慢性非特异性颈肩痛的病因与病理生理机制 研究进展

Advances in the Etiology and Pathophysiology Mechanism of Chronic Non-Specific Neck and Shoulder Pain

摘要: 慢性非特异性颈肩痛的发病机制涉及复杂的多因素交互作用。文章系统梳理了该领域的最新研究进展，包含4个方面：生物力学方面，颈椎小关节功能障碍、肌筋膜触发点形成及椎间盘退变通过异常张力分布和炎症反应诱发疼痛；中枢调节异常表现为脊髓水平的中枢敏化、下行抑制通路功能减弱及痛觉调制异常；社会心理因素如工作压力、焦虑抑郁状态导致疾病恶化与慢性化；组学揭示遗传变异、表观遗传调控及代谢紊乱等生物标志物。因此提出慢性颈肩痛需多学科整合管理，包括生物力学矫正、中枢调控干预、心理认知行为疗法。而基于组学生物标志物的研究，则为精准分型和制定治疗方案指出新的方向，未来研究可聚焦于多学科数据的临床转化，通过机器学习构建预测模型，形成多维诊疗体系及全科转化路径。

Abstract: The pathogenesis of chronic non-specific neck and shoulder pain (CNSNSP) involves complex multifactorial interactions. This review systematically summarizes recent advances in this field from four perspectives: biomechanical factors, such as cervical facet joint dysfunction, myofascial trigger points formation and cervical disc degeneration, which contribute to pain through aberrant tension distribution and inflammatory responses; central regulatory abnormalities, including central sensitization at the spinal level, weakened descending inhibitory pathways, and abnormal pain modulation; psychosocial factors, such as work-related stress, anxiety and depression, which promote disease progression and chronicity; and omics-based findings, which reveal potential biomarkers including genetic variants, epigenetic regulation, and metabolic disorders. Consequently, the management of CNSP necessitates an integrated multidisciplinary approach encompassing biomechanical correction, central modulation interventions, and cognitive behavioral therapy. Omics biomarkers also offer novel directions for precise subtyping and treatment planning. Future research should focus on translating multidisciplinary data into clinical practice, building predictive models via machine learning, and establishing a multidimensional diagnostic and therapeutic framework and a generalist care pathway.