腰痛患者视觉-姿势控制的神经可塑性变化：从急性到慢性阶段的动态机制综述

蓥皓 沈; 丽 李; 壮壮 苗; 鹏飞 程; 俊杰 刘

doi:10.70693/cjmsr.v1i2.1226

Authors

蓥皓沈哈尔滨体育学院研究生院
丽李哈尔滨体育学院运动人体科学学院
壮壮苗哈尔滨体育学院研究生院
鹏飞程哈尔滨体育学院研究生院
俊杰刘哈尔滨体育学院研究生院

DOI:

https://doi.org/10.70693/cjmsr.v1i2.1226

Keywords:

腰背痛、视觉姿势控制、神经可塑性、急性疼痛、慢性疼痛、动态机制

Abstract

腰背痛是高发的肌肉骨骼疾病，约 20% 急性患者可进展为慢性，其急慢转变涉及神经可塑性、心理及生物因素的复杂作用。本文围绕腰痛患者视觉 - 姿势控制的神经可塑性动态变化展开综述。研究发现，健康人群通过前庭、视觉、本体感觉系统的神经整合维持姿势，而腰痛状态下该系统的神经可塑性呈现阶段特异性：急性阶段以保护性适应为特征，表现为视觉依赖性增强及运动皮层快速重组；亚急性期出现中枢敏化早期迹象，视觉 - 姿势控制策略适应性调整，依赖视觉补偿本体感觉缺陷；慢性阶段则伴随大脑结构（如前额叶皮层灰质减少）与功能（如默认模式网络连接异常）重塑，视觉 - 姿势控制持续异常并形成恶性循环。同时，疼痛记忆通过长时程增强、表观遗传修饰等机制形成，经条件性恐惧、疼痛预期影响视觉 - 姿势控制相关神经回路。研究表明，生物 - 心理 - 社会因素共同驱动这一动态过程，未来需结合纵向追踪与多模式评估，制定个性化干预以阻断慢性化进程，为临床治疗提供理论依据。

References

[1] BALAGUÉ F, MANNION A F, PELLISÉ F, et al. Non-specific low back pain[J]. Lancet (London, England), 2012, 379(9814): 482-491.

[2] SIGMUNDSSON F G, JOELSON A, STRÖMQVIST F. Patients with no preoperative back pain have the best outcome after lumbar disc herniation surgery[J]. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2022, 31(2): 408-413.

[3] MOHAMMADI M, GHAMKHAR L, ALIZADEH A, et al. Comparison of the reliance of the postural control system on the visual, vestibular and proprioceptive inputs in chronic low back pain patients and asymptomatic participants[J]. Gait & Posture, 2021, 85: 266-272.

[4] YANG J, LO W L A, ZHENG F, et al. Evaluation of Cognitive Behavioral Therapy on Improving Pain, Fear Avoidance, and Self-Efficacy in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis[J]. Pain Research & Management, 2022, 2022: 4276175.

[5] KNEZEVIC N N, CANDIDO K D, VLAEYEN J W S, et al. Low back pain[J]. Lancet (London, England), 2021, 398(10294): 78-92.

[6] ALIZADEH A, JAFARPISHEH A S, MOHAMMADI M, et al. Visual, Vestibular, and Proprioceptive Dependency of the Control of Posture in Chronic Neck Pain Patients[J]. Motor Control, 2022, 26(3): 362-377.

[7] YAGI C, MORITA Y, YAMAGISHI T, et al. Changes in functional connectivity among vestibulo-visuo-somatosensory and spatial cognitive cortical areas in persistent postural-perceptual dizziness: resting-state fMRI studies before and after visual stimulation[J]. Frontiers in Neurology, 2023, 14: 1215004.

[8] ZHANG C, ZHANG Z, LI Y, et al. Alterations in functional connectivity in patients with non-specific chronic low back pain after motor control exercise: a randomized trial[J]. European Journal of Physical and Rehabilitation Medicine, 2024, 60(2): 319-330.

[9] SUNG P, LEE D. Visual dependence, postural stability during repeated unilateral standing tasks, and quality of life in adults with chronic low back pain[J]. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2025.

[10] PARK J, NGUYEN V Q, HO R L M, et al. The effect of chronic low back pain on postural control during quiet standing: A meta-analysis[J]. Scientific Reports, 2023, 13(1): 7928.

[11] CHENG X, YANG J, HAO Z, et al. The effects of proprioceptive weighting changes on posture control in patients with chronic low back pain: a cross-sectional study[J]. Frontiers in Neurology, 2023, 14: 1144900.

[12] VAN DEN HOORN W, MERONI R, KLYNE D M, et al. Balance control in unstable sitting in individuals with an acute episode of low back pain[J]. Gait & Posture, 2022, 95: 15-21.

[13] BRUMAGNE S, DIERS M, DANNEELS L, et al. Neuroplasticity of Sensorimotor Control in Low Back Pain[J]. The Journal of Orthopaedic and Sports Physical Therapy, 2019, 49(6): 402-414.

