Neuromodulation-neurostimulation : physiopathologie de la douleur et cibles neurochirurgicales

Pain is a result of an unpleasant emotional experience: its various components may be increased or decreased considering the different characteristics of the stimulus and of the affective state of the patient, as well as the context in which this stimulus is applied. Physiological aspects of acute pain are described in order to understand central control mechanisms of pain described: spinal segmentary and supraspinal excitatory and inhibitory controls; diffuse noxious inhibitory controls (DNIC). New ways for alleviating intractable chronic pain have been developed based on surgical neuromodulation of these descending control systems of pain: transcutaneous electrical nerve stimulation (TENS); dorsal column spinal cord stimulation; deep brain stimulation; motor cortex stimulation. These various techniques are described in relation with the anatomical and physiological hypotheses which underly them.