NJ Fibromyalgia Treatment of FMS in New Jersey

Pain Threshold vs Pain Tolerance

There is a huge misconception that still exists when it comes to understanding the degree of pain people with Fibromyalgia experience. The reason for this confusion is that there are actually 2 separate terms used to describe levels of pain. The term “pain threshold” defines the level at which the body first perceives a stimuli as being painful. The term “pain tolerance” has a completely different meaning and basically defines how much pain a person can actually take without breaking. We can think of tolerance as the “acceptance level” of an existing pain.

People that suffer with Fibromyalgia have a low threshold and most often a very high tolerance to pain. This is partly true because they have been found to have greatly increased levels of substance P in the cerebral spinal fluid. Substance P is a neuromodulator (a substance that changes neurotransmitter effectiveness) that allows us to perceive a stimulus as painful. It is interesting to mention that there are actually some rare medical conditions where substance P is very low or completely absent and a person feels little or no pain. That may initially seem like a blessing but actually it can be very dangerous because there is then no “warning pain” when a critical condition requiring treatment exists in the body. Can you imagine how serious it would be for someone with acute appendicitis to not feel any pain and have the appendix rupture?

Obviously having a normal level of substance P is the ideal situation where your body tells you exactly what it should be feeling and pain is perceived at the appropriate level. Take a look at the illustration below and you will get a general idea how Substance P works. You can see that the transmission of nerve impulses and pain is quite intricate and involves many more chemicals but Substance P plays a very important role.

Now with elevation of Substance P, as in Fibromyalgia, a sensation that should be perceived as normal is felt as painful. The term for this condition of increased pain perception is hypergesia. Sometimes even a light touch on the skin can feel like burning and I have seen many patients that can’t even stand to have the bed sheets touch their legs at night. In Fibro patients a relatively minor muscle strain due to over exertion will often cause a totally inappropriate severe level of pain and then cause unnecessary muscle splinting and spasm which then has a downward spiraling effect. The body over responds due to an inaccurate pain signal caused by high substance P and starts what I call the “cascading of symptoms”. One simple strain becomes a serious of pains that can sometimes throw the Fibro patient into a severe flare.

So does this mean that Fibro patients are weak? Does it mean that we are just being hysterical with the pain and over reacting? No, actually it is usually the complete opposite. Here is where the definitions of threshold vs. tolerance become very important. Fibro patients do feel pain sooner and at inappropriate levels but, for most of us, we have incredibly high pain tolerances. The reason for this is because Fibro patients deal with some level of pain all the time. I guess you can say that we grow more accustomed to living with pain. Most Fibro patients that I counsel and treat have a remarkable way of dealing with levels of pain that would drive a “NON Fibro” person absolutely insane. This is one of the main reasons that it makes me frustrated when I hear people that obviously do not understand Fibromyalgia say that Fibro patients are just being weak or wimpy. Considering what level of pain Fibro patients need to deal with, it is surely one of the worst things you can say to them. If those accusers ever woke up in a Fibro body for even 1 day, they would likely run to the ER or beg their doctor for some heavy duty narcotics. The thing is this: Fibro people have grown accustomed to living and dealing with pain and most often accept the lower to moderate levels in silence. That is where the high tolerance comes in to play. I often tell people that we look at most of our pain like we would view “elevator music”. It just is a low level background noise and we learn how to still have a life and accept or even ignore it. Usually it is just the severe flares that make most Fibro patients really complain but at that level the pain can be completely intrusive and there is no way one can ignore it.

It would really make things a whole lot easier if the people around us that do not have Fibromyalgia could understand the difference between the two terms threshold and tolerance. Most Fibro patients are not looking for sympathy; they are just seeking understanding. I have personally observed the supreme importance of a good support system in all of my Fibro patients. You can’t expect true support unless the ones that are most important to us understand that we are coming from a position of strength, not weakness.


  • Posted August 27, 2011 at 10:58 pm | Permalink

    What a fabulous explanation. I’ve been trying to explain this to my family for years, but they just don’t seem to get it. This would explain a lot of the issues that I had as a child, and why they continue. It also makes me want to be more aware with my son who already is exhibiting many of these same symptoms.

