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Research advances on the neurological mechanisms of chronic neck pain: Focusing on neuroimaging evidence of acute-to-chronic transition
LI Jinghu  ZHANG Shuaipan  ZHOU Xin  KONG Lingjun  ZHU Qingguang  REN Jun  JIN Ming  MA Ying  WANG Shoujian  FANG Min 

DOI:10.12015/issn.1674-8034.2025.12.024.


[Abstract] The understanding of the pathophysiological mechanisms underlying chronic neck pain has undergone profound evolution, shifting from traditional models centered on peripheral tissue injury toward a systemic theoretical framework emphasizing adaptive remodeling within the central nervous system. Multimodal MRI studies consistently demonstrate that patients with chronic neck pain exhibit extensive and systemic central remodeling. This manifests as alterations in gray matter volume and impaired white matter microstructural integrity in key pain processing nodes such as the anterior cingulate cortex, insula, prefrontal cortex, and thalamus. These changes are accompanied by dysfunctional connectivity within large-scale brain networks, including the default mode network, salience network, and central executive network. Crucially, prospective longitudinal studies have identified a series of predictive neurobiological markers, including early hyperactivation in the insula and anterior cingulate cortex, pathological reorganization of the sensorimotor cortex, and abnormal connectivity patterns within specific networks. These markers provide objective evidence for assessing individual risk of progression from subacute to chronic pain. This chain of evidence collectively demonstrates the central role of central sensitization in maintaining chronic neck pain, establishing the brain as an active regulator in the chronic pain process. However, research in this field still faces several significant limitations: existing imaging studies are predominantly single-center and small-sample designs, requiring validation of predictive biomarkers' robustness and universality through multicenter independent cohorts; Furthermore, the molecular mechanisms underlying neuroplastic changes and their causal relationship with clinical manifestations remain unclear. Future research urgently requires large-scale, multicenter prospective cohort studies to validate existing neurobiological markers. Integrating multi-omics technologies with behavioral assessments will elucidate the driving mechanisms of central neural remodeling, ultimately advancing the translation of neuroimaging biomarkers into clinical prediction models and targeted intervention strategies. This research direction holds profound scientific significance and clinical value for overcoming bottlenecks in the clinical management of chronic neck pain. This paper systematically integrates neuroimaging evidence to elucidate the central neural mechanisms underlying the transition from acute pain to chronic status.
[Keywords] chronic neck pain；acute phase transition；neuroimaging；magnetic resonance imaging；functional connectivity；central sensitization

LI Jinghu1   ZHANG Shuaipan1   ZHOU Xin1   KONG Lingjun1   ZHU Qingguang2   REN Jun1   JIN Ming1   MA Ying1   WANG Shoujian1   FANG Min1, 2*  

1 Department of Tuina, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China

2 Tuina Research Institute, Shanghai Academy of Traditional Chinese Medicine, Shanghai 200437, China

Corresponding author: FANG M, E-mail: fm-tn0510@shutcm.edu.cn

Conflicts of interest   None.

Received  2025-06-09
Accepted  2025-12-09
DOI: 10.12015/issn.1674-8034.2025.12.024
DOI:10.12015/issn.1674-8034.2025.12.024.

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