Articles on Fibromyalgia

Fibromyalgia is a chronic pain syndrome that typically provides the basis for a number of different symptoms and clinical signs. Here you can read more about the various articles we have written about the chronic pain disorder fibromyalgia - and not least what kind of treatment and self-measures are available for this diagnosis.

 

Fibromyalgia is also known as soft tissue rheumatism. The condition can include symptoms such as chronic pain in the muscles and joints, fatigue and depression.

Fibromyalgia and substance P: A painful worry

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Fibromyalgia and substance P: A painful worry

Here we take a closer look at the connection between fibromyalgia and substance P. Substance P is a biochemical pain modulator that affects pain signals - and which plays a central role in the pain picture in people with the chronic pain syndrome fibromyalgia.

Fibromyalgia is a chronic, multifactorial chronic pain syndrome. The diagnosis involves both neurological and rheumatological components - and is one of the most complex pain syndromes we know of. Fortunately, research into this diagnosis is progressing, and more and more important discoveries are being made, such as the relationship between fibromyalgia and thin fiber neuropathyand fibromyalgia and sleep apnea (the links open in new browser windows, so you can finish reading this article first). Research may also show an interesting link between fibromyalgia and substance P – a biochemical pain modulator that appears to play a central role.

Substance P: A pain-producing factor among people with fibromyalgia

Research in neurological journals, including recognized ones 'Frontiers in Cellular Neuroscience', shows a clearly increased content of substance P in fibromyalgia patients.¹ But to understand what this really means, we need to take a closer look at substance P.

Tips: Mobility exercises can help maintain movement and flexibility. Towards the end of the article shows chiropractor Alexander Andorff presented a video with recommended mobility exercises for people with fibromyalgia.

What is substance P?

Substance P is a neuropeptide consisting of 11 amino acids – an undecapeptide to be exact. Simply put, a neuropeptide is a signaling substance that affects functions in the nervous system. The main function of substance P is as a nerve signaling substance and pain modulator - which is also pro-inflammatory. It affects the pain signals and how we experience pain by changing the function of the pain signal-carrying nerve pathways.² In addition to affecting pain, substance P also plays a central role in:

  • Bowel function
  • Memory function
  • Inflammations (pro-inflammatory)
  • Blood vessel formation
  • Dilation of blood vessels
  • Cell growth

We are already beginning to gain a clear insight into how substance P plays a central role in fibromyalgia. Many people with fibromyalgia will also raise their eyebrows when they see how substance P can affect the gut and cognitive function, as we know that many people with the chronic pain syndrome suffer from irritable bowel and brain fog (ed. note also called fibrous mist).

Our clinic departments at Vondtklinikkene (click here  for a complete overview of our clinics), including in Oslo (Lambert seats) and Viken (Eidsvoll Sound og Raw wood), has a distinctively high professional competence in the investigation, treatment and rehabilitation of pain in muscles, tendons, nerves and joints. Toe contact us if you want the help of therapists with expertise in these fields.

But how does substance P affect people with fibromyalgia?

aches in muscles and joints

As we now gradually unravel substance P - we also understand more of how it can affect people with fibromyalgia. Researchers also believe that substance P plays a central role in why some pains become chronic - and others do not.³

Substance P and increased pain

A higher concentration of substance P in our serum levels will contribute to increased pain, symptoms and inflammatory reactions. Hyperalgesia, which involves greatly increased reporting of pain, is a central component in fibromyalgia - and the researchers therefore believe that this can be linked back to substance P. Here it may be of interest to many to read that heat salve with capsaicin has a documented effect on the content of substance P in the pain nerves - and has shown to be able to reduce this content when applied.4 However, the researchers describe that the total effect is not immediate, as it can take 1-4 weeks of application to reduce the concentration of the signaling substance and desensitize the pain areas.

Recommendation: Application of heat salve with capsaicin (link opens in a new browser window)

This natural heat salve contains, among other things, capsaicin. The active ingredient in chili. It is this active ingredient that the researchers published in the study Journal of British Anaesthesia showed that it had a documented effect in reducing substance P.4 You only need to use very small amounts, so a tube usually lasts quite a while. Do not apply more than a very thin layer (one drop is enough). Press the image or here to read more about how the heat salve works.

