When my patient was first referred to me by her oncologist, she was at a breaking point. Diagnosed with lung cancer, she had started immunotherapy in hopes of a better outcome. However, while the treatment was successfully attacking her cancer, it brought an unexpected and overwhelming side effect: severe joint pain.
The pain affected nearly every joint in her body, from her hands and knees to her hips and shoulders. She described it as unbearable, making it difficult to walk, sit, or even sleep. At one point, her discomfort was so intense that she seriously considered stopping her cancer treatment altogether. Her oncologist, concerned that the joint pain might lead her to give up, sent her to us for pain management.
We quickly developed a plan to relieve her pain without compromising her cancer treatment. To limit her exposure to corticosteroids—since steroids can potentially interfere with the effectiveness of her immunotherapy—we took a balanced approach. We started with NSAIDs, combined with physical therapy to improve mobility, and used selective joint injections to target the most painful areas. This combination allowed us to control her pain and protect her cancer-fighting treatment.
Over time, the pain eased, and she was able to continue her immunotherapy without interruption. Now, I’m happy to say that she is disease-free, thanks to immunotherapy—and the pain is well-managed.
Understanding Joint Pain During Immunotherapy
My patient’s experience highlights one of the more challenging side effects of immunotherapy: joint pain. Immunotherapy has changed the cancer treatment landscape by harnessing the power of the immune system to fight cancer cells. While it offers a powerful tool in battling the disease, it can also cause unintended effects on the body.
How Immunotherapy Triggers Joint Pain
Immunotherapy treatments work by boosting the immune system’s ability to identify and attack cancer cells. However, in some cases, this enhanced immune response can mistakenly target healthy tissues, including joints. This process is known as an immune-related adverse event (irAE), and it can result in inflammation that causes pain, stiffness, and swelling in multiple joints.
For my patient, her immune system became so overactive that it attacked her joints, creating widespread inflammation. This response is similar to what happens in autoimmune diseases like rheumatoid arthritis, though in this case, the joint pain was directly tied to her cancer treatment.
Managing Joint Pain: A Balanced Approach
The challenge in managing joint pain caused by immunotherapy is balancing pain relief with maintaining effective cancer treatment. Some of the medications that help relieve joint pain—such as corticosteroids—can potentially weaken the immune system’s ability to attack cancer cells. To minimize this risk, we took a multi-faceted approach.
NSAIDs for Inflammation Control
NSAIDs, like ibuprofen or naproxen, were the first step in managing my patient’s joint pain. These medications help reduce inflammation in the joints, making movement less painful. However, NSAIDs alone were not enough to provide her with complete relief.
Physical Therapy to Improve Mobility
Physical therapy played a crucial role in my patient’s recovery. Gentle, guided exercises helped her regain joint flexibility and strength without worsening her pain. Regular sessions allowed her to keep moving, which was key to maintaining her mobility and preventing joint stiffness.
Selective Joint Injections for Targeted Relief
For the areas where her pain was most intense, we used selective joint injections. These injections delivered anti-inflammatory medications directly into the joints that were causing her the most discomfort. This targeted approach helped reduce inflammation locally while minimizing the need for systemic corticosteroids.
Minimizing Steroid Use to Preserve Immunotherapy Efficacy
Corticosteroids, while effective for controlling inflammation, can suppress the immune system. In my patient’s case, the goal was to limit her exposure to steroids as much as possible to maintain the effectiveness of her immunotherapy. The use of NSAIDs, physical therapy, and selective joint injections allowed us to keep her steroid dosage low while still managing her joint pain effectively.
Common Symptoms of Immunotherapy-Related Joint Pain
Immunotherapy-related joint pain can present in many ways. Most commonly, patients experience:
- Pain in multiple joints, often symmetrical
- Stiffness, especially in the morning or after periods of rest
- Swelling and tenderness in affected areas
- Warmth or redness around inflamed joints
These symptoms can resemble those seen in autoimmune conditions like rheumatoid arthritis, making it important for healthcare providers to differentiate between joint pain caused by cancer treatment and pain from other conditions.
Emotional and Physical Toll of Cancer Pain
For many patients, cancer pain is not limited to the tumor itself. As seen in my patient’s case, the side effects of treatments—like immunotherapy—can introduce new types of pain. This “cancer pain” encompasses the physical discomfort caused by both the disease and its treatments.
Immunotherapy-related joint pain can take a significant emotional toll. Patients who suffer from joint pain often feel helpless or isolated, unable to participate in their daily lives as they once did. The emotional burden can make it harder for them to focus on their cancer recovery, leading to thoughts of giving up, as my patient experienced.
Managing Cancer Pain: A Multi-Disciplinary Effort
It’s important to remember that managing cancer pain, including joint pain caused by immunotherapy, is a team effort. Patients should work closely with their oncologist, pain management specialist, and physical therapist to find the right combination of treatments. By taking a collaborative approach, patients can find relief without compromising their cancer care.
The Role of the Pain Management Specialist
A pain management specialist plays a vital role in developing a tailored plan that suits each patient’s needs. For my patient, managing her joint pain meant reducing her exposure to corticosteroids while still achieving pain relief. Through selective joint injections, physical therapy, and NSAIDs, we found a plan that allowed her to continue immunotherapy with minimal disruption.
Support from the Care Team
The emotional support from the care team is just as important as physical treatment. For patients struggling with severe joint pain, it’s important to feel heard and understood. Support from healthcare providers, friends, and family can make the difference between giving up and pushing forward.
The Future of Immunotherapy and Joint Pain
As immunotherapy becomes more widespread in cancer treatment, researchers are continuing to study ways to minimize side effects like joint pain. Ongoing research is focused on identifying better ways to predict who will experience these immune-related side effects and how best to treat them. The goal is to find methods that allow patients to benefit from immunotherapy without enduring debilitating pain.
Finding Relief and Continuing the Fight
Immunotherapy offers hope for many cancer patients, including those with advanced cancers like lung cancer. However, as with any treatment, it comes with side effects. Joint pain, though challenging, doesn’t have to be a reason to stop treatment.
Through careful pain management—using a combination of NSAIDs, physical therapy, and selective joint injections—patients like mine can find relief. By minimizing the use of corticosteroids, we preserved her immunotherapy’s effectiveness, allowing her to continue fighting her cancer.
My patient’s story shows that even when cancer treatment becomes overwhelming, there is hope. With proper care and support, patients can find relief from joint pain and continue their journey toward healing.