Substance P plays an important role in the transmission of pain-related information in the dorsal horn of the spinal cord. Recent immunocytochemical studies have shown a mismatch between the distribution of substance P and its receptor in the superficial laminae of the dorsal horn. Because such a mismatch was not observed by using classical radioligand binding studies, we decided to investigate further the issue of the relationship between substance P and its receptor by using an antibody raised against a portion of the carboxyl terminal of the neurokinin 1 receptor and a bispecific monoclonal antibodies against substance P and horseradish peroxidase. Light microscopy revealed a good correlation between the distributions of substance P and the neurokinin 1 receptor, both being localized with highest densities in lamina I and outer lamina II of the spinal dorsal horn. An ultrastructural double-labeling study, combining preembedding immunogold with enzyme-based immunocytochemistry, showed that most neurokinin 1 receptor immunoreactive dendrites were apposed by substance P containing boutons. A detailed quantitative analysis revealed that neurokinin 1 receptor immunoreactive dendrites received more appositions and synapses from substance P immunoreactive terminals than those not expressing the neurokinin 1 receptor. Such preferential innervation by substance P occurred in all superficial dorsal horn laminae even though neurokinin 1 receptor immunoreactive dendrites were a minority of the total number of dendritic profiles in the above laminae. These results suggest that, contrary to the belief that neuropeptides act in a diffuse manner at a considerable distance from their sites of release, substance P should act on profiles expressing the neurokinin 1 receptor at a short distance from its site of release.Substance P (SP) is a neuropeptide prominently expressed in small sensory primary afferents that is involved in the modulation of pain-related information in the spinal dorsal horn (1, 2). The central terminations of SP-containing primary sensory afferents occur mainly in laminae I and II (3, 4). There is abundant evidence supporting the notion that SP acts preferentially on the neurokinin 1 receptor (NK-1r) (5). The distribution of the NK-1r in the spinal cord has been studied extensively by using radioactive ligand binding and, more recently, immunocytochemistry. The former approach has shown a close match between the distribution of SP immunoreactivity and NK-1r binding sites in the superficial laminae of the dorsal horn (6, 7). In contrast, studies using two different antibodies against the NK-1r have shown a conspicuous lack of NK-1r immunostaining in lamina II (8-10), an area that is abundantly innervated by SP. Therefore, these results using immunocytochemistry do not favor a direct synaptic association between SP-containing afferents and neurons expressing the NK-1r. A confocal microscopic study adds to the controversy by showing that NK-1r immunoreactive neurons with cell bodies in laminae III-IV ...