Ironic, the P in Substance P: The Relationship of Pain in Fibromyalgia

Substance P is one of two principle neurotransmitters (chemical messengers) in the central nervous system, the other being serotonin. Disturbance of these two important transmitters of information has an intense effect on pain perception. We know there is a chronic stress response in fibromyalgia and this constant strain on the body to reach well-being activates and causes hyperactivity of substance P.

Various neurotransmitters, including substance P, target cells across synaptic junctions between the cell’s axon and dendrite, binding to cellular receptors creating an action or electrical potential of the cell. These neurotransmitters create a union from a bounty of forerunners, such as amino acids, which are readily available from the diet. When neurotransmitters are disrupted, it can affect mood, sleep, cognitive function, and other symptoms present in fibromyalgia. These upsets also affect our modulation of the messaging system between the central nervous system and the peripheral and autonomic nervous systems.

BOOK EXCERPT - Chapter One Fibromyalgia Pain, Chronic Fatigue Immunodysfunction, and Chronic myofascial Pain from Trigger Points, subsection, Central Nervous System©

Substance P, which has been found in increased amounts in FM patients, is a peptide substance in spinal fluid (fluid that circulates in the central nervous system); its job is to regulate pain information. (Liu, et al, 2000).
Cooper and Miller, pg. 19 2010.

There are many types of neurotransmitters. Substance P is considered a nueropeptide and functions as a disseminator and interpreter of information, such as perception of pain. In response to pain the body engages in very specific interactions with opioid receptors in the central nervous system, and it can become quite complicated for us in this discussion, but suffice it to say, our body is constantly struggling to deal with painful impulses because our alarm system has become frayed with wear and tear. In chronic pain and widespread allodynia, this system is on perpetual high alert, sometimes called as wind-up, and eventually this exhausts the body’s ability to reach the balance it constantly strives to achieve.

The elevation of substance P in fibromyalgia patients leads many to the conclusion that FM is a disorder of heightened pain sensitivity. For those of us who have FM, we have pretty much already reached that conclusion.

All blogs, posts and answers are based on the work in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN, and Jeff Miller, PhD. 2010, Vermont: Healing Arts press and are not meant to replace medical advice.

This blog is based on my original answer at ShareCare, “What is substance P and how is related to fibromyalgia?”

View my other answered questions as fibromyalgia expert for Dr. Oz at Sharecare.


Other resources:

Khasar SG, Burkham J, Dina OA, Brown AS, Bogen O, Alessandri-Haber N, Green PG, Reichling DB, Levine JD. Stress induces a switch of intracellular signaling in sensory neurons in a model of generalized pain. J Neurosci. 2008 May 28;28(22):5721-30.

Z. Liu, M. Welin, B. Bragee, and F. Nyberg, “A high-recovery extraction procedure for quantitative analysis of substance P and opioid peptides in human cerebrospinal fluid,” Peptides 21, no. 6 (2000): 853–60.

Lyon P, Cohen M, Quintner J. An evolutionary stress-response hypothesis for chronic widespread pain (fibromyalgia syndrome). Pain Med. 2011 Aug;12(8):1167-78.

Stahl SM. Fibromyalgia--pathways and neurotransmitters. Hum Psychopharmacol. 2009 Jun;24 Suppl 1:S11-7.

Staud R, Spaeth M. Psychophysical and neurochemical abnormalities of pain processing in fibromyalgia. CNS Spectr. 2008 Mar;13(3 Suppl 5):12-7.