[The chronically painful hand. A consecutive series of 60 cases]

This study was based on 60 patients presenting with hand pain refractory to usual treatment. The aim of this study was to assess the pathophysiological and neuropsychological factors involved in a population of patients recruited in a hand surgery unit. Analysis of this series revealed the frequency of desafferentation mechanisms. These symptoms can be treated by means of antidepressants, antiepileptics and peripheral neurostimulation. Anxio-depressive factors were of limited importance in this series, at least in comparison with the population usually examined in a pain treatment centre. However, their presence in a subgroup of patients (26% of cases) and the limitations of symptomatic analgesic treatment justifie a global approach to chronic pain in order to establish the participation of the various factors in each particular case. It is useful to combine aetiological treatments with psychological treatments (antidepressants, relaxation therapy, for example) to increase the patient's tolerance of their persistent painful symptoms.