Immunotherapy and Back Pain: Causes, Signs, and Coping Strategies

Yes, immunotherapy can cause back pain for some people. Back pain is reported with several immune checkpoint inhibitors and can be part of broader joint or muscle pain side effects. ^[1] Back pain may stem from inflammation of joints and muscles (arthralgia and myalgia), nerve irritation (neuropathy), or less commonly, hormone gland problems that affect muscles and energy. ^{[2] [3] [4]}

How immunotherapy can lead to back pain

• Muscle and joint inflammation: Immune activation can cause new or increased joint pain, muscle pain, stiffness, and swelling, which many people feel in the spine or lower back. ^[2]
• Documented drug side effects: Back pain and spinal pain are listed among common adverse reactions with drugs such as nivolumab and durvalumab. ^{[1] [5]}
• Nerve-related symptoms: Some immunotherapies can cause neuropathy (numbness, tingling, burning), which may be felt in the back or radiate to limbs. ^[3]
• Hormonal changes: Problems with thyroid, pituitary, adrenal, or pancreas can lead to fatigue, muscle aches, and stiffness that worsen back discomfort. ^[4]

Most side effects can be managed safely if addressed early, but some can harm organs if untreated, so timely reporting is important. ^[6]

When to seek medical help

• New, worsening, or severe back pain, especially with stiffness, swelling, or weakness, should be discussed promptly with your care team. ^[2]
• Red flags to act on quickly: Back pain with numbness, tingling, leg weakness, bowel/bladder changes, or sudden difficulty walking may signal spinal compression, which in cancer care is treated as urgent until proven otherwise. ^[7]
• Systemic symptoms such as fever, marked fatigue, dizziness, or vision changes can point to hormone-related side effects and need evaluation. ^[4]

First-line coping tips at home

• Gentle movement and stretching: Short walks, light stretches, and posture changes reduce stiffness and muscle guarding. Keeping joints moving within comfort helps. ^[2]
• Heat for stiffness, cold for sore spots: Warm packs relax tight muscles; cold packs can lessen localized tenderness or swelling. ^[8]
• Over-the-counter pain relief: Acetaminophen (paracetamol) is commonly used; non‑steroidal anti‑inflammatory drugs (NSAIDs) may help if your doctor says