each patient. He treats every person that enters his office as a unique ecosystem, with unique synergies between genetics, age, general health, environmental factors, and lifestyles.

That's why he takes the time to understand your whole health before crafting your custom S.H.I.N.E® treatment plan - and helps you follow it until you get relief. This protocol consists of:

Sleep: restoring your energy

The shortened, tightened muscles that cause pain for fibromyalgia patients require deep, restorative sleep - preferably 8 - 9 hours a night. As the sleep center in the brains of fibromyalgia patients is not functioning optimally, they have trouble sleeping and their muscles remain knotted and achy.

Whatever your key symptom, sleep replenishes your body's energy and helps heal sore, damaged muscles. Dr. Borenstein provides aggressive but patient-appropriate sleep support.

After examining you and carefully noting all your symptoms he will test you to diagnose or rule out sleep apnea - a serious condition that can lead to heart disease or stroke.

Then, he will prescribe one or more of the following to optimize your energy levels:

• supplements: amino acids like L-theanine and tryptophan, melatonin, and 5HTP - a supplement extracted from the African griffonia simplicifolia plant - have all been clinically validated as sleep and relaxation aids
• medications: if necessary, pharmaceutical sleep aids like Ambien, Trazodone or Gabapentin can be prescribed as hypnotics to help foster deep sleep
• sleep hygiene lifestyle: abiding by a strict sleep schedule to establish a consistent biorhythm is crucial; sometimes altering window coverings to ensure complete darkness and tweaking humidity levels for ideal breathing comfort can enable you to sleep deeply through the night - so can cutting out caffeine and alcohol
• relaxation techniques: whether it's meditation, Qi Gong, Tai Chi, relaxing music or an Epsom salt bath before bed, Dr. Borenstein will brainstorm strategies until you're able to relax and get at least 8 hours of restorative sleep every night

Dr. Borenstein will brainstorm strategies with you until you're able to get at least 8 hours of restorative sleep every night and reduce your pain and/or fatigue.

Hormones: balancing your biochemistry

Various hormone deficiencies can contribute to fibromyalgia. Unfortunately, traditional blood testing often misses subtle imbalances.

Dr. Borenstein will perform in-depth blood, saliva and urine testing to determine your precise levels of the following:

• thyroid: every cell of your body needs thyroid to function optimally; Dr. Borenstein evaluates these thyroid dysfunction markers: TSH (Thyroid Stimulating Hormone), Free Thyroxine (T4), Free Triiodothyronine (T3), Reverse T3, and thyroid antibodies
• cortisol: our adrenal glands secrete this stress hormone; level imbalance or disrupted secretion rhythm can cause you to feel fatigue or hunger
• estrogen: the ratio of the three forms of estrogen - estrone (E1), estradiol (E2), estriol (E3) - is important for both women and men; imbalances have been linked to heart disease and can stimulate depression
• progesterone: helps balance and neutralize effects of excessive estrogen; if a woman's symptoms are worse around her menses, estrogen and progesterone may be needed
• testosterone: low levels have been linked to heart disease in both men and women; men with CFS have testosterone levels in the lowest 30% of the population
• insulin: insulin resistance is a hormonal resistance pattern (your body is producing insulin but it's not shuttling blood sugar into your cells where you can use it); can occur in those who are pre-diabetic or have a sub-clinical blood sugar imbalance
• leptin: produced by fat cells to signal your brain to use the body's fat stores for energy; leptin resistance occurs when your hypothalamus stops recognizing it, tricking your brain into thinking you're starving

Because all the systems in your body function synergistically, if one hormone is out of whack, others are likely imbalanced as well. Dr. Borenstein will analyze your blood and saliva samples to determine which combination of imbalances you're struggling with. He'll check your free T4 levels and adjust the dose every time he gets feedback about how you're feeling.

Immunity/Infections: battling your invaders

Underlying viral, bacterial, bowel, sinus and yeast infections are often contributing causes of fibromyalgia, or even the result of it. Dr. Borenstein will test you for viruses and concurrent bacterial infections like:

• HHV-6 virus
• Epstein-Barr virus
• XMRV virus
• HSV1 and HSV2 virus
• yeast infections
• candida

Then, after explaining which condition/s you have and in what intensities, he will prescribe low sugar chronic fatigue syndrome diet, probiotics, antivirals, or antifungals accordingly.

