НЕЙРОФИЗИОЛОГИЧЕСКИЕ И ПСИХОСОЦИАЛЬНЫЕ МЕХАНИЗМЫ ХРОНИЗАЦИИ НЕСПЕЦИФИЧЕСКОЙ ПОЯСНИЧНОЙ БОЛИ: КЛИНИЧЕСКАЯ СТРАТИФИКАЦИЯ РИСКА И ИНДИВИДУАЛИЗИРОВАННАЯ НЕЙРОРЕАБИЛИТАЦИЯ

Abstract

Background. Chronic nonspecific low back pain is a major contributor to persistent disability and reduced quality of life. Contemporary understanding emphasizes interactions between peripheral nociceptive input, central pain processing, neuroplastic changes, and psychosocial factors. Central sensitization, altered descending pain modulation, fear-avoidance behavior, pain catastrophizing, and sleep disturbances may contribute to persistent symptoms. However, self-reported features attributed to central sensitization do not necessarily correspond to objective measures of nociceptive processing.

Materials and Methods. A narrative analytical review of international clinical guidelines, cohort investigations, randomized controlled trials, systematic reviews, and meta-analyses was conducted. The analysis focused on nociceptive, neuropathic, and nociplastic pain mechanisms, quantitative sensory testing, psychological assessment, prognostic instruments, and rehabilitation strategies.

Results. Clinical pain phenotypes, prognostic characteristics, diagnostic assessment methods, and evidence-based rehabilitation approaches were systematically examined. Six comparative analytical tables were developed. An original conceptual framework, NEURO-LBP-RISK, was proposed to integrate neurological findings, pain phenotype, functional disability, sleep disturbances, and psychosocial characteristics.

Conclusion. Comprehensive assessment of chronic nonspecific low back pain should extend beyond structural spinal abnormalities and incorporate central pain processing, behavioral responses, and functional consequences. Individualized rehabilitation combining therapeutic exercise, education, and selected psychological interventions is a promising management strategy. Prospective validation of the proposed framework is required.