About Fibromyalgia

Fibromyalgia is a pain syndrome that affects the muscles and nerves throughout the entire body. While fibromyalgia symptoms may occur at any age in both males and females, it is most prevalent in women, beginning in middle age. The underlying cause of fibromyalgia is not fully understood, but there is growing evidence to suggest that symptoms are caused by a hypersensitized autonomic nervous system that sends amplified pain signals to the brain, in the absence of structural damage or injury. Chronic systemic inflammation is suspected to be a contributing factor.

New research sheds significant light on how the body becomes hypersensitized, and new technology offers hope for patients suffering from fibromyalgia symptoms.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Fibromyalgia Specialist Dr. Lev Kalika

Dr. Kalika has devoted his career to finding the most advanced and effective ways to treat physical pain, dysfunction and injuries. He has embraced new technologies and sought out innovative therapeutic treatment methods to provide his patients with the best and fastest treatment solutions.

Patients suffering from fibromyalgia pain and fatigue often wander from doctor to doctor, spending untold time and money seeking medical solutions, or exploring alternative treatments like acupuncture, without resolving their pain. When they run out of options, they often give up hope, resigning themselves to a life of pain and fatigue that infringes on their quality of life.

The human body is an extremely complex organism, and chronic pain requires an integrative approach. Early in his career, Dr. Kalika studied under world renowned professors Karel Lewit and Vladimir Janda, both pioneers in integrative medicine. It soon became clear that allopathic medicine had tunnel vision, and that more effective diagnostic tools and treatment options were available to treat pain syndromes.

Dr. Kalika is an innovator when it comes to applying technology to fibromyalgia treatment. He has published multiple scientific papers on myofascial trigger points, ultrasound guided dry needling, and the application of shockwave therapy to treat fibromyalgia. He is a skilled and seasoned expert in diagnostic ultrasonography.

Dr. Kalika is an active member of the International Myopain Society. You can find more information about Dr. Kalika’s research here.


Why Physical Therapy Alone May Not Resolve Your Condition

Physical therapy is a valuable and effective approach to resolving musculoskeletal pain and dysfunction, but in many cases, physical therapy does not provide a stand-alone solution. Prior to beginning physical therapy, patients often need to address underlying issues that contribute to their pain and disability.

Unfortunately, mainstream physical therapy clinics are often not adequately equipped or experienced to identify and treat complications that undermine the effectiveness of physical therapy. They often rely on one-size-fits-all treatment protocols that overlook the unique characteristics of the individual condition, opting to treat the symptoms and not the patient.

Issues that should be addressed prior to beginning physical therapy include:

  • Scar tissue and fascia adhesions
  • Neurogenic inflammation
  • Joint edema
  • Inflamed soft tissues
  • Myofascial trigger points
  • Compressed or entrapped nerves
  • Tendons that have degenerated and lost their elastic properties
  • Compensation patterns developed post-injury
Block PT

Holistic Non-Invasive Diagnosis and Regenerative Therapy

Identifying and treating underlying issues prior to beginning physical therapy is key to getting fast and effective results. Failure to do so can completely undermine your treatment protocol, and in some cases, your condition may even worsen.

At NYDNRehab, we use a broad range of advanced technologies and innovative therapeutic approaches to resolve issues that can potentially undermine the success of physical therapy.

Our talented staff is certified in a diverse array of treatment methodologies, rarely found in run-of-the-mill physical therapy clinics. Our one-on-one sessions are personalized, based on the patient’s unique diagnostic profile.

Obstacles to physical therapy success include:

  • Scar tissue and fascia adhesions
  • Neurogenic inflammation
  • Joint edema
  • Inflamed soft tissues
  • Myofascial trigger points
  • Compressed or entrapped nerves
  • Tendons that have degenerated and lost their elastic properties
  • Compensation patterns developed post-injury
NESA Neuromodulation: Cutting-Edge Technology to Soothe Hypersensitized Nerves

NESA Neuromodulation: Cutting-Edge Technology to Soothe Hypersensitized Nerves

NESA neuromodulation is a new type of therapy that uses the body’s own electrical pathways to manipulate the autonomic nervous system. Neuromodulation works by actively stimulating nerves to produce a natural biological response in nervous tissue. NESA is a non-invasive neuromodulation therapy that helps to calm overstimulated nerves, to restore the autonomic nervous system to a balanced state where it can function at its best.

Dr. Kalika recently traveled to Spain to learn about NESA neuromodulation therapy, and to receive first-hand training from the technology’s source. NYDNRehab is one of the few clinics in NYC to offer NESA neuromodulation therapy to our patients. Dr. Kalika is one of a handful of practitioners with advanced training and experience in Zimmer and NESA neuromodulation therapy.


