[The chronically painful hand]

The usual concept of pain, constituting a warning signal corresponding to an identifiable peripheral lesion, is very different from that of chronic pain, a real pathological syndrome with a dual aspect, an organic component and a psychological component, with no obvious relationship to the original cause. The authors distinguish pain due to excessive nociception, which can be cured by treatment of the cause, from disafferentation pain due to a defect of transmission of nerve impulses to processing centres and which is refractory to surgical treatment. The approach to pain must be multidisciplinary: surgery, drugs, percutaneous neurostimulation, physiotherapy and psychotherapeutic management ensure a "therapeutic alliance" in difficult chronic pain patients.