Autonomic dysfunction, also called dysautonomia, occurs when the nervous system has difficulty regulating automatic body functions such as heart rate, blood pressure, digestion, sweating, temperature control, and stress response. At Manhattan Pain Medicine, we look for the underlying drivers of this imbalance, including hypermobility, craniocervical instability, small fiber neuropathy, immune dysfunction, visceral pain, and chronic nervous system sensitization.
Symptoms of autonomic dysfunction can be complex. Dr. Siefferman discusses diagnosis and treatment options.
Our team organizes conditions and treatments into related zones of expertise to make it easier to explore the care paths most relevant to your symptoms and goals.
Use the zone tags above to browse dedicated pages for each focus area, including services, providers, and what to expect during treatment.
Hi, I’m Dr. Jason Siefferman with Manhattan Pain Medicine, and I want to take a moment to talk about autonomic dysfunction. It’s one of our zones of expertise. The autonomic nervous system includes the sympathetic nervous system and the parasympathetic nervous system. The sympathetic is the fight-or-flight response. Parasympathetic is rest and digest. Between the two of them, they control the automatic functions of the body. Things like digestion, your pulse, sweating, stress response—things that happen automatically without you having to think about them.
Dysautonomia is the imbalance between these two parts of the nervous system, and generally, there’s hyperactivity or hyper-reflexivity in the sympathetic nervous system response, meaning the fight-or-flight response is exaggerated. When treating dysautonomia, we have to look for the reasons for those imbalances, correct those, and then we attempt to rebalance the sympathetic and parasympathetic responses.
Dysautonomia will often show up with a variety of conditions that we see. Specifically, we see dysautonomia with hypermobility because craniocervical instability, or looseness of the head-neck junction, very directly stresses both the vagus nerve, which is parasympathetic, and the sympathetic chain, which is sympathetic. With the mechanical instability at the head-neck junction and the mechanical stress of those nerves, both sympathetic and parasympathetic are not working correctly. In order to treat that, yes, we can give you medications like beta blockers, but ultimately, we want to correct the structural issue that’s driving the irritation to the nervous system.
Other situations like post-COVID, chronic Lyme, mast cell activation syndrome—these can also all cause dysautonomia. A signal that’s abnormal or painful in that part of the nervous system can cause a reflex response that throws the sympathetic-parasympathetic balance off. We also see this with visceral pain conditions. So going back to the vascular compression syndromes, if you’re familiar with endometriosis or any other visceral pain—even ulcers, chronic pancreatitis—we can see visceral pain triggering dysautonomia, which can present as chronic constipation, gastroparesis, or just a physiologic stress response.
Some patients come in just feeling like there’s a fire and they can’t exit the building. It feels like anxiety, but it’s not actual mental anxiety. It’s a physiologic anxiety, and usually, when patients have the context of understanding how this occurs, it makes sense to them. Just to know that there is something in the body driving it can be very reassuring.
So when we meet patients and we see signs of dysautonomia, we really strive to understand what is underlying that. What is driving the imbalance between the sympathetic and the parasympathetic? How do we fix that? And then, how do we re-regulate the nervous system?
We view dysautonomia as one of our zones of expertise because of the breadth of causes that can be underlying. So for example, just a cardiologist, just a rheumatologist, just a neurologist will see their scope of things that can cause dysautonomia. At our practice at Manhattan Pain Medicine, we have a full breadth of providers of subspecialties where we can evaluate every angle of cause. So between the providers here, collectively, we can identify any and all causes of dysautonomia to make sure that your reason is understood and that will address your needs in this area.
The autonomic nervous system helps regulate the body’s automatic functions through two major pathways: the sympathetic nervous system, often described as the fight-or-flight system, and the parasympathetic nervous system, often described as the rest-and-digest system.
When these systems fall out of balance, patients may experience symptoms across many parts of the body, including heart rate changes, dizziness, blood pressure instability, digestive slowing, constipation, reflux, nausea, sweating changes, temperature sensitivity, fatigue, brain fog, and physical sensations that can feel like anxiety or panic.
At Manhattan Pain Medicine, we approach dysautonomia by asking why the autonomic system is dysregulated. The goal is not only to reduce symptoms, but to understand what is driving the imbalance and how to help the nervous system re-regulate over time.
Autonomic dysfunction often crosses traditional specialty boundaries. At Manhattan Pain Medicine, the evaluation may involve pain medicine, rheumatology, rehabilitation, pain psychology, and other clinical perspectives depending on the patient’s symptoms and suspected drivers.
Patients may benefit from evaluation when symptoms such as dizziness, rapid heart rate, brain fog, fatigue, nausea, constipation, sweating changes, temperature sensitivity, or body-wide stress responses occur alongside chronic pain, hypermobility, inflammatory symptoms, nerve symptoms, or suspected craniocervical instability.
