[Neurological basis of the emotional dimension of pain]

Feeling pain is in the same time a sensory and an affective experience. Pain asymbolia and prefrontal lobotomy, two distinct neurological pictures, help to better understand the cerebral basis of the emotional dimension of pain. In pain asymbolia, the selective alteration of the affective dimension of pain is associated with a loss of the sense of threat and danger. Following prefrontal lobotomy, the emotional impact of chronic pain is dramatically reduced, while affective responses to acute pain are paradoxically increased. Such clinical observations allow to make a clear distinction between immediate pain unpleasantness on the one hand, and secondary pain affect, linked to the significance of the pain experience in terms of the self and of the future, on the other hand. Moreover, recent functional neuroimaging data allow to better define the neural substrates of the affective dimension of pain and to highlight the shared neuro-anatomical networks between physical and psychic suffering.