[14] Treating Acute and Chronic Low Back Pain[J]. The Journal of Orthopaedic and Sports Physical Therapy, 2021, 51(12): 628.

[15] SEE Q Y, TAN J N B, KUMAR D S. Acute low back pain: diagnosis and management[J]. Singapore Medical Journal, 2021, 62(6): 271-275.

[16] VAN DEN HOORN W, HODGES P W, VAN DIEËN J H, et al. Effect of acute noxious stimulation to the leg or back on muscle synergies during walking[J]. Journal of Neurophysiology, 2015, 113(1): 244-254.

[17] ML M, A V, P S. Low Back Pain: The Potential Contribution of Supraspinal Motor Control and Proprioception[J]. The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry, 2019, 25(6).

[18] KNOX M F, CHIPCHASE L S, SCHABRUN S M, et al. Anticipatory and compensatory postural adjustments in people with low back pain: a protocol for a systematic review and meta-analysis[J]. Systematic Reviews, 2016, 5: 62.

[19] CURATOLO M. Is central sensitization relevant in acute low back pain?[J]. European Journal of Pain (London, England), 2023, 27(4): 457-458.

[20] VAN DEN BERG R, JONGBLOED E M, DE SCHEPPER E I T, et al. The association between pro-inflammatory biomarkers and nonspecific low back pain: a systematic review[J]. The Spine Journal: Official Journal of the North American Spine Society, 2018, 18(11): 2140-2151.

[21] LI H, SONG Q, ZHANG R, et al. Enhanced Temporal Coupling between Thalamus and Dorsolateral Prefrontal Cortex Mediates Chronic Low Back Pain and Depression[J]. Neural Plasticity, 2021, 2021: 7498714.

[22] KLYNE D M, MOSELEY G L, STERLING M, et al. Are Signs of Central Sensitization in Acute Low Back Pain a Precursor to Poor Outcome?[J]. The Journal of Pain, 2019, 20(8): 994-1009.

[23] ITO T, SAKAI Y, MORITA Y, et al. Proprioceptive Weighting Ratio for Balance Control in Static Standing Is Reduced in Elderly Patients With Non-Specific Low Back Pain[J]. Spine, 2018, 43(24): 1704-1709.

[24] ALSHEHRI M A, ALZAHRANI H, VAN DEN HOORN W, et al. Trunk postural control during unstable sitting among individuals with and without low back pain: A systematic review with an individual participant data meta-analysis[J]. PloS One, 2024, 19(1): e0296968.

[25] SUNG W, ABRAHAM M, PLASTARAS C, et al. Trunk motor control deficits in acute and subacute low back pain are not associated with pain or fear of movement[J]. The Spine Journal: Official Journal of the North American Spine Society, 2015, 15(8): 1772-1782.

[26] SOYSAL TOMRUK M, TOMRUK M, KALEMCI O. Comparisons of postural control, proprioception, muscle strength, pain and disability between individuals with acute, subacute and chronic low back pain[J]. Somatosensory & Motor Research, 2024, 41(1): 26-33.

[27] LI X, MENG F, HUANG W, et al. The Alterations in the Brain Corresponding to Low Back Pain: Recent Insights and Advances[J]. Neural Plasticity, 2024, 2024: 5599046.

[28] KIM J, MAWLA I, KONG J, et al. Somatotopically specific primary somatosensory connectivity to salience and default mode networks encodes clinical pain[J]. Pain, 2019, 160(7): 1594-1605.

[29] VAN ETTINGER-VEENSTRA H, LUNDBERG P, ALFÖLDI P, et al. Chronic widespread pain patients show disrupted cortical connectivity in default mode and salience networks, modulated by pain sensitivity[J]. Journal of Pain Research, 2019, 12: 1743-1755.

[30] WANG H, ZHENG J, FAN Z, et al. Impaired static postural control correlates to the contraction ability of trunk muscle in young adults with chronic non-specific low back pain: A cross-sectional study[J]. Gait & Posture, 2022, 92: 44-50.

[31] SUNG P S, LEE D. Effects of Visual Input on Postural Stability and Compensatory Strategies in Adults with Chronic Low Back Pain[J]. Vision (Basel, Switzerland), 2025, 9(1): 14.

[32] SUNG P S, LEE D. A study on the effects of visual condition on postural stability in adults with and without chronic low back pain[J]. Journal of Biomechanics, 2024, 171: 112193.

[33] ZHENG D K Y, LIU J Q J, CHANG J R, et al. Are changes in pain intensity related to changes in balance control in individuals with chronic non-specific low back pain? A systematic review and meta-analysis[J]. Journal of Sport and Health Science, 2024, 14: 100989.

[34] VEINOT J, CANE D, HASHMI J A. Low working memory underpins the association between aberrant functional properties of pain modulation circuitry and chronic back pain severity[J]. The Journal of Pain, 2025, 28: 104795.

