呼吸中枢与颈肩疼痛通路的神经交互：中枢与外周机制的整合作用综述

沈之栋; 刘俊杰

doi:10.70693/cjmsr.v1i3.1468

Authors

沈之栋沈阳医学院
刘俊杰哈尔滨体育学院

DOI:

https://doi.org/10.70693/cjmsr.v1i3.1468

Keywords:

呼吸中枢, 肩颈痛, 中枢机制, 外周机制, 疼痛调节

Abstract

慢性颈肩痛是临床高发且易反复的慢性痛综合征，常伴随呼吸功能异常，其疼痛迁延与呼吸 - 痛觉中枢 - 外周神经交互紊乱及生物 - 心理因素密切相关。本文围绕呼吸中枢与颈肩疼痛通路的中枢 - 外周神经交互机制展开综述，研究发现颈肩疼痛患者其延髓前博琴格复合体、喙腹内侧髓质、前扣带回皮层等中枢结构，会与颈肩痛觉传导通路、自主神经系统协同作用，共同维持呼吸节律稳定与痛觉调节平衡。当发生颈肩痛时，该神经交互系统会出现功能紊乱，具体表现为呼吸模式转向胸式为主、辅助呼吸肌过度激活，自主神经失衡，低碳酸血症引发颈部肌肉血管收缩缺血、呼吸肌疲劳诱发姿势代偿，进而形成 “呼吸紊乱 - 疼痛加剧” 的病理循环，焦虑等心理因素还会通过边缘系统进一步放大这一交互异常，部分患者还伴随大脑结构与功能重塑，且疼痛记忆会通过神经递质重塑机制形成，经疼痛预期、情绪应激影响呼吸 - 痛觉相关神经回路。未来需聚焦解析二者交互的特异性神经回路、建立 “呼吸 - 疼痛 - 心理” 多维评估模型，结合多模态神经评估制定个性化呼吸干预方案，为慢性颈肩痛精准防治提供支撑。

References

Popescu A, Lee H. Neck Pain and Lower Back Pain[J]. The Medical Clinics of North America, 2020, 104(2): 279-292.

Stephen S, Brandt C, Olivier B. Neck Pain and Disability: Are They Related to Dysfunctional Breathing and Stress?[J]. Physiotherapy Canada. Physiotherapie Canada, 2022, 74(2): 158-164.

Krohn F, Novello M, van der Giessen R S, et al. The integrated brain network that controls respiration[J]. eLife, 2023, 12: e83654.

Kahlaee A H, Ghamkhar L, Arab A M. The Association Between Neck Pain and Pulmonary Function: A Systematic Review[J]. American Journal of Physical Medicine & Rehabilitation, 2017, 96(3): 203-210.

Ashhad S, Kam K, Del Negro C A, et al. Breathing Rhythm and Pattern and Their Influence on Emotion[J]. Annual Review of Neuroscience, 2022, 45: 223-247.

De Preter C C, Heinricher M M. Direct and Indirect Nociceptive Input from the Trigeminal Dorsal Horn to Pain-Modulating Neurons in the Rostral Ventromedial Medulla[J]. The Journal of Neuroscience: The Official Journal of the Society for Neuroscience, 2023, 43(32): 5779-5791.

Chen Q, Heinricher M M. Plasticity in the Link between Pain-Transmitting and Pain-Modulating Systems in Acute and Persistent Inflammation[J]. The Journal of Neuroscience: The Official Journal of the Society for Neuroscience, 2019, 39(11): 2065-2079.

Sarmah N, Nauli A M, Ally A, et al. Interactions among Endothelial Nitric Oxide Synthase, Cardiovascular System, and Nociception during Physiological and Pathophysiological States[J]. Molecules (Basel, Switzerland), 2022, 27(9): 2835.

Liu S, Ye M, Pao G M, et al. Divergent brainstem opioidergic pathways that coordinate breathing with pain and emotions[J]. Neuron, 2022, 110(5): 857-873.e9.

López-de-Uralde-Villanueva I, Del Corral T, Salvador-Sánchez R, et al. Respiratory dysfunction in patients with chronic neck pain: systematic review and meta-analysis[J]. Disability and Rehabilitation, 2023, 45(15): 2422-2433.

Su N, Cai P, Dou Z, et al. Brain nuclei and neural circuits in neuropathic pain and brain modulation mechanisms of acupuncture: a review on animal-based experimental research[J]. Frontiers in Neuroscience, 2023, 17: 1243231.

Gu X, Zhang Y Z, O’Malley J J, et al. Neurons in the caudal ventrolateral medulla mediate descending pain control[J]. Nature Neuroscience, 2023, 26(4): 594-605.

Jhang J, Park S, Liu S, et al. A top-down slow breathing circuit that alleviates negative affect in mice[J]. Nature Neuroscience, 2024, 27(12): 2455-2465.

Juventin M, Ghibaudo V, Granget J, et al. Respiratory influence on brain dynamics: the preponderant role of the nasal pathway and deep slow regime[J]. Pflugers Archiv: European Journal of Physiology, 2023, 475(1): 23-35.

