Interest of repetitive transcranial magnetic stimulation of the motor cortex in the management of refractory cancer pain in palliative care: Two case reports.
BACKGROUND
Non-drug treatments should be systematically associated to the medical analgesic treatment during the terminal phase of cancer.


METHODS
Patient 1, a 23-year-old woman, presented an adenocarcinoma of the rectum, with liver and lung metastases. Pain was initially treated by oral morphine and a combination of pregabalin and amitriptyline. Ketamine and intrathecal administration of morphine were both ineffective. Patient 2, a 69-year-old woman, presented a cutaneous T-cell lymphoma. She was admitted to the palliative care unit with mixed pain related to cutaneous lymphomatous infiltration. World Health Organization (WHO) step 3 analgesics had not been tolerated.


RESULTS
Both patients received five consecutive 20-min sessions of repetitive transcranial magnetic stimulation to the right motor cortex.
Patient 1 experienced a marked improvement of her pain over the days following the first repetitive transcranial magnetic stimulation session. Medical treatment was able to be rapidly decreased by about 50%, which restored an almost normal level of consciousness and lucidity. Patient 2's pain was also markedly decreased over the days following these five consecutive sessions, and repetitive transcranial magnetic stimulation also appeared to have had a beneficial effect on the patient's anxiety and mood.


CONCLUSIONS
In the context of palliative care of cancer patients experiencing refractory pain that is difficult to control by the usual treatments, motor cortex repetitive transcranial magnetic stimulation, due to its noninvasive nature, can be used as an adjuvant therapy to improve various components of pain, including the emotional components. By reducing the doses of analgesics, repetitive transcranial magnetic stimulation decreases the severity of their adverse effects and improves the patient's quality of life.
Pain-Palliative-Support Care and Ethics, UIC 22 and Laboratoire de Thérapeutique (EA3826), University Hospital, CHU Nord Laënnec, Nantes, France julien.nizard@univ-nantes.fr.
Julien
J
Nizard
Pain-Palliative-Support Care and Ethics, UIC 22 and Laboratoire de Thérapeutique (EA3826), University Hospital, CHU Nord Laënnec, Nantes, France.
Amélie
A
Levesque
Pain-Palliative-Support Care and Ethics, UIC 22 and Laboratoire de Thérapeutique (EA3826), University Hospital, CHU Nord Laënnec, Nantes, France.
Nathalie
N
Denis
Pain-Palliative-Support Care and Ethics, UIC 22 and Laboratoire de Thérapeutique (EA3826), University Hospital, CHU Nord Laënnec, Nantes, France.
Edwige
E
de Chauvigny
Pain-Palliative-Support Care and Ethics, UIC 22 and Laboratoire de Thérapeutique (EA3826), University Hospital, CHU Nord Laënnec, Nantes, France.
Aurélie
A
Lepeintre
Neurosurgery Department, University Hospital, Nantes, France.
Sylvie
S
Raoul
Pain-Palliative-Support Care and Ethics, UIC 22 and Laboratoire de Thérapeutique (EA3826), University Hospital, CHU Nord Laënnec, Nantes, France.
Jean-Jacques
JJ
Labat
Psychiatry Department, University Hospital, Nantes, France.
Samuel
S
Bulteau
Pain-Palliative-Support Care and Ethics, UIC 22 and Laboratoire de Thérapeutique (EA3826), University Hospital, CHU Nord Laënnec, Nantes, France.
Benoît
B
Maillard
Neurosurgery Department, University Hospital, Nantes, France.
Kevin
K
Buffenoir
Pain-Palliative-Support Care and Ethics, UIC 22 and Laboratoire de Thérapeutique (EA3826), University Hospital, CHU Nord Laënnec, Nantes, France.
Gilles
G
Potel
EA 4391 and Department of Physiology, Faculty of Medicine Henri Mondor, Créteil, France.
Jean-Pascal
JP
Lefaucheur
Neurosurgery Department, University Hospital, Nantes, France.
Jean Paul
JP
Nguyen
D000368:Aged; D000698:Analgesia / Q000379:methods*; D005260:Female; D006801:Humans; D009044:Motor Cortex / Q000502:physiology*; D009369:Neoplasms / Q000150:complications*; D059408:Pain Management / Q000379:methods; D010148:Intractable Pain / Q000628:therapy*; D010166:Palliative Care / Q000379:methods*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
Refractory pain; cancer pain; quality of life; rTMS; repetitive transcranial magnetic stimulation