[35] WAUTERS A, NOEL M, VAN RYCKEGHEM D M L, et al. The Moderating Role of Attention Control in the Relationship Between Pain Catastrophizing and Negatively-Biased Pain Memories in Youth With Chronic Pain[J]. The Journal of Pain, 2021, 22(10): 1303-1314.

[36] NIMBLEY E, CAES L, NOEL M, et al. Distress and Resilience Narratives within Pain Memories of Adolescents and Young Adults with Complex Regional Pain Syndrome: A Multi-Method Study[J]. The Journal of Pain, 2023, 24(7): 1275-1287.

[37] SUN J, ZHANG C, WANG Y, et al. Electroacupuncture Alleviates Hyperalgesia and Anxiety-Like Behaviors in Pain Memory Model Rats Through Activation of GABAergic Neurons and GABA Receptor in the Rostral Anterior Cingulate Cortex[J]. Molecular Neurobiology, 2024, 61(9): 6613-6627.

[38] XU Y, ZHU X, CHEN Y, et al. Electroacupuncture alleviates mechanical allodynia and anxiety-like behaviors induced by chronic neuropathic pain via regulating rostral anterior cingulate cortex-dorsal raphe nucleus neural circuit[J]. CNS neuroscience & therapeutics, 2023, 29(12): 4043-4058.

[39] XIE M, HU Y, JI M, et al. Electroacupuncture alleviates the relapse of behaviors associated with pain sensory memory and pain-related aversive memory by activating MORs and inhibiting GABAergic neurons in the insular cortex[J]. Brain Research Bulletin, 2025, 227: 111394.

[40] SCHUMACHER M A. Peripheral Neuroinflammation and Pain: How Acute Pain Becomes Chronic[J]. Current Neuropharmacology, 2024, 22(1): 6-14.

[41] TORRADO-CARVAJAL A, TOSCHI N, ALBRECHT D S, et al. Thalamic neuroinflammation as a reproducible and discriminating signature for chronic low back pain[J]. Pain, 2021, 162(4): 1241-1249.

[42] MORRISSEY E J, ALSHELH Z, KNIGHT P C, et al. Assessing the potential anti-neuroinflammatory effect of minocycline in chronic low back pain: Protocol for a randomized, double-blind, placebo-controlled trial[J]. Contemporary Clinical Trials, 2023, 126: 107087.

[43] CROMBEZ G, VERVAET L, BAEYENS F, et al. Do pain expectancies cause pain in chronic low back patients? A clinical investigation[J]. Behaviour Research and Therapy, 1996, 34(11-12): 919-925.

[44] BUCHMANN J, BAUMANN N, MENG K, et al. Endurance and avoidance response patterns in pain patients: Application of action control theory in pain research[J]. PloS One, 2021, 16(3): e0248875.

[45] HEDAYATI R, KAHRIZI S, PARNIANPOUR M, et al. The study of the variability of anticipatory postural adjustments in patients with recurrent non-specific low back pain[J]. Journal of Back and Musculoskeletal Rehabilitation, 2014, 27(1): 33-40.

[46] VAN WESEMAEL S, BOGAERTS K, DE BAETS L, et al. The association between pain-related psychological variables and postural control in low back pain: A systematic review and meta-analysis[J]. Gait & Posture, 2024, 107: 253-268.

[47] MATHEVE T, JANSSENS L, GOOSSENS N, et al. The Relationship Between Pain-Related Psychological Factors and Maximal Physical Performance in Low Back Pain: A Systematic Review and Meta-Analysis[J]. The Journal of Pain, 2022, 23(12): 2036-2051.

[48] ELLINGSEN D M, NAPADOW V, PROTSENKO E, et al. Brain Mechanisms of Anticipated Painful Movements and Their Modulation by Manual Therapy in Chronic Low Back Pain[J]. The Journal of Pain, 2018, 19(11): 1352-1365.

[49] BARKE A, PREIS M A, SCHMIDT-SAMOA C, et al. Neural Correlates Differ in High and Low Fear-Avoidant Chronic Low Back Pain Patients When Imagining Back-Straining Movements[J]. The Journal of Pain, 2016, 17(8): 930-943.

[50] HU P, JIANG Z, MA S, et al. Sarcopenia in older adults is associated with static postural control, fear of falling and fall risk: A study of Romberg test[J]. Gait & Posture, 2024, 112: 147-153.

[51] HAZRA S, HANDA G, NAYAK P, et al. A Dysfunctional Descending Pain Modulation System in Chronic Nonspecific Low Back Pain: A Systematic Review and ALE Meta-Analysis[J]. Neurology India, 2022, 70(4): 1344-1360.

腰痛患者视觉-姿势控制的神经可塑性变化：从急性到慢性阶段的动态机制综述

Authors

DOI:

Keywords:

Abstract

References

Downloads

Published

How to Cite

Issue

Section

License

1

2