  • Kirsten
    Posted January 9, 2012 at 1:18 pm | Permalink

    I have read numerous studies on fibro. And borderline personality disorder being co-related. …showing that it is not purely medical, but psychological as well. This article also doesn’t explain if fibro branches out as one ages, or whether it is from birth…I would like more info.

  • Lynne
    Posted January 4, 2013 at 11:54 pm | Permalink

    This is so true. I have had Frybromyalgia for more than 20 years and although it has lessened in intesity I still have a very low pain threshold which concerned me greatly until I read this article. This explanation has stopped my concern with the explanation of the difference between tolerence and threshold thank you. You are very correct about telling Frybro people to ignore it and get on with life. My now husband does understand where as my ex-husband told me that I was stupid and pathetic needed to stop complaining and just get over it. Understanding is all we need and yes it is part of the reason I left my ex and why am with my present man.

  • Posted May 9, 2013 at 10:03 pm | Permalink

    is the pain from neuropathy the same as fibromyalga?

  • Aisha abbas
    Posted January 20, 2015 at 12:02 pm | Permalink

    I like your site kip it up

  • Aisha abbas
    Posted January 20, 2015 at 12:05 pm | Permalink

    Please how do i manage a patient with pain,i need ur help please.

  • Diana
    Posted February 6, 2015 at 9:13 am | Permalink

    More than 20 years ago I was in a car accident (whip lash). The pain in my body continued and my doctor said it was the whip lash, then the seat belt. Finally the pain was so bad I could not lay down to sleep, I could not sit normally in a chair, even wearing clothes on my body hurt. I was getting less than 2 hours of sleep a night. As someone who played in sports and injured herself often, this was not something I ever experienced. I remember telling my doctor that I would rather deliver 100 babies then to suffer like I was. Why, because after the 100th birth I would know it was over, the pain would be gone but with Fibro, it never ends. I told my doctor, I can be in pain and do nothing, or be in pain and do something. Even when my pain ends up at its worst, I don’t dwell at how I am feeling but what I accomplished in that pain level. The hardest part of Fibro is not knowing what will cause a horrible flair up….one day I can rake the lawn and still tolerate the pain, the next day, or week later I can do the exact same action and the pain wants to drive me into running straight towards a wall to knock myself out to stop the pain. At times I don’t know what is more frustrating, the pain level, or how to control it since there isn’t any way to do that. When someone suffers a bad back, they are told how to avoid possibly hurting themselves further and ways to get better, with Fibro, all the stretching and strengthening exercise has not rid me of my pain, but has helped me to cope with it. I don’t blame people who don’t understand, if it wasn’t happening to me, I wouldn’t understand.

  • martha
    Posted June 27, 2015 at 12:04 pm | Permalink

    Can we be tested for substance P

  • Kim
    Posted August 30, 2015 at 6:49 am | Permalink

    It’s exciting every time I learn something new about Fibromyalgia. Especially now learning about “pain tolerance vs. threshold”. Not only because it’s important to know but, each time it validates what I’m experiencing and that I’m not just another hyperchondriac.
    I also suffer from other painful medical problems, and have for 25 years, and am so tired and annoyed with people who don’t even make an effort to try and understand what I’m going through. But what bothers me the most is when people don’t believe me when giving my level of pain on the scale of “1-10”! I’m consistently at least a 7 and the response I most often hear is, “no way are you having that much pain, you’re smiling and laughing”! So I try to explain that I’ve been living with pain for so long that it’s part of who I am and have had to learn to live with it! But I am sure they don’t believe me. And some of these people are actually in the medical field! You would think at least THEY would be more aware of how that works.
    So it is a very frustrating ongoing battle!

  • Angel
    Posted February 4, 2016 at 1:31 am | Permalink

    I have severe fybro.as a result of a very serious auto accident . I have a roomate who works for people who are disabled.
    What amazes me is she has no compasion or understanding of the severity ,pain or struggles this disease causes. Even though she sees me suffering greatly everyday. She acts like I just have a cold that will go away. Its scary to think that she is filling out disability forms and other important government paperwork for these people after seeing her real personality and lack of compassion. We need to educate more people about fybrimyalgia and how to be more supportive.

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