Latest Advances in Central Analgesic Mechanism of Osteopathic Manipulative Treatment for Cervical Spondylosis

doi:10.12114/j.issn.1007-9572.2022.0427

Chinese General Practice ›› 2023, Vol. 26 ›› Issue (02): 225-232.DOI: 10.12114/j.issn.1007-9572.2022.0427

• TCM Research·Technique Development • Previous Articles Next Articles

Latest Advances in Central Analgesic Mechanism of Osteopathic Manipulative Treatment for Cervical Spondylosis

¹Wangjing Hospital of CACMS, Beijing 100102, China
²Beijing Institute of Integrative Chinese and Western Medicine Traumatology and Orthopaedics, Beijing 100700, China
³Second Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300250, China
⁴Shandong Pharmaceutical Biotechnology Research Center, Ji'nan 250062, China

Received:2022-06-20 Revised:2022-06-28 Published:2023-01-15 Online:2022-08-05
Contact: WEI Xu
About author:
JIN Z K, WANG X, SUN K. Latest advances in central analgesic mechanism of osteopathic manipulative treatment for cervical spondylosis [J] . Chinese General Practice, 2023, 26 (2) : 225-232.

手法治疗颈椎病中枢镇痛机制研究进展

¹100102　北京市，中国中医科学院望京医院
²100700　北京市，中西医结合骨伤研究所
³300250　天津市，天津中医药大学第二附属医院
⁴250062　山东省济南市，医药生物技术研究中心

通讯作者: 魏戌
作者简介:
金子开，王旭，孙凯，等.手法治疗颈椎病中枢镇痛机制研究进展[J].中国全科医学，2023，26（2）：225-232.[www.chinagp.net] 作者贡献：金子开、朱立国、魏戌提出论文的构思与设计；金子开负责文献及资料的整理，并撰写论文初稿；王旭负责检索和汇总文献及资料；孙凯、王艳国、师彬、罗杰负责对初稿进行修订；朱立国、魏戌负责论文的质量控制及审校，对论文整体负责。
基金资助:
国家级非物质文化遗产代表性项目(160202013000190004); 国家中医药管理局传承创新团队项目(ZYYCXTD-C-202003); 北京市科技新星计划(Z191100001119025); 中国中医科学院中国中医科学院优秀青年科技人才（创新类）培养专项计划(ZZ13-YQ-039)

Abstract

Abstract:

Osteopathic manipulative treatment (OMT) is a popular treatment for cervical spondylosis, a common degenerative disease of the spine. It has proven to be effective in relieving the pain from cervical spondylosis, but the mechanism is not clear. The development of neuroimaging has made it possible to perform visualization analyses of the cerebral structure and function in patients with cervical spondylosis, made the theory of somatosensory cortical remodeling proposed from the central perspective a new hot spot in the research on pathogenesis of cervical spondylosis, and the exploration of different manipulation treatments for cervical spondylosis based on the central effect a new direction of research on OMT. We reviewed the latest advances in central analgesic mechanisms of OMT for cervical spondylosis, mainly involving modulating the activity of brain regions, changing the default mode network, and regulating sympathetic nerve function, and summarized that OMT may improve pain via the following paths: enhancing central gating and modulating sensory-motor integration processes, or enhancing the strength of connections between sensory cortex and prefrontal cortex (an important structure for performing executive functions) in the default mode network, accelerating local neural remodelling and weakening white matter fibre connections between negative memory and emotion-related areas, or modulating sympathetic function and restoring brain mechanisms in inhibiting pain and central sensitisation for analgesic effects. The brain regions, functional brain networks and various biomarkers and observable indicators related to pain activation summarised in this study provide directions for future research. Future applied and basic research is recommended to adopt a step-by-step design, pay attention to the diversity of the research population, use the multi-point observation technique to assess the mechanism of efficacy, and enrich the scientific essentials of OMT.

