• Julien Nizard, Amélie Levesque, Nathalie Denis, Edwige de Chauvigny, Aurélie Lepeintre, Sylvie Raoul, Jean-Jacques Labat, Samuel Bulteau, Benoît Maillard, Kevin Buffenoir, Gilles Potel, Jean-Pascal Lefaucheur, and Jean Paul Nguyen.
• 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.
• Palliat Med. 2015 Jun 1; 29 (6): 564-8.

BackgroundNon-drug treatments should be systematically associated to the medical analgesic treatment during the terminal phase of cancer.Cases PresentationPatient 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.Cases ManagementBoth patients received five consecutive 20-min sessions of repetitive transcranial magnetic stimulation to the right motor cortex.Cases OutcomePatient 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.ConclusionIn 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.© The Author(s) 2015.

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