Substance P can be a central cause of chronic pain

Research also shows that substance P appears to activate certain pain pathways and pain receptors. One therefore links the elevated content of this signaling substance with the "vicious circle" that fibromyalgia entails - and also believes that so-called fibromyalgia flare-ups (particularly bad periods) can be directly linked to periods of higher concentrations of substance P in the body.

Also found in patients with arthritis (rheumatoid arthritis)

rheumatic arthritis edited 2

It is very important to point out that other diagnoses also experience higher concentrations of substance P than the general population. Previous research has shown that joints with a higher concentration of substance P develop more severe rheumatic arthritis - which thus includes more wear and tear changes, inflammation and breakdown of the joint.5 Thus, it is believed that this plays a central role in the development of arthritis and an answer to why certain joints develop more severe arthritis than others.

- Pain clinics: We can help you with pain in muscles and joints

Our publicly authorized clinicians at our affiliated clinics The pain clinics has a distinctive professional interest and expertise in the investigation, treatment and rehabilitation of muscle, tendon, nerve and joint ailments. We work purposefully to help you find the cause of your pain and symptoms - and then help you get rid of them.

See clinic overview

Treatment to reduce substance P?

There are several forms of treatment that have a documented effect in relation to reducing the concentration of substance P. This includes, among other things:

  1. Low-dose laser therapy
  2. Massage and muscular treatment
  3. Relaxation techniques

For patients with Bekhterev's, movement is one of the most important things. We know that inactivity and prolonged sitting lead to increased stiffness, more pain and inflammatory reactions.

1. Low-dose laser therapy and substance P

Previous meta-analyses, the strongest form of research, have shown that therapeutic laser therapy is a proven good treatment technique for people with fibromyalgia.6 Other studies have been able to document a reduction of substance P in animals with chronic pain.7 All our publicly authorized practitioners know our clinic departments belonging to Vondtklinikkene has expertise in the use of therapeutic laser therapy.

2. Massage, muscular treatment and dry needling

acupuncture nalebehandling

Studies have shown that patients with fibromyalgia can have a positive effect from massage and physical therapy. But remember that the massage must not be too tough. Improved sleep and less substance P were also documented in measurements after the treatments.8 In addition to this, meta-analyses have also been able to show a reduction in muscle pain among people with fibromyalgia when treated with intramuscular acupuncture (dry needling / IMS).9

3. Relaxation techniques

A daily focus on relaxation can help reduce stress. And we know that too much stress can really be a trigger for increased pain and symptoms among people with fibromyalgia. This is precisely why we want to emphasize the importance of setting up relaxation routines. Examples can include a daily walk, relaxation on an acupressure mat or in a neck hammock (with positive thought therapy at the same time) or other activities that you know give you peace of mind and body.

Good relaxation tip: 10-20 minutes daily in neck hammock (link opens in a new browser window)

Many people with fibromyalgia suffer a lot from tension in the upper back and neck. A neck hammock is a well-known relaxation technique that stretches the muscles and joints of the neck - and can therefore provide relief. In the case of significant tension and stiffness, you can expect to feel the stretch extra well the first few times. Thus, it may be wise to only take short sessions at the start (around 5 minutes). Press the image or here to read more about how it works.

Pain clinics: A holistic treatment approach is important

Feel free to contact one of our clinic departments belonging to Vondtklinikkene if you would like more information about how we use combinations of treatment techniques – including massage, nerve mobilization and therapeutic laser therapy – to achieve the best possible results.

VIDEO: 5 adapted mobility exercises for fibromyalgia

In the video above shows chiropractor Alexander Andorff v/ Vondtklinikkene ward Lambertseter in Oslo presented five gentle exercises for patients with fibromyalgia. Stimulating movement and circulation is very important for maintaining good function in muscles and joints.

