J Orthop Sports Phys Ther. 2019 Jun;49(6):389-401. doi: 10.2519/jospt.2019.8716.
Pain is complex. It is no longer acceptable to consider pain solely as a peripheral phenomenon involving activation of nociceptive neurons. The contemporary understanding of pain involves consideration of different underlying pain mechanisms and an increasing awareness of plasticity in all of the biological systems. Of note, recent advances in technology and understanding have highlighted the critical importance of neuroimmune interactions, both in the peripheral and central nervous systems, and the interaction between the nervous system and body tissues in the development and maintenance of pain, including low back pain (LBP). Further, the biology of many tissues changes when challenged by pain and injury, as reported in a growing body of literature on the biology of muscle, fat, and connective tissue. These advances in understanding of the complexity of LBP have implications for our understanding of pain and its interaction with the motor system, and may change how we consider motor control in the rehabilitation of LBP. This commentary provides a state-of-the-art overview of plasticity of biology in LBP. The paper is divided into 4 parts that address (1) biology of pain mechanisms, (2) neuroimmune interaction in the central nervous system, (3) neuroimmune interaction in the periphery, and (4) brain and peripheral tissue interaction. Each section considers the implications for clinical management of LBP. .
疼痛是复杂的。不再仅仅将疼痛视为涉及伤害性神经元激活的外周现象。目前对疼痛的理解包括对不同潜在疼痛机制的考虑，以及对所有生物系统可塑性的日益认识。值得注意的是，技术和认识的最新进展强调了神经免疫相互作用的关键重要性，无论是在周围神经系统还是中枢神经系统，以及神经系统与身体组织在疼痛的发展和维持中的相互作用，包括下腰痛 (LBP)。此外，正如关于肌肉、脂肪和结缔组织生物学的大量文献所报道的那样，许多组织的生物学在受到疼痛和损伤的挑战时会发生变化。对 LBP 复杂性的这些理解上的进展对我们理解疼痛及其与运动系统的相互作用具有启示意义，并可能改变我们在 LBP 康复中考虑运动控制的方式。本评论提供了 LBP 生物学可塑性的最新概述。本文分为 4 个部分，分别涉及（1）疼痛机制的生物学，（2）中枢神经系统中的神经免疫相互作用，（3）外周的神经免疫相互作用，以及（4）大脑和外周组织的相互作用。每个部分都考虑了对 LBP 临床管理的影响。