Fibromyalgia Symptoms
and Causes


  • Fibromyalgia Symptoms and Causes

  • Chronic fatigue

  • Difficulty sleeping

  • Stiff achy joints

  • Brain fog

  • Increased sensitivity to touch, noise, light, odors and temperature


The underlying causes of fibromyalgia are as yet unclear. Suspected contributing factors include:

  • Genetics — fibromyalgia runs in some families, but also occurs in patients with no family history

  • Chronic systemic inflammation may increase pressure on nerves

  • Stress and emotions may contribute to central sensitization

  • Anxiety and depression may play a role

Advanced Technology Meets Experience and Expertise in Successful Treatment of Fibromyalgia Symptoms

People suffering from fibromyalgia symptoms are often willing to try anything to ease their pain. Many try to modify their diets or take nutritional supplements in hopes of reducing symptoms. But while improving a poor diet is bound to have a positive impact on overall health, there is very little scientific evidence to support a dietary approach to fibromyalgia treatment.

At its core, fibromyalgia is a central sensitization disorder, with systemic inflammation as a contributing factor. As such, we believe the primary course of treatment should be geared to restoring optimal function of the nerves and muscles, which may help to alleviate symptoms.

The clinic at NYDNRehab features some of the most advanced technologies available, to calm hypersensitized nerves and elicit a prolonged anti-inflammatory effect.

Advanced Technology Meets Experience and Expertise in Successful Treatment of Fibromyalgia Symptoms

Your fibromyalgia treatment protocol may include some or all of the following therapies:

NESA Neuromodulation Therapy

NESA Neuromodulation Therapy

uses a biphasic low-frequency electrical current to emit a series of intermittent and cyclical stimuli, to calm hyper-excited nerves and restore optimal neural signaling to the brain.

INDIBA Radiofrequency Therapy

uses electrical current to increase the exchange of ions in dysfunctional cells, to restore optimal nerve and muscle function at the cellular level.

INDIBA Radiofrequency Therapy
Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation
Technology (EPAT)

also known as defocused shock wave therapy, uses acoustic pressure waves to enhance blood circulation to targeted tissues, to accelerate the healing process.

High Energy Inductive Therapy (HEIT)

uses electromagnetic fields to penetrate cells, tissues, organs and bones, to reactivate the electrochemical function of cells and cell membranes.

Focused Extracorporeal Shock Wave Therapy (ESWT)

produces high frequency sound waves to stimulate the body’s reparative mechanisms. It is especially effective for degenerative tendon disorders and myofascial pain.

Extracorporeal Magnetic Transduction Therapy (EMTT)

transmits high energy magnetic pulses that synchronize with the body’s own magnetic fields, to trigger a regenerative response in damaged tissues.

Ultrasound Guided Dry Needling

targets myofascial trigger points, tense knots of muscle fibers that often contribute to fibromyalgia pain.

When combined with Dr. Kalika’s experience and expertise, fibromyalgia treatment at NYDNRehab provides patients with the most advanced and effective modalities for fibromyalgia treatment.


Get the Best Fibromyalgia Treatment in
NYC that Really Works!

Many patients struggle with fibromyalgia for years, going from doctor to doctor, and trying any and all potential remedies to alleviate symptoms. After exhausting all avenues of treatment, many patients resign themselves to living with fibromyalgia and the limits it imposes on their overall quality of life.

At NYDNRehab, we never give up on our patients, and we are always on the lookout for new treatment approaches to resolve pain syndromes. Don’t let fibromyalgia keep you from enjoying the activities and people you love. To get an effective and personalized fibromyalgia treatment plan, designed just for you, contact NYDNRehab today.

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    LDN Treatment for Fibromyalgia

    For millions of people suffering from fibromyalgia, only a handful of available treatments is able to treat opioid addiction, Naltrexone, is showing some promise for relieving muscle and joint pain in fibromyalgia patients.

    Naltrexone is classified as an opioid antagonist — that is to taking opioid drugs or drinking alcohol, Naltrexone prevents the brain from producing endorphins, depriving the user of the desired euphoric high.

    Low Dose Naltrexone and Pain Relief

    Opioids are among the many treatments prescribed for fibromyalgia pain. Yet fear of addiction makes opioid drugs a last-resort option for many fibromyalgia sufferers. As an opioid blocker, one might think that Naltrexone would have an opposite effect to reduce muscle and joint pain in fibromyalgia patients.

    How Low Dose Naltrexone Reduces Pain

    The mechanisms by which low dose Naltrexone (LDN) works to reduce fibromyalgia pain are somewhat of a mystery, although two theories prevail.