«Summary: As you have understood, the signaling substance substance P appears to play a central role in fibromyalgia pain. It is also important to note that the concentration of substance P can be reduced with active measures such as adapted physical therapy, intramuscular acupuncture (IMS) and MSK laser therapy. Application of heat salve with capsaicin (link opens in new window) is also a natural measure that should be tested to see if it has an effect."

Join our Rheumatism and Fibromyalgia Support Group

Feel free to join the Facebook group «Rheumatism and Chronic Pain - Norway: Research and news» (Press here) for the latest updates on research and media articles on rheumatic and chronic disorders. Here, members can also get help and support - at all times of the day - through the exchange of their own experiences and advice. Otherwise, we would greatly appreciate it if you would follow us on the Facebook page and Our Youtube channel (the link opens in a new window).

Please share to support those with rheumatism and chronic pain

Hello! Can we ask you a favor? We kindly ask you to like the post on our FB page and to share this article on social media or via your blog (please link directly to the article). We are also happy to exchange links with relevant websites (contact us on Facebook if you want to exchange links with your website). Understanding, general knowledge and increased focus is the first step towards a better everyday life for those with rheumatism and chronic pain diagnoses. So we hope that you will help us with this battle of knowledge!

The pain clinics: Your choice for modern interdisciplinary health

Our clinicians and clinic departments always aim to be among the top elite in the field of investigation, treatment and rehabilitation of pain and injuries in muscles, tendons, nerves and joints. By pressing the button below, you can see an overview of our clinics - including in Oslo (incl Lambert seats) and Viken (Raw wood og Eidsvoll Sound).

See clinic overview

Sources and research

1. Theoharides et al, 2019. Mast Cells, Neuroinflammation and Pain in Fibromyalgia Syndrome. Front Cell Neurosci. 2019 Aug 2;13:353. [PubMed]

2. Graefe et al, 2022. Biochemistry, Substance P. StatPearls. [PubMed]

3. Zieglgänsberger et al, 2019. Substance P and pain chronicity. Cell Tissue Res. 2019; 375(1): 227–241. [PubMed]

4. Anand et al, 2011. Topical capsaicin for pain management: therapeutic potential and mechanisms of action of the new high-concentration capsaicin 8% patch. Br J Anaesth. 2011 Oct; 107(4): 490–502. [PubMed]

5. Levine et al, 1984. Intraneuronal Substance P Contributes to the Severity of Experimental Arthritis. Science 226,547-549(1984).

6. Yeh et al, 2019. Low-Level Laser Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis. Pain Physician. 2019 May;22(3):241-254. [PubMed]

7. Han et al, 2019. Involvement of Substance P in the Analgesic Effect of Low-Level Laser Therapy in a Mouse Model of Chronic Widespread Muscle Pain. Pain Med. 2019 Oct 1;20(10):1963-1970.

8. Field et al, 2002. Fibromyalgia pain and substance P decrease and sleep improves after massage therapy. J Clin Rheumatol. 2002 Apr;8(2):72-6. [PubMed]

9. Valera-Calero et al, 2022. Efficacy of Dry Needling and Acupuncture in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis. [Meta-analysis / PubMed]

Article: Fibromyalgia and substance P – a painful worry

Written by: Our publicly authorized chiropractors and physiotherapists at Vondtklinikkene

Fact check: Our articles are always based on serious sources, research studies and research journals - such as PubMed and the Cochrane Library. Please contact us if you spot any errors or have comments.

FAQ: Frequently asked questions about fibromyalgia and substance P

1. How can people with fibromyalgia reduce pain in everyday life?

Here we wish there was a clear and simple answer, but the truth is that the path to pain relief in everyday life is complicated and extensive. Not all patients with fibromyalgia respond in the same way, but we know that relaxation techniques, physical therapy for muscles and joints, intramuscular acupuncture, adapted rehabilitation exercises and MSK laser therapy can provide relief.