Key words: Cervical spondylosis, Neck pain, Musculoskeletal manipulations, Manipulation, spinal, Central nervous system, Analgesia, Review

摘要：

颈椎病是常见的脊柱退行性疾病，手法治疗是治疗颈椎病的临床常用方法之一，有研究表明手法治疗在改善颈椎病患者疼痛方面疗效显著，但其具体机制尚不明确。随着神经影像学的发展，临床对颈椎病患者脑结构及脑功能的可视化分析成为可能，从中枢角度提出的体感重塑学说成为研究颈椎病发病机制的新热点，基于中枢效应探究不同类型手法治疗颈椎病是手法研究的新方向。本文从调控大脑区域活动、改变默认模式网络、调节交感神经功能三方面阐述不同类型手法治疗颈椎病的中枢镇痛机制，发现手法治疗可通过加强中枢门控作用调节感觉运动整合过程的方式；或通过增强默认模式网络中感觉皮质和执行功能皮质的连接强度加快局部神经重塑，进而减弱负性记忆、情绪相关区域之间的白质纤维连接的方式；或通过调节交感神经功能，恢复脑疼痛抑制机制和中枢敏化作用的方式来达到镇痛效果。本研究总结的疼痛激活相关脑区、脑功能网络及各种生物标志物与观察指标为今后研究提供方向。未来应用基础研究应循序渐进设计研究方案，注重研究人群的广泛性，多时点观测手法疗效机制，进一步丰富手法的科学内涵。

关键词: 颈椎病, 颈部疼痛, 肌肉骨骼手法, 推拿，脊柱, 中枢神经系统, 镇痛, 综述

JIN Zikai,WANG Xu,SUN Kai, et al. Latest Advances in Central Analgesic Mechanism of Osteopathic Manipulative Treatment for Cervical Spondylosis[J]. Chinese General Practice, 2023, 26(02): 225-232. DOI: 10.12114/j.issn.1007-9572.2022.0427.
金子开,王旭,孙凯等. 手法治疗颈椎病中枢镇痛机制研究进展[J]. 中国全科医学, 2023, 26(02): 225-232. DOI: 10.12114/j.issn.1007-9572.2022.0427.

Figures/Tables 4

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发表年份（年）	第一作者	涉及区域	检测方法	具体改变
2021	WANG^[9]	大脑白质	DSI	整个大脑的广义各向异性较低，胼胝体和辐射冠QA增加
2019	DE PAUW^[12]	楔前叶、前扣带回、顶上回、颞上回、中央前回	VBM、SBM	存在左顶上回和楔前叶灰质体积选择性增加，中央前回和颞上回灰质体积选择性减少
2015	TAN^[29]	左侧初级感觉运动皮质、右侧感觉关联皮质	RS-fMRI	左侧初级感觉和运动皮质中Reho显著较低，右侧感觉关联皮质中Reho较高；术后3个月，左侧PostG/PreG Reho增加
2015	张华^[32]	扣带前回，顶下回、楔前叶、岛叶、顶上回、中央前回，额叶执行功能区域	独立成分分析、SVM算法	DMN本身主要区域、运动感觉区、额叶执行功能区域的DMN连接增强
2014	ZHOU^[30]	感觉运动皮质	RS-fMRI	右侧中央前回、右侧中央后回和左侧补充运动区皮质低频振荡振幅（ALFF/LFO）增加
2013	SPARKS^[13]	小脑、杏仁核、丘脑、岛叶、中央前回	血氧水平依赖性功能磁共振成像	左右小脑、杏仁核、丘脑、中脑导水管周围灰质、岛叶皮质、前扣带皮质、体感皮质、辅助运动区和运动前区显著激活

