Supportive Care Services

Pain Clinic

Pain may be caused by a number of things, including your cancer, treatment, or an unrelated medical problem. Most pain can be treated with medication or treatments such as physical therapy. Your physician and nurse will help you find the best possible way to control your pain. On occasion this may involve an expert from the Fred Hutchinson Cancer Center Pain Clinic, which specializes in managing complex pain related to cancer.

Cancer pain care needs to be carefully coordinated. It requires careful follow-up of issues and medications that can complicate a patient’s overall care. Cancer pain changes frequently, is complex, and can be addressed by many different care professionals. This contrasts with chronic pain, which remains relatively stable over time and can be managed by one or two physicians.

Pain Clinic services

The Pain Clinic manages complex, cancer related pain before, during, and after treatment. Staff includes registered nurses, clinical pharmacists, and attending physicians. If you are interested in being seen in the Pain Clinic, please discuss a referral with your oncology team.

How can we treat your pain?

Your pain can be treated or managed in many ways, including relaxation techniques, cold packs, physical therapy, over-the-counter medication, or prescription narcotics.

As a patient at Fred Hutch you have the right to: be informed about pain and pain management; have your pain treated promptly; and have health care providers who believe your report of pain.

Your health care team relies on you to: describe and rate your pain; ask about pain management; discuss options; ask for pain relief when you first experience pain; inform your doctor if your pain treatment is not working; and work with your doctors develop a treatment plan for you.

Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Pain care

Assessing your pain

Assessment is the first step to controlling your pain. Your doctor or nurse will ask you to “rate” your pain using a simple method. Remember, only YOU know what and where your pain is, and your doctor needs your help to help you.

Your doctor or nurse will ask you to point to the area of your pain. They will also ask:

What will cause the pain?
What do you think will get rid of the pain?
What is the quality of your pain? (e.g. burning, radiating, throbbing, stabbing)

Non-drug approaches to pain

Non-drug methods of pain relief to try are:

Hot or cold packs
Massage/therapeutic touch
Hypnosis
Relaxation and music therapy
Physical therapy

Medication

Your doctor may choose to prescribe Tylenol, ibuprofen, or narcotics/opioids such as morphine. Sometimes your doctor may use a local anesthetic. The method depends on the location and severity of your pain.

Pain medication may be given in different ways:

Pill
Patch (like a bandage placed on the skin)
Intravenously
Subcutaneously (SQ under the skin)
PCA-intravenous (a small computerized pump that lets you control how much pain medication you receive)
Epidural (a small tube inserted into your back)

Some pain medications should be taken on a regular basis (called long-acting medication), while others should be taken only when you begin to feel pain (break-through medicine.)

Myths about narcotics/opioids

Some people worry they will become addicted to narcotics or opioids if they take them for pain. Research has shown that this is not true. If your pain medication is used the way your doctor prescribes it, it is very rare to become addicted.

Some patients don’t want narcotics because they worry about the side effects from the medication. Nausea, vomiting, sleepiness, constipation, and itching are common side effects, but they can be easily managed by changing your medication or adding other treatments.

Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.

What you can do at home

These steps can help:

Maintain your treatment plan.
Take medications as ordered.
Do not increase your dose of medication without talking to your nurse or doctor.
Keep a pain journal.
Use hot or cold packs.
Find a relaxation technique that works for you, such as guided imagery, hypnosis, massage, and therapeutic touch.
Listen to relaxing music.
Continue activities that are meaningful to you. Such activities may help you notice less pain or discomfort.
Before taking pain medication/opioids, ask your nurse or doctor about ways to prevent constipation.

Taking care of your pain will help you sleep better, feel stronger and be better able to cope with your illness.

Emergency signs and symptoms

Call 911 now if you experience:

Severe chest/arm pain
Severe squeezing or pressure in chest
Severe sudden headache
Severe sedation or inability to stay awake

Urgent signs and symptoms

Call your care team if you experience:

New pain
Uncontrolled pain
New headache
Burning in chest or stomach
Strong stomach pain
Pain with infusion of medications or fluids into your central line
Pain at your central line site or area of “tunnel”
Chest discomfort or heart “flip-flop” feeling
Pounding heart
Unexpected or intolerable side effects of your pain medications (sedation, confusion, nausea, etc.)
Nausea/vomiting causing inability to take your pain medications

Central venous catheter A small, flexible tube inserted into a large vein near the heart. This serves as a route for medications and intravenous nutrition and to take blood samples. A small, flexible tube inserted into a large vein near the heart. This serves as a route for medications and intravenous nutrition and to take blood samples. These catheters are also known as a Hickman line, central line, tunneled catheter or Port-a-Cath®. Infusion An injection of medications or fluids into a vein over a period of time. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.

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