Chemo and back pain

The Side Effects of Chemotherapy

The side effects of chemotherapy depend largely on the specific chemotherapy drugs you are receiving, and sometimes on the dose and schedule of the treatments. Medications that are given along with chemotherapy to prevent or ameliorate side effects, such as anti-nausea medicines or medicines given to increase blood counts, can also have their own side effects.

This may be the situation in your case, because back pain is not a typical side effect of most chemotherapy drugs. However, it is a very common side effect of medicines that are sometimes given after chemotherapy to help keep the white blood cell count closer to the normal range. These drugs are called granulocyte-colony stimulating factors (their common names are Neupogen and Neulasta). They are given by an under-the-skin injection, generally one or two days after chemotherapy, and it is very common for patients to experience bone pain for a few days afterward. Generally, acetaminophen (Tylenol) will help alleviate the discomfort, but some patients require stronger pain medicines.

Be sure to tell your doctor about your back pain, and ask about the chemotherapy drugs you’re receiving and their expected side effects. You may want to ask specifically if you are being given “growth factors.” If so, discuss with your doctor whether these medicines may be causing your pain and how this pain can best be managed.

Learn more in the Everyday Health Cancer Center.

Medically reviewed by Janet L. Abrahm, MD and James A. Tulsky, MD

Back pain can occur for a variety of reasons not related to cancer, such as injury or arthritis; in certain circumstances, back pain can be related to cancer. Though extremely uncommon, it may be a sign of certain cancers, a side effect of chemotherapy or other cancer therapies, a symptom of metastasis, or a latent side effect of treatment.

A primary bone cancer tumor in the spine can cause back pain, as can a number of cancers when they have metastasized, such as breast cancer, testicular cancer, colon cancer, and lung cancer. In fact, back pain is often the first symptom that people with lung cancer notice before they are diagnosed; around 25 percent of people with lung cancer list it as a symptom they experience at some point. A tumor in the lungs can put pressure on the spine, or can affect the nerves around the chest wall and spine.

Some people may not experience back pain prior to their diagnosis, but may deal with it during treatment. It is important to keep your treatment team updated on any pain you may experience. The pain may be related to the cancer itself and arise as a result of the disease spreading, or it may be a side effect of treatment. For example, Herceptin, a hormone therapy used to treat some breast cancers and gastric cancers, can cause back pain during or within hours of treatment, or a few days to weeks later.

Back pain may be a lasting issue for some cancer survivors. Pain does not necessarily mean there is cause for concern that the disease has spread, but it is still good to check with your doctor if you experience pain. Palliative care experts, who are focused on medicine that relieves symptoms of illness, can offer various methods of alleviating back pain, including pain medication, antidepressant medicines, physical therapy, braces, acupuncture, yoga and meditation, relaxation skills, nerve blocks, or surgery. Often, back pain lessens with regular exercise, stretching, and a healthy diet.

It is important to remember that wanting to control pain is not a sign of weakness. It is a way to help you feel better and stay active.

Learn more about pain management from Dana-Farber Cancer Institute.

Coping with cancer

Sometimes people can feel pain from an organ in the body in a different part of their body. This is called referred pain.

For example, a swollen liver may cause pain in the right shoulder, even though the liver is under the ribs on the right. This is because the liver presses on nerves that end in the shoulder.

How much pain you might have

The amount of pain you have with cancer depends on:

  • the type of cancer you have
  • where it is
  • the stage of your cancer
  • whether the cancer or treatment has damaged any nerves

Other factors can also affect how you feel pain, such as fear, anxiety, depression and a lack of sleep.

It’s very important to let your medical team know straight away if you have pain. Don’t try to put up with it. This can cause nerve changes that could make the pain harder to control in the future.

Controlling chronic pain

Chronic pain is also called persistent pain. It can be difficult to treat, but often painkillers or other pain control methods can successfully control it.

Pain that is not well controlled can develop into chronic pain. So it is important to take the painkillers that the doctor prescribes for you. Trying to put up with the pain can make it harder to control in the future.

People with chronic cancer pain might have times when their medicines do not control the pain. This is called breakthrough pain.

Tell your doctor or nurse if you’re taking regular painkillers but still get pain at times. They can prescribe extra doses of painkillers for you to take when you need them.

Getting support with cancer pain

Pain can greatly affect your quality of life. Chronic pain can make it hard for you to do everyday things such as bathing, shopping, cooking, sleeping and eating.

This can be hard for your close friends and relatives to understand. You might need support to deal with how pain can affect you and your loved ones.

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