Immunotherapy has changed the way we fight cancer. By boosting the immune system, it helps the body target and destroy cancer cells more effectively. While this treatment has brought hope to many, it can also come with side effects, including pain in the joints, muscles, and nerves.
If you’re experiencing discomfort during your treatment, you’re not alone. Many patients feel frustrated by the pain, but the good news is that there are ways to manage it. In this post, we’ll dive into why immunotherapy can cause pain, what’s happening in your body, and how to get relief without interfering with your treatment.
Why Does Immunotherapy Cause Pain?
Immunotherapy works by supercharging the immune system. It trains immune cells to recognize and attack cancer cells, which is a major breakthrough in treatment. However, this heightened immune response can sometimes affect healthy tissues too. When the immune system becomes overly active, it can lead to inflammation, irritation, or even damage in other areas of the body.
Let’s break it down further:
- Joint Pain (Arthralgia): Inflammation can develop in the joints when immune cells mistakenly attack healthy tissues. This mimics autoimmune conditions like rheumatoid arthritis.
- Muscle Pain (Myalgia): Muscles can become sore or inflamed as part of an immune response. In severe cases, this may lead to a condition called myositis.
- Nerve Pain (Neuropathy): Nerves can be damaged by inflammation or by the immune system targeting them directly. This results in burning, tingling, or shooting pain.
Understanding why this pain occurs helps us find ways to treat it effectively while keeping your cancer treatment on track.
Joint Pain: Why It Happens and What to Do
What’s Causing the Pain?
Joint pain during immunotherapy usually comes from inflammation. When the immune system is on high alert, it may release proteins called cytokines. These cytokines are meant to help fight cancer, but they can also trigger swelling and tenderness in the joints. Overactive T-cells may also target the joint lining, leading to stiffness and pain.
How Does It Feel?
Patients often describe joint pain as:
- Achy or throbbing discomfort.
- Stiffness, especially in the morning.
- Swelling around the affected joints.
How to Manage It Without Interfering with Immunotherapy:
- Over-the-Counter NSAIDs: Medications like ibuprofen or naproxen can reduce inflammation and relieve pain. Always check with your oncologist before starting NSAIDs, as they may not be suitable for everyone.
- Ultrasound-Guided Steroid Injections: For more severe joint pain, low-dose corticosteroid injections directly into the affected joints can provide targeted relief. Using ultrasound guidance ensures the medication is precisely delivered to the inflamed area, minimizing systemic absorption and preserving the effectiveness of immunotherapy. These injections are typically quick, effective, and performed in a clinical setting.
- Heat and Cold Therapy: Use a heating pad to relax stiff joints or a cold pack to reduce swelling.
- Stay Active: Gentle stretching or low-impact exercises like yoga can keep your joints flexible. It might feel counterintuitive to move when you’re in pain, but regular activity can help reduce stiffness.
Muscle Pain: What’s Going On and How to Feel Better
What’s Causing the Pain?
Muscle pain, or myalgia, happens when immune cells target muscle fibers. This is often due to inflammation triggered by the release of cytokines. In some cases, a condition called myositis may develop, where the muscles themselves are inflamed.
How Does It Feel?
Patients with muscle pain report:
- Soreness or stiffness throughout the body.
- Muscle weakness, particularly in larger muscles like those in the legs or back.
- Fatigue that makes physical activity more difficult.
How to Manage Muscle Pain:
- Acetaminophen: This is a great option for mild to moderate pain. It won’t interfere with your immune response.
- Massage Therapy: Gentle massages can reduce muscle tension and improve blood flow to sore areas.
- Hydration and Nutrition: Staying hydrated and eating foods rich in magnesium and potassium (like bananas or spinach) can help reduce muscle cramps.
- Electrotherapy Devices: TENS units (small devices that send electrical pulses to sore muscles) can provide temporary relief.
- Warm Baths: Adding Epsom salts to a bath can relax muscles and ease pain.
Nerve Pain: Why It’s So Challenging and What Can Help
What’s Causing the Pain?
Nerve pain (neuropathy) occurs when the immune system attacks the nerves or when inflammation damages them. Cytokines released during immunotherapy may irritate or degrade nerve fibers, leading to abnormal pain signals. For some, this can feel like “pins and needles,” while others experience burning or shooting pain.
How Does It Feel?
Nerve pain from immunotherapy can include:
- Tingling or numbness in the hands and feet.
- Sharp, stabbing pain that comes and goes.
- Sensitivity to touch or temperature.
How to Manage Nerve Pain:
- Medications for Nerve Pain:
- Gabapentin or Pregabalin: These drugs help calm overactive nerve signals.
- Duloxetine: This antidepressant also works for nerve pain by increasing serotonin and norepinephrine levels.
- Topical Creams: Lidocaine patches or capsaicin creams can target specific areas of nerve pain for localized relief.
- Vitamin B12: Low levels of B12 can worsen nerve damage. Supplementing with this vitamin may help improve nerve function.
- Ketamine Infusions: In severe cases, low-dose ketamine infusions have been shown to help modulate pain pathways in the central nervous system.
- Lidocaine Infusions: These infusions can provide relief by numbing affected nerves and reducing signal coming from irritated nerves to your brain.
Preventing Nerve Pain:
While not always avoidable, you can take steps to reduce your risk:
- Anti-inflammatory Diet: Eating foods rich in omega-3 fatty acids, like salmon or walnuts, may help reduce overall inflammation.
- Supplements: Alpha-lipoic acid and vitamin D have shown promise in protecting nerves. Talk to your doctor before adding these to your routine.
- Stay Active: Light exercises that improve circulation can help maintain nerve health.
How Can We Treat Pain Without Impacting Immunotherapy?
One of the biggest concerns for patients is whether pain management strategies might interfere with their cancer treatment. The goal is to relieve pain while ensuring immunotherapy continues to work effectively.
Safe Pain Management Strategies Include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) in moderate doses with your oncologist’s approval.
- Acetaminophen for mild to moderate pain.
- Physical therapy to reduce stiffness and improve mobility.
- Complementary therapies like massage or acupuncture (with your care team’s approval).
Lifestyle Adjustments to Improve Quality of Life
Pain management isn’t just about medications—it’s about creating a plan that works for your body and lifestyle. Here are some additional tips to help you stay comfortable during treatment:
- Mindfulness and Relaxation: Deep breathing exercises, meditation, and yoga can help lower stress and reduce pain perception.
- Hydration: Staying hydrated can reduce inflammation and muscle soreness.
- Support Groups: Talking to others who understand what you’re going through can be incredibly validating and helpful.
Looking Ahead: Relief Is Possible
Pain from immunotherapy can feel overwhelming, but it doesn’t have to define your treatment journey. With the right strategies, you can manage your symptoms and stay focused on healing. Whether you’re dealing with joint stiffness, muscle soreness, or nerve pain, there are solutions that work alongside your therapy, not against it.
At Red Butte Pain Solutions, we specialize in helping patients manage cancer treatment pain. Our goal is to help you live comfortably and stay on track with your treatment plan. Contact us today to learn how we can support you during this time.