[Contamination by the patient's affect: a source of trauma for the caregiver]. / La contamination par les affects du patient : une source traumatogène pour le soignant.

In complex aid relationships, the caregiver's confrontation with the patient's suffering can lead to trauma, like compassion fatigue and vicarious trauma. During prolonged and repeated exposure to a care situation, the caregiver may be contaminated by the violence of the patient's affects. This requires developing strategies to recognize, counter, and cope with the phenomenon.

[The sexualisation of the care relationship by the patient in gerontology]. / La sexualisation de la relation de soin par le patient en gérontologie.

The expression of the sexuality of the ageing patient in the care setting, particularly when it concerns the genital area and involves the caregiver without he or she being aware, constitutes a critical situation for the geriatric teams. A psychodynamic reading of these situations is important for the caregiving teams in order to optimise the somatic treatment and to prevent the risk of an unsuitable reactive treatment. This article presents a clinical case as an example.

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. CASES PRESENTATION: 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. CASES MANAGEMENT: Both patients received five consecutive 20-min sessions of repetitive transcranial magnetic stimulation to the right motor cortex. CASES OUTCOME: 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. CONCLUSION: 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.