    One theory proposes that since fibromyalgia produces chronic pain, endorphin receptoms.

    The second theory is that LDN interacts with glial cells in the spinal cord and brain. When the brain sends chronic pain signals, the glial cells respond by releasing inflammatory chemicals, thereby reducing pain.

    LDN as a Promising Treatment for Fibromyalgia

    When taken in larger doses, side effects are almost undetectable, with the worst reported being vivid dreams and difficulty falling asleep. The low cost of LDN and its effectiveness in reducing pain make it an attractive treatment option for fibromyalgia symptoms.

    Fibromyalgia Treatment at NYDNR

    When it comes to target fibromyalgia pain.

    Treatment methods may include:

    • Acupuncture
    • Ultrasound guided dry needling
    • Virtual reality physical therapy
    • Soft-focused shock waves
    • Exercise and stretching

    At NYDNR, our goal is toms so you can move and live, pain-free.

    Fibromyalgia is one of the most misundersto normal sensations which normally we are not aware of. The level of dopamine in our brain establishes our pain threshold.

    How Is Fibromyalgia Diagnosed?

    Majority of patient suffering from fibromyalgia are not diagnosed immediately. The medical diagnostic criteria for fibromyalgia diagnosis is the presence of classic tender points. The tender point are the places where muscle attaches to constant increased awareness of these spots.

    What Are the Symptoms Associated with Fibromyalgia?

    Constant pains and aches , flu like condition, feeling chronically tired, confusion, skin flushing, itching, unexplained tingling and numbness, feeling to hot.

    What Are the Causes of Fibromyalgia?

    Poor interrupted sleep, sleep apnea, dysfunctional beathing patterns, stress, anxiety and panic disorders, depression, posttraumatic stress disorder, restless leg syndrome, histor system.

    What Other Conditions Commonly Coexist with Fibromyalgia?

    Patient with fibromyalgia frequently have other syndromes (headaches, TMJ pain, irritable bowel syndrome, chronic sinus infection,PMS and others) together with it . Although they may not be directly related, removing those generally improves fibromyalgia.

    What Other Conditions Can Mimic Fibromyalgia?

    Lyme disease, chronic fatigue syndrome, underactive thyroid and arthritis. Chronic multiple regional pain syndromes.

    Why Is Fibromyalgia so Difficult to Treat?

    Primarily most of the patients with fibromyalgia are not diagnosed timely and not being properly treated ones the condition is established. This create a chronic state which is more difficult to treat.

    Each patien’s clinical presentation with fibromyalgia is slightly different from another. There is however not even one patient with fibromyalgia who is tors in dealing with fibromyalgia.

    Another important factor in management of fibromyalgia is the coexistance of myofascial dysfunction and regional pain syndromes.

    Since most of the patient presenting with fibromyalgia are 40-60 age group it is obvious that there are some either functional or structural spinal pathology or frequently both which are present. Often times these patient have a histor system dysfunction.

    Much improvement can be achieved if these physical insults are removed. This removes some of already existing nonciception (pain) and allows patients to dependency and chronicity.

    Fibromyalgia Specialist in NYC – Advanced Approach

    Treatment of fibromyalgia requires cooperation of different specialties. Most important is a cooperation between neuromuscular specialist, rheumatologist and psychologist.

    We also use natural supplements toms of fibromyalgia:

    • Calcium and magnesium – to relax the muscles
    • 5-HTP and SAMe increase seroto reduction of pain signals
    • Sugar D -ribose to improve energy production within cells
    • Neprinol- a specifically developed enzyme for patient with fibromyalgia and other arthritic conditions. It works by removing excess fibrin.
    • Various meditation technigues work to be most effective.

    Fibromyalgia patients usually have neck and back and other pains within the locomoor system, thus allowing for pain free motion is one of the beginning steps in treatment of fibromyalgia. Although this is not always works with all fibromyalgia patients in my clinical experience it does work for majority of patients with fibromyalgia.

    There is however one most important aspect of treating fibromyalgia patients. It is trusting docto implement other treatment which are necessary for successful treatment of fibromyalgia.


    In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

    Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

    The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

    Dynamic ultrasonography examination demonstrating
    the full thickness tear and already occurring muscle atrophy
    due to misdiagnosis and not referring the patient
    to proper diagnostic workup

    Demonstration of how very small muscle defect is made and revealed
    to be a complete tear with muscle contraction
    under diagnostic sonography (not possible with MRI)


    Complete tear of rectus femoris
    with large hematoma (blood)


    Separation of muscle ends due to tear elicited
    on dynamic sonography examination

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