发表年份（年）	第一作者	涉及区域	检测方法	具体改变
2021	WANG^[9]	大脑白质	DSI	整个大脑的广义各向异性较低，胼胝体和辐射冠QA增加
2019	DE PAUW^[12]	楔前叶、前扣带回、顶上回、颞上回、中央前回	VBM、SBM	存在左顶上回和楔前叶灰质体积选择性增加，中央前回和颞上回灰质体积选择性减少
2015	TAN^[29]	左侧初级感觉运动皮质、右侧感觉关联皮质	RS-fMRI	左侧初级感觉和运动皮质中Reho显著较低，右侧感觉关联皮质中Reho较高；术后3个月，左侧PostG/PreG Reho增加
2015	张华^[32]	扣带前回，顶下回、楔前叶、岛叶、顶上回、中央前回，额叶执行功能区域	独立成分分析、SVM算法	DMN本身主要区域、运动感觉区、额叶执行功能区域的DMN连接增强
2014	ZHOU^[30]	感觉运动皮质	RS-fMRI	右侧中央前回、右侧中央后回和左侧补充运动区皮质低频振荡振幅（ALFF/LFO）增加
2013	SPARKS^[13]	小脑、杏仁核、丘脑、岛叶、中央前回	血氧水平依赖性功能磁共振成像	左右小脑、杏仁核、丘脑、中脑导水管周围灰质、岛叶皮质、前扣带皮质、体感皮质、辅助运动区和运动前区显著激活

发表年份（年）	第一作者	观察指标及生物标志物	主要区域	手法机制	手法类型
2021	刘钰^[35]	FA	大脑左侧扣带海马束	促进局部神经的形成与重塑，调节脑功能网络连接，且能减弱负性记忆及情绪相关区域白质纤维连接，从而改善疼痛及相关不良记忆与情绪	软组织放松手法联合关节松动手法
2019	WEBER^[18]	NPS	次级体感皮质、前扣带皮质、枕叶复合体	改变处理身体疼痛的特定脑区内与疼痛有关的大脑活动	关节松动手法
2017	HAAVIK^[21]	SEP	中央后回	加强中枢对过度感觉信息的门控作用，调节感觉运动整合过程	关节松动手法
2015	张华^[32]	DMN	左中央后回，右侧顶上、下回、右侧额中回	增强中枢水平DMN中感觉皮质和执行功能皮质的连接强度	软组织放松手法
2013	SPARKS^[13]	BOLD	小脑、杏仁核、丘脑、岛叶、中央前回	降低疼痛基质相关区域脑血流量，并减少岛叶皮质的激活	关节松动手法
2013	JULIAN^[28]	CBI	小脑	通过减轻小脑抑制运动皮质的程度，保持小脑正常运动整合、输出过程	关节松动手法
2011	OGURA^[47]	FDG	小脑蚓部后端、前扣带皮质	激活前扣带皮质，提高葡萄糖代谢，调节交感神经活动恢复脑疼痛抑制机制和中枢敏化作用	关节松动手法

发表年份（年）	第一作者	观察指标及生物标志物	主要区域	手法机制	手法类型
2021	刘钰^[35]	FA	大脑左侧扣带海马束	促进局部神经的形成与重塑，调节脑功能网络连接，且能减弱负性记忆及情绪相关区域白质纤维连接，从而改善疼痛及相关不良记忆与情绪	软组织放松手法联合关节松动手法
2019	WEBER^[18]	NPS	次级体感皮质、前扣带皮质、枕叶复合体	改变处理身体疼痛的特定脑区内与疼痛有关的大脑活动	关节松动手法
2017	HAAVIK^[21]	SEP	中央后回	加强中枢对过度感觉信息的门控作用，调节感觉运动整合过程	关节松动手法
2015	张华^[32]	DMN	左中央后回，右侧顶上、下回、右侧额中回	增强中枢水平DMN中感觉皮质和执行功能皮质的连接强度	软组织放松手法
2013	SPARKS^[13]	BOLD	小脑、杏仁核、丘脑、岛叶、中央前回	降低疼痛基质相关区域脑血流量，并减少岛叶皮质的激活	关节松动手法
2013	JULIAN^[28]	CBI	小脑	通过减轻小脑抑制运动皮质的程度，保持小脑正常运动整合、输出过程	关节松动手法
2011	OGURA^[47]	FDG	小脑蚓部后端、前扣带皮质	激活前扣带皮质，提高葡萄糖代谢，调节交感神经活动恢复脑疼痛抑制机制和中枢敏化作用	关节松动手法

Latest Advances in Central Analgesic Mechanism of Osteopathic Manipulative Treatment for Cervical Spondylosis

手法治疗颈椎病中枢镇痛机制研究进展

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