Autonomic dysfunction is not treated as one isolated diagnosis. We work to understand the system behind the symptoms, calm the overactive signals, and address the structural, inflammatory, neurologic, or pain-related factors that may be keeping the body in a high-alert state.
Your evaluation may include a detailed symptom history, review of triggers, orthostatic vital signs, physical examination, medication response review, and assessment for related drivers such as hypermobility, craniocervical instability, small fiber neuropathy, inflammatory disease, mast cell activation, visceral pain, or chronic nervous system sensitization. The goal is to understand the pattern before selecting a treatment path.
Two patients may both have dysautonomia, but for different reasons. One may have blood pooling related to connective tissue laxity, another may have small fiber neuropathy, another may have craniocervical instability, and another may have visceral pain or immune activation keeping the nervous system on high alert. Understanding the driver helps determine the right treatment sequence.
These guys are the best. I've been going here for over 6 years and their familiarity with my Schwannomatosis (most ppl have never even heard of it - its rather rare) and their ability to diagnose my CRPS quickly and accurately and then treat it like I was merely getting a flu shot is just incredible...
Highly recommended for those who need Pain Management. Everyone at Manhattan Pain Medicine is extremely nice and helpful. I have had very good interactions with both Dr. Siefferman and Dr. Louis. All of the staff is very responsive. 5 stars.
The providers at Manhattan Pain Medicine are exceptional. I wish I had found them 30 years ago!
I genuinely can’t say enough good things about the team at Manhattan Pain Medicine. I have MCAS, EDS, and an inflammatory autoimmune disease, and I’ve basically been searching for answers since I was a kid. I had years of unexplained inflammation markers, chronic pain, and allergic reactions despite...
I have a complex medical history and have seen a lot of doctors over the years. Dr. Mikaberidze and Dr. Siefferman each took the time to really listen and understand everything I had been dealing with. I also appreciated how they work together and communicated about my care. I left with a plan that...
Sharing my gratitude for the pleasant experience last week during my visit, the medical team provided great care and also treated my session as a learning experience, I left my session with a wealth of knowledge. A big thank you to the kind, and professional staff who welcomed me to the office as a...
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
Dr Siefferman is the most thorough, patient doctor I have even been to. Currently I travel from miami to nyc to see him because his bed side manner and desire to help is incomparable.
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This practice is wonderful. I have been a patient of Dr. Siefferman’s since 2019 and he’s extremely helpful and kind. He has brought in a Rheumatologist who is also great. They handle very complex pain issues and always try to find new ways to help me.
Dr. Siefferman is an incredible doctor! He is extremely diligent and knowledgeable. It feels like you are his only patient. He invests a lot of time and effort into your injuries and concerns. I did not find these wonderful qualities with other pain specialists before, who were always rushed and som...
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Dr. Siefferman is a doctor who combines the old world bedside manner of doctors from my childhood (60 years ago) with a sta te of the art embrace of modern technology. It is always a pleasure to have an appointment with him...always has options and solutions to my medical issues. He is truly the doc...
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Dr. Siefferman is a genius. He is very informed and listens attentively.
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Dr. Siefferman and his entire team continue to be efficient, dedicated, and driven by precision and a genuine desire to give fantastic care. Will always recommend.
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Doctor Siefferman is fantastic. Have been seeing him for 5 years. Couldn’t recommend more.
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Dr. Siefferman is the ONLY doctor who has ever been able to diagnose my pain and treat it. He is hands down the best
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Autonomic dysfunction, or dysautonomia, occurs when the autonomic nervous system has difficulty regulating automatic body functions. These include heart rate, blood pressure, digestion, sweating, temperature control, and the body’s fight-or-flight and rest-and-digest responses.
Dysautonomia can cause dizziness, rapid heart rate, blood pressure changes, fatigue, brain fog, sweating changes, heat or cold intolerance, nausea, reflux, constipation, gastroparesis, exercise intolerance, and physical sensations that may feel like anxiety or panic.
Yes. Postural Orthostatic Tachycardia Syndrome, or POTS, is one form of autonomic dysfunction. It often involves an abnormal heart rate response when moving from lying or sitting to standing. At MPM, we look at why POTS symptoms may be occurring, including blood pooling, hypermobility, adrenal or volume issues, sympathetic overactivity, small fiber neuropathy, or other contributors.
In patients with hypermobility, connective tissue laxity can affect blood vessels, joints, and the head-neck junction. Stretchy blood vessels may allow blood to pool in the legs, while craniocervical instability may irritate the vagus nerve or sympathetic chain. These factors can disrupt autonomic regulation and contribute to symptoms such as dizziness, fatigue, brain fog, and rapid heart rate.
Yes. Dysautonomia can create a physical fight-or-flight response that feels like anxiety or panic even when the primary driver is physiologic. Patients may feel jittery, overwhelmed, shaky, hot, sweaty, or unable to settle. Understanding this distinction can help patients feel less confused and may guide treatment toward the nervous system itself.