Folschweiller S, Sauer J F. Behavioral State-Dependent Modulation of Prefrontal Cortex Activity by Respiration[J]. The Journal of Neuroscience: The Official Journal of the Society for Neuroscience, 2023, 43(26): 4795-4807.

Harrison O K, Köchli L, Marino S, et al. Interoception of breathing and its relationship with anxiety[J]. Neuron, 2021, 109(24): 4080-4093.e8.

Homma I, Phillips A G. Critical roles for breathing in the genesis and modulation of emotional states[J]. Handbook of Clinical Neurology, 2022, 188: 151-178.

Ortego G, Villafañe J H, Doménech-García V, et al. Is there a relationship between psychological stress or anxiety and chronic nonspecific neck-arm pain in adults? A systematic review and meta-analysis[J]. Journal of Psychosomatic Research, 2016, 90: 70-81.

Jafari H, Gholamrezaei A, Franssen M, et al. Can Slow Deep Breathing Reduce Pain? An Experimental Study Exploring Mechanisms[J]. The Journal of Pain, 2020, 21(9-10): 1018-1030.

Anwar S, Arsalan A, Zafar H, et al. Effects of breathing reeducation on cervical and pulmonary outcomes in patients with non specific chronic neck pain: A double blind randomized controlled trial[J]. PLoS ONE, 2022, 17(8): e0273471.

Wehrwein E A, Orer H S, Barman S M. Overview of the Anatomy, Physiology, and Pharmacology of the Autonomic Nervous System[J]. Comprehensive Physiology, 2016, 6(3): 1239-1278.

Goudman L, De Smedt A, Louis F, et al. The Link Between Spinal Cord Stimulation and the Parasympathetic Nervous System in Patients With Failed Back Surgery Syndrome[J]. Neuromodulation: Journal of the International Neuromodulation Society, 2022, 25(1): 128-136.

Mikkonen J, Kupari S, Tarvainen M, et al. To what degree patient-reported symptoms of central sensitization, kinesiophobia, disability, sleep, and life quality associated with 24-h heart rate variability and actigraphy measurements?[J]. Pain Practice: The Official Journal of World Institute of Pain, 2024, 24(4): 609-619.

Arslan D, Ünal Çevik I. Interactions between the painful disorders and the autonomic nervous system[J]. Agri: Agri (Algoloji) Dernegi’nin Yayin Organidir = The Journal of the Turkish Society of Algology, 2022, 34(3): 155-165.

Bonaz B, Sinniger V, Pellissier S. Anti-inflammatory properties of the vagus nerve: potential therapeutic implications of vagus nerve stimulation[J]. The Journal of Physiology, 2016, 594(20): 5781-5790.

Tatsios P I, Grammatopoulou E, Dimitriadis Z, et al. The Effectiveness of Manual Therapy in the Cervical Spine and Diaphragm, in Combination with Breathing Reeducation Exercises, in Patients with Non-Specific Chronic Neck Pain: Protocol for Development of Outcome Measures and a Randomized Controlled Trial[J]. Diagnostics (Basel, Switzerland), 2022, 12(11): 2690.

Cheon J H, Lim N N, Lee G S, et al. Differences of Spinal Curvature, Thoracic Mobility, and Respiratory Strength Between Chronic Neck Pain Patients and People Without Cervical Pain[J]. Annals of Rehabilitation Medicine, 2020, 44(1): 58-68.

Tunç E, Atıcı E. Effects of neural mobilization on respiratory parameters, pain, range of motion, and neck awareness in patients with chronic neck pain: A randomized controlled trial[J]. Journal of Back and Musculoskeletal Rehabilitation, 2025, 38(4): 817-828.

López-de-Uralde-Villanueva I, Sollano-Vallez E, Del Corral T. Reduction of cervical and respiratory muscle strength in patients with chronic nonspecific neck pain and having moderate to severe disability[J]. Disability and Rehabilitation, 2018, 40(21): 2495-2504.

Batool S A, Shakil-ul-Rehman S, Tariq Z, et al. Effects of fasciatherapy versus fascial manipulation on pain, range of motion and function in patients with chronic neck pain[J]. BMC Musculoskeletal Disorders, 2023, 24: 789.

Rodríguez-Sanz J, Malo-Urriés M, Corral-de-Toro J, et al. Does the Addition of Manual Therapy Approach to a Cervical Exercise Program Improve Clinical Outcomes for Patients with Chronic Neck Pain in Short- and Mid-Term? A Randomized Controlled Trial[J]. International Journal of Environmental Research and Public Health, 2020, 17(18): 6601.

Dareh-Deh H R, Hadadnezhad M, Letafatkar A, et al. Therapeutic routine with respiratory exercises improves posture, muscle activity, and respiratory pattern of patients with neck pain: a randomized controlled trial[J]. Scientific Reports, 2022, 12(1): 4149.