Fibromyalgia and sleep apnea: Irregular nocturnal breathing stops

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Fibromyalgia and sleep apnea: Irregular nocturnal breathing stops

The pain syndrome fibromyalgia causes characteristic chronic pain, fatigue and sleep difficulties. Sleep apnea syndrome can contribute to symptoms such as morning fatigue and poor sleep quality.

Research has shown that a disturbingly high number of people with fibromyalgia struggle greatly with sleep and sleep quality. This includes, among other things:

  • Problems falling asleep (takes a long time)
  • Awakenings throughout the night
  • Reduced sleep quality
  • Fatigue in the morning

In fact, research studies show that as many as 50% of people with fibromyalgia have some form of sleep apnea.¹ The findings were then divided into three severity levels of sleep apnea:

  • Mild (33%)
  • Moderate (25%)
  • Significant (42%)

These clinical findings are very important and exciting. In short, it shows that there is a clearly higher proportion of fibromyalgia patients who suffer from sleep apnea. For that reason, we believe that such research may one day help us understand the very complex pain syndrome. We also know that night pain is a significant factor that reduces sleep quality in this patient group.

- What is sleep apnea?

sleeping problems

Sleep apnea syndrome involves episodes of total (apnea) or partial (hypoapnea) collapse of the upper airways - which results in respiratory arrest or breathing difficulties when you sleep.² Such breathing stops or difficulties will result in reduced oxygen saturation or awakenings. The disturbances make the person restless and sleep poorly. That it has now been seen that such a large proportion of fibromyalgia patients probably suffer from this condition - this shows how particularly important relaxation techniques and sleep routines are for this patient group. Towards the end of the article links to an article called 9 good tips for better sleep with fibromyalgia, based on the statements of a medical specialist with expertise in sleep. We believe that this may be of interest to many here.

Other symptoms of sleep apnea

In addition to the above symptoms, people with sleep apnea may also have the following symptoms. See the list below:

  • Loud and disturbing snoring
  • Witnessed breathing stops at night (by partner or similar)
  • Significant sleepiness and fatigue during the day

Our clinic departments at Vondtklinikkene (click here  for a complete overview of our clinics), including in Oslo (Lambert seats) and Viken (Eidsvoll Sound og Raw wood), has a distinctively high professional competence in the investigation, treatment and rehabilitation of pain in muscles, tendons, nerves and joints. Toe contact us if you want the help of therapists with expertise in these fields.

Consequences of sleep apnea among fibromyalgia patients

Let's go back to the study that showed that it is possible that as many as 50% of people with fibromyalgia suffer from sleep apnea. What potential consequences can this lead to in an already affected patient group? A group where many are also affected by night pain? Well, to understand that we need to take a closer look at what function and benefits sleep has for us. In the list below, we take a closer look at eight health benefits of improved sleep.

Certain self-measures can reduce sleep apnea symptoms and improve sleep quality

An exciting research study has shown that head pillow with memory foam can reduce breathing disorders and sleep apnea symptoms. It works by optimizing the ergonomic position to open our airways in the best possible way. They further write in the study that it works best for mild to moderate sleep apnea.6 In addition, also have nasal breathing apparatus (which helps prevent the pharynx from 'collapsing') documented effect. All product recommendations open in a new browser window.

Our recommendation: Try sleeping with an ergonomic head pillow with modern memory foam

There is little doubt that we spend large parts of our lives in bed. And that underlines the need for good quality in our pillow. Studies point to that head pillow with modern memory foam may be the best option for many. You can read more about our recommendation here .

8 benefits of good sleep

  1. You get sick less often
  2. Repairs soft tissue, nerves and joints
  3. Reduces the risk of health problems - such as diabetes and heart disease
  4. Helps maintain a healthy weight
  5. Lowers the stress level in the body and improves mood
  6. Sharpens cognitive functions and the way of thinking
  7. More surplus for social gatherings and activities
  8. Faster decision-making and responsiveness

1. Sleep improves the functioning of the immune system and prevents disease

Restless bone syndrome - neurological sleep state

Sleep contributes to the good functioning and maintenance of our immune system.³ This strengthening effect on the defense system itself in our body contributes to a more efficient breakdown of disease-causing bacteria and viruses. The result is both less frequent occurrence of illness, but also faster healing if you do get sick in the first place.

2. Repair of soft tissue, connective tissue and joints

During the night, when we sleep, a significantly higher rate of repair occurs to the structures of our body. This includes both maintenance and active repair of muscles, tendons, connective tissue and joints. For a group of patients who are already suffering from significant tension and pain from these areas, this is bad news. Consequently, this is a possible factor that contributes to persistent pain in people with fibromyalgia - and thus makes function-improving and symptom-alleviating measures even more important. Daily stretching exercises, use of natural pain ointments (see below), relaxation techniques and adapted physical therapy are some of the measures that can help you.

Good tip: Biofrost (natural pain relief)

Many people report that natural pain relievers help them to calm muscle tension and pain - such as Biofrost or Arnica gel. The gel works in such a way that it desensitizes the pain fibres, and thus causes them to send less pain signals. Press the image or here to read more about how it works.

3. Reduces the risk of health problems

Heart

It is not only muscles and connective tissue that depend on sleep. Organs, including our heart, also receive much-needed rest and maintenance when we enter dreamland. The research is clear that poor sleep over time increases the risk of health problems - including diabetes and heart problems.4

4. Helps us maintain a healthy weight

The doorstep mileage is extra high with poor sleep. There is no doubt about that. The vast majority of us have known how motivation completely disappears when we feel exhausted. One way that sleep helps us keep the weight off is that we actually have more physical stamina – that, for example, you can stomach the daily walk or the customized exercise session (perhaps the one in the hot water pool?) that you had originally planned to do. In addition to this, improved sleep quality contributes to better functioning of the thyroid gland and metabolism.

- Pain clinics: We can help you with pain in muscles and joints

Our publicly authorized clinicians at our affiliated clinics The pain clinics has a distinctive professional interest and expertise in the investigation, treatment and rehabilitation of muscle, tendon, nerve and joint ailments. We work purposefully to help you find the cause of your pain and symptoms - and then help you get rid of them.

See clinic overview

5. Lowers stress and improves mood

typing on laptop 2

Stress takes place on several levels in our body - including physical, psychological and chemical. Sleep is good for our control tower (the brain) and helps to reduce biochemical stress markers in the body and mind. If we again combine this with improved repair of soft tissue and tissue structures, the result is increased energy surplus and better mood. Consequently, we can use the energy surplus on things we like to do - such as social gatherings and going to a cafe (or similar).

6. Improved cognitive function

Fibro fog is an expression that describes what we call brain fog in patients with fibromyalgia. Again, we can link this back to, among other things, sleep disturbances in this patient group. Brain fog can include:

  • Impaired short-term memory
  • Difficulty finding words
  • Difficulty concentrating
  • Slight confusion

Thus, such cognitive disturbances can also contribute to what we call a "vicious circle", as the person experiencing this feels increased stress. But by all means remember that this is not your fault, dear. Getting stressed or disappointed when such events occur will actually only reinforce the temporary "blockage", so remember to take a few deep breaths with your stomach and reset yourself.

- Take simple steps towards improved sleep quality

There are many things that disrupt your sleep, including too much caffeine and alcohol. In addition to this, many people are surprised by how much it means that you actually have it dark and without disturbances. Using a sleep mask can be a fairly simple and ingenious self-measure. We also recommend that you read the article 9 tips for better sleep with fibromyalgia (linked to at the end of the article) for even more good advice on how to achieve better sleep.

Good tip: Sleep mask (with extra space for the eyes)

Being dark leads to less disturbances in the nervous system. Light is perceived in the form of electrical signals which in turn must be interpreted in the brain. In fact, sleep studies have shown that people with sleep mask experienced less disturbed sleep quality - and could have both more REM sleep and deep sleep - than the control group who did not sleep with a sleep mask.5 Press the image or here to read more about why we recommend this specially designed sleep mask.