Evaluation may include a detailed history, orthostatic vitals, review of symptom patterns, physical examination, medication response, review of imaging, and assessment for related drivers such as hypermobility, craniocervical instability, small fiber neuropathy, immune dysfunction, inflammatory conditions, or visceral pain. In selected cases, diagnostic tools such as skin punch biopsy or targeted sympathetic blocks may help clarify the picture.
Treatment depends on the underlying driver. Care may include medications that reduce sympathetic overactivity, volume support, treatment of inflammatory or immune contributors, sympathetic nerve blocks, autonomic-focused physical rehabilitation, pacing strategies, biofeedback, pain psychology, and treatment of structural or visceral pain generators when they are contributing.
Yes. The autonomic nervous system helps regulate digestion. When sympathetic tone is too high or vagus nerve function is disrupted, patients may experience reflux, nausea, delayed stomach emptying, constipation, bloating, or symptoms consistent with gastroparesis or small intestinal bacterial overgrowth.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Autonomic dysfunction, also called dysautonomia, refers to dysregulation of the body’s automatic nervous system. This system controls functions that should happen without conscious effort, including heart rate, blood pressure, digestion, sweating, temperature regulation, and stress response.
The autonomic nervous system includes the sympathetic nervous system, often described as fight or flight, and the parasympathetic nervous system, often described as rest and digest. When these systems fall out of balance, the body may feel trapped in a state of physiologic alarm, with symptoms that can affect multiple systems at once.
At Manhattan Pain Medicine, we do not treat dysautonomia as a standalone label. We look for the reason the autonomic nervous system is dysregulated. In many patients, dysautonomia is driven by an underlying structural, neurologic, inflammatory, immune, or pain-related process.
Hypermobility and connective tissue laxity can contribute to blood pooling because blood vessels may not provide enough resistance against gravity. Craniocervical instability can place mechanical stress on the head-neck junction, potentially affecting the vagus nerve and sympathetic chain. Small fiber neuropathy can impair autonomic nerve fibers involved in temperature regulation, sweating, and vascular control. Visceral pain, inflammatory disease, post-viral syndromes, mast cell activation, and chronic pain sensitization can also keep the nervous system in a high-alert state.
Postural Orthostatic Tachycardia Syndrome, or POTS, is one of the most common dysautonomia patterns. Patients may experience rapid heart rate, dizziness, fatigue, brain fog, shakiness, sweating, or a sense of internal alarm when standing. In some patients, this is related to blood pooling. In others, it may reflect sympathetic overactivity, volume dysregulation, adrenal or hormonal contributors, small fiber neuropathy, or a combination of factors.
The autonomic nervous system also regulates digestion. When sympathetic tone is high or parasympathetic signaling is disrupted, patients may develop nausea, reflux, constipation, bloating, delayed stomach emptying, or symptoms consistent with gastroparesis. In some patients, the digestive symptoms are part of the same autonomic pattern as dizziness, fatigue, and heart rate instability.
Many patients describe a feeling of anxiety that does not feel purely emotional. The body may surge with adrenaline, heat, sweating, shakiness, racing heart, or panic-like sensations. At MPM, we often explain this as a physiologic autonomic surge. The experience is real, but the driver may be the nervous system rather than a primary psychiatric condition.
The first step is to understand the pattern. We ask what symptoms appear, when they happen, what triggers them, what relieves them, and what other pain or systemic conditions are present. We may assess orthostatic vitals by tracking blood pressure and pulse across lying, sitting, and standing positions.
We also look for underlying drivers. This may include evaluating hypermobility, craniocervical instability, small fiber neuropathy, autoimmune disease, mast cell activation, post-viral syndromes, visceral pain, chronic migraine, pelvic pain, or other sources of nervous system sensitization.
In selected cases, diagnostic interventions can help clarify the role of the sympathetic nervous system. For example, an intravenous lidocaine challenge or a targeted sympathetic block may provide useful information when symptoms are being maintained by a hyperactive sympathetic response.
Treatment depends on the reason the autonomic system is dysregulated. The goal is to calm the overactive signals, support the body’s ability to regulate itself, and address the underlying drivers when possible.
Maintenance begins when the patient understands the pattern, the major drivers have been identified, and the nervous system is more stable. The goal is not simply to avoid symptoms, but to build body literacy and a practical plan for managing flares.
Patients may learn how to pace activity, take supine breaks, elevate the legs, track delayed responses to exertion, use medications or procedures appropriately, and recognize when symptoms represent a temporary autonomic flare versus a new or worsening problem.
For many patients, understanding the why behind dysautonomia is itself a turning point. When patients can connect symptoms to a physiologic process, the experience often becomes less frightening and easier to manage.