Gherscovici E D, Mayer J M. Impact of Indoor Air Quality and Breathing on Back and Neck Pain: A Systematic Review[J]. Cureus, 2023, 15(8): e43945.

Nystrom N A, Daulat S R, Zakaria A, et al. Respiratory dysfunction in whiplash associated disorders (WAD) with cervical plexus syndrome - A case report[J]. Surgery in Practice and Science, 2025, 20: 100271.

Mutlu C, Birinci T, Senel A, et al. A multi-dimensional assessment of internet gaming disorder in children and adolescents: A case-control study[J]. Work (Reading, Mass.), 2024, 77(4): 1089-1099.

Chand null, Vaish H. Effect of diaphragmatic breathing, respiratory muscle stretch gymnastics and conventional physiotherapy on chest expansion, pulmonary function and pain in patients with mechanical neck pain: A single group pretest-posttest quasi-experimental pilot study[J]. Journal of Bodywork and Movement Therapies, 2023, 36: 148-152.

Tatsios P I, Grammatopoulou E, Dimitriadis Z, et al. The Effectiveness of Manual Therapy in the Cervical Spine and Diaphragm, in Combination with Breathing Re-Education Exercises, on the Range of Motion and Forward Head Posture in Patients with Non-Specific Chronic Neck Pain: A Randomized Controlled Trial[J]. Healthcare (Basel, Switzerland), 2025, 13(14): 1765.

Tsai C S, Li H T, Yang W L, et al. The effect of craniocervical flexion and neck endurance exercises plus pulmonary rehabilitation on pulmonary function in spinal cord injury: a pilot single-blinded randomised controlled trial[J]. Spinal Cord Series and Cases, 2024, 10(1): 27.

Cefalì A, Santini D, Lopez G, et al. Effects of Breathing Exercises on Neck Pain Management: A Systematic Review with Meta-Analysis[J]. Journal of Clinical Medicine, 2025, 14(3): 709.

Busch V, Magerl W, Kern U, et al. The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing--an experimental study[J]. Pain Medicine (Malden, Mass.), 2012, 13(2): 215-228.

Sakakibara M. Evaluation of Heart Rate Variability and Application of Heart Rate Variability Biofeedback: Toward Further Research on Slow-Paced Abdominal Breathing in Zen Meditation[J]. Applied Psychophysiology and Biofeedback, 2022, 47(4): 345-356.

Luo Q, Li X, Zhao J, et al. The effect of slow breathing in regulating anxiety[J]. Scientific Reports, 2025, 15(1): 8417.

Furdui A, da Silveira Scarpellini C, Montandon G. Anatomical distribution of µ-opioid receptors, neurokinin-1 receptors, and vesicular glutamate transporter 2 in the mouse brainstem respiratory network[J]. Journal of Neurophysiology, 2024, 132(1): 108-129.

Oliveira L M, Moreira T S, Takakura A C. Interaction between Kölliker-Fuse/A7 and the parafacial respiratory region on the control of respiratory regulation[J]. Respiratory Physiology & Neurobiology, 2024, 320: 104201.

Leyro T M, Versella M V, Yang M J, et al. Respiratory therapy for the treatment of anxiety: Meta-analytic review and regression[J]. Clinical Psychology Review, 2021, 84: 101980.

Rasmussen-Barr E, Halvorsen M, Bohman T, et al. Summarizing the effects of different exercise types in chronic neck pain - a systematic review and meta-analysis of systematic reviews[J]. BMC musculoskeletal disorders, 2023, 24(1): 806.

Mueller J, Weinig J, Niederer D, et al. Resistance, Motor Control, and Mindfulness-Based Exercises Are Effective for Treating Chronic Nonspecific Neck Pain: A Systematic Review With Meta-Analysis and Dose-Response Meta-Regression[J]. The Journal of Orthopaedic and Sports Physical Therapy, 2023, 53(8): 420-459.

Maccarone M C, Masiero S. Spa therapy interventions for post respiratory rehabilitation in COVID-19 subjects: does the review of recent evidence suggest a role?[J]. Environmental Science and Pollution Research International, 2021, 28(33): 46063-46066.

Hii E Y X, Kuo Y L, Cheng K C, et al. Ultrasonographic measurement indicated patients with chronic neck pain had reduced diaphragm thickness and mobility along with declined respiratory functions[J]. Musculoskeletal Science & Practice, 2024, 72: 102951.

Tatsios P I, Grammatopoulou E, Dimitriadis Z, et al. The Effectiveness of Spinal, Diaphragmatic, and Specific Stabilization Exercise Manual Therapy and Respiratory-Related Interventions in Patients with Chronic Nonspecific Neck Pain: Systematic Review and Meta-Analysis[J]. Diagnostics (Basel, Switzerland), 2022, 12(7): 1598.

Filippini D F L, Smit M R, Bos L D J. Subphenotypes in Acute Respiratory Distress Syndrome: Universal Steps Toward Treatable Traits[J]. Anesthesia and Analgesia, 2024.