Nutrition: supplementing your deficiencies

Dr. Borenstein will perform a series of tests to determine your vitamin and nutrient levels. Then, he'll prescribe fibromyalgia supplements and diet plans to address your deficiencies and their related symptoms - which present differently in, and are delivered differently to every patient.

To help you reach your optimal energy levels, he may also prescribe a diet that will flush out your specific irritants. If your tests show you have candida, for example, he will determine the strongest candida killer for your age and body type. If it turns out you're deficient in magnesium, acetyl L-carnitine, glutathione, vitamins B-12, A, B, C or D he will prescribe the optimal supplementation in the most efficient form.

Decades of research shows that only about 30% of oral vitamins are absorbed and available to the body. That's why Dr. Borenstein prefers to use IV infusion to deliver these treatments:

Myers Cocktail

This powerful treatment provides your metabolism with optimal cellular and immune function by combining vitamin C, several B vitamins, and magnesium.

The cocktail is usually given 1-2 times per week, and beneficial effects are usually felt by the fourth visit. Many patients with chronic conditions choose to continue the infusions every 1-4 weeks or when they feel their energy slipping.

Low Dose Naltrexone

Though we still do not understand exactly how, clinical trials have demonstrated that LDN helps relieve fibromyalgia symptoms. Some researchers have observed that this opiate blocker helps normalize the immune system by acting as an anti-inflammatory in the central and peripheral nervous systems. How? Possibly by limiting the activity of specialized microglia cells. Or, it may be that LDN blocks certain receptors in the nervous system that cause symptoms.

Whatever its function, LDN has been clinically proven effective and is well tolerated. Researchers at Stanford University have observed as much as a 30 percent decline in patients' symptoms compared to placebo. It's most effective in people who have inflammatory response.

Only when taken at very low doses (1-5 mg dosage range) LDN reduces pain by:

• increasing the release of endorphins - your body's natural opiates
• reducing inflammation in your central nervous system

Symptom-specific supplements

After observing your specific symptoms and medical history, Dr. Borenstein may also deliver electrolytes, vitamins, anti-oxidants, minerals, amino acids, and various supplements to resolve each of the following symptoms:

• to relieve pain and tenderness: lysine, magnesium malate, omega-3 (fish oil), turmeric, vitamin D
• to boost energy: carnitine, CoQ10, creatine, D-ribose, magnesium malate, NADH, SAM-e, vitamin B12
• to improve sleep: melatonin, valerian
• to manage mood: DHEA, folic acid, lysine
• to improve immune function: carnitine, CoQ10, DHEA, lysine, Rhodiola, theanine
• to optimize brain function/neurotransmitter balance: 5-HTP, carnitine, folic acid, omega-3 (fish oil), rhodiola, SAM-e, theanine

Dr. Borenstein is very experienced in detecting possible contraindications with any medication you may be taking, as well as avoiding negative interactions between these supplements.

Exercise: increasing your oxygen

If you're wondering how to relieve sore muscles fast, please know it will take time and patience. Exercise stimulates your respiratory system, increasing your capacity and providing more oxygen for your sleeping body. Knowing how to increase oxygen saturation levels is a great way to feed your stiff muscles the oxygen they need to rest and release during the night.

However, you should only do the type and amount of exercise your body can handle. After following the first four steps listed above for about 10 weeks, our patients are usually able to slowly increase their exercising time.

Overdoing it by trying to keep up with normal exercise recommendations may throw you into Post Exertional Malaise, which can leave you wiped out for days.

How do you know which type and how much exercise you need? We'll coach you to start with low impact activities that require the least amount of exertion possible, like:

• walks in the park
• basic yoga
• Qi Gong or Tai chi
• water aerobics
• golfing

If those don't cause Post Exertional Malaise, we'll kick your routine up a notch to:

• swimming
• weight lifting
• gentle jogging
• bicycling
• tennis

As with all other treatments, Dr. Borenstein and his team will craft a custom exercise plan, monitor your progress, and check in for your feedback before making any changes. As rare as it may seem in some medical circles, we really do listen - for as long as it takes.

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Reserve your appointment

You don't have to live with the pain, stiffness, fibromyalgia fatigue, and the unnerving uncertainty that shrouds your days. Dr. Borenstein understands what you're going through. He will help customize the S.H.I.N.E.® protocol to address your unique combination of symptoms and contributing factors.

Call his team at Manhattan Integrative Medicine to schedule a consultation at ☎ (212) 262-2412 or contact us here.