7. More surplus for social gatherings and activities

natural painkillers

Good sleep gives more energy and surplus. A bad night's sleep can be the last straw if you cancel meeting your girlfriend, skip your walk or skip your daily stretching session. In this way, the night's sleep has a number of unfortunate consequences - both short-term and long-term.

8. Faster decision-making and responsiveness

Our ability to react can be strongly influenced by the quality of our sleep. This can be linked back to cognitive function in the brain - and that the maintenance processes in the supercomputer have not been optimal. It has been documented, for example, that someone who has been awake all night has a reaction capacity equivalent to a person with 1.0 in the blood alcohol level. Thus, extremely poor sleep can also be directly dangerous for those who drive a lot.

"Summary: As you have understood, sleep apnea can have clear negative consequences. Has your partner or someone else commented that you stop breathing at night? Then it might be a good idea to have you evaluated for sleep apnea. Such a referral to a sleep study is made via your GP.

Join our fibromyalgia and rheumatism support group

Feel free to join the Facebook group «Rheumatism and Chronic Pain - Norway: Research and news» (Press here) for the latest updates on research and media writing about rheumatic and chronic disorders. Here, members can also get help and support - at all times of the day - through the exchange of their own experiences and advice. Otherwise, we would greatly appreciate it if you would follow us on the Facebook page and Our Youtube channel (the link opens in a new window).

Please share to support those with rheumatism and chronic pain

Hello! Can we ask you a favor? We kindly ask you to like the post on our FB page and to share this article on social media or via your blog (please link directly to the article). We are also happy to exchange links with relevant websites (contact us on Facebook if you want to exchange links with your website). Understanding, general knowledge and increased focus are the first step towards a better everyday life for those with chronic pain diagnoses. So we hope that you will help us with this battle of knowledge!

The pain clinics: Your choice for modern interdisciplinary health

Our clinicians and clinic departments at Vondtklinikkene Tverrfaglig Helse always aim to be among the top elite in the field of investigation, treatment and rehabilitation of pain and injuries in muscles, tendons, nerves and joints. By pressing the button below, you can see an overview of our clinic departments, including in Oslo (incl Lambert seats) and Akershus (Raw wood og Eidsvoll Sound).

See clinic overview

Sources and research

1. Köseoğlu et al, 2017. Is There a Link Between Obstructive Sleep Apnea Syndrome and Fibromyalgia Syndrome? Turk Thorac J. 2017 Apr;18(2):40-46. [PubMed]

2. Esteller et al, 2019. Clinical Practice Guideline recommendations on examination of the upper airway for adults with suspected obstructive sleep apnea-hypopnoea syndrome. Acta Otorhinolaryngol Esp (Engl Ed). 2019 Nov-Dec;70(6):364-372.

3. Medic et al, 2017. Short- and long-term health consequences of sleep disruption. Nat Sci Sleep. 2017; 9: 151–161. Published online 2017 May 19.

4. Yeghiazarians et al, 2021. Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2021 Jul 20;144(3):e56-e67.

5. Hu et al, 2010. Effects of earplugs and eye masks on nocturnal sleep, melatonin and cortisol in a simulated intensive care unit environment. Crit Care. 2010;14(2):R66.

6. Stavrou et al, 2022. Memory Foam Pillow as an Intervention in Obstructive Sleep Apnea Syndrome: A Preliminary Randomized Study. Front Med (Lausanne). 2022 Mar 9:9:842224.

Article: Fibromyalgia and sleep apnea - irregular nocturnal breathing stops

Written by: Our publicly authorized chiropractors and physiotherapists at Vondtklinikkene

Fact check: Our articles are always based on serious sources, research studies and research journals - such as PubMed and the Cochrane Library. Please contact us if you spot any errors or have comments.

FAQ: Frequently asked questions about fibromyalgia and sleep apnea

1. How can you get better sleep quality?

Previously, we wrote an article, based on a doctor who is an expert on sleep, about 9 tips for better sleep with fibromyalgia. We recommend that you read that article to get good tips and advice on how you can personally achieve better sleep quality. But good routines before bedtime, reduction of caffeine and alcohol, and sleep mask, are perhaps among the most important own measures.