Bouisset Nicolas, Phylactou Phivos, Duport Arnaud
Human Threshold Research Group, Lawson Research Institute, London, ON, Canada.
Vestibular Lab, Lawson Research Institute, London, ON, Canada.
Front Neurosci. 2025 Sep 3;19:1661515. doi: 10.3389/fnins.2025.1661515. eCollection 2025.
Musculoskeletal pain is increasingly understood as a product of disrupted multisensory integration rather than a direct consequence of tissue damage alone. Among the sensory systems involved in shaping body representation and modulating pain, the vestibular system remains largely overlooked. Beyond its classical role in balance and spatial orientation, vestibular input contributes to embodiment, self-location, and bodily self-consciousness-processes that are frequently altered in chronic pain conditions. Neuroimaging and clinical evidence reveal a striking overlap between vestibular integration regions and the so-called pain neuromatrix, suggesting shared cortical substrates for vestibular and nociceptive/pain processing. Moreover, vestibular dysfunction is associated with disembodiment phenomena such as depersonalization and derealization, which mirror sensory distortions observed in chronic pain syndromes. Experimental studies demonstrate that vestibular stimulation-via caloric or electric modalities-can modulate pain perception, influence somatosensory integration, and recalibrate distorted body representations. This perspective paper synthesizes current findings at the intersection of vestibular neuroscience, pain modulation, and embodiment, proposing that the vestibular system could constitute a critical but underrecognized component in musculoskeletal health. Incorporating vestibular pathways into pain models may, therefore, improve our understanding of chronicity and open novel therapeutic avenues for neuromodulation.
肌肉骨骼疼痛越来越被认为是多感官整合失调的产物，而不仅仅是组织损伤的直接后果。在参与塑造身体表征和调节疼痛的感觉系统中，前庭系统在很大程度上仍被忽视。除了其在平衡和空间定向方面的经典作用外，前庭输入还有助于身体体现、自我定位和身体自我意识，而这些过程在慢性疼痛状态下经常会发生改变。神经影像学和临床证据显示，前庭整合区域与所谓的疼痛神经矩阵之间存在显著重叠，这表明前庭和伤害感受/疼痛处理具有共同的皮质基质。此外，前庭功能障碍与人格解体和现实解体等脱离身体的现象有关，这些现象反映了在慢性疼痛综合征中观察到的感觉扭曲。实验研究表明，通过热或电方式进行的前庭刺激可以调节疼痛感知、影响体感整合，并重新校准扭曲的身体表征。这篇观点论文综合了前庭神经科学、疼痛调节和身体体现交叉领域的当前研究结果，提出前庭系统可能是肌肉骨骼健康中一个关键但未得到充分认识的组成部分。因此，将前庭通路纳入疼痛模型可能会增进我们对慢性疼痛的理解，并为神经调节开辟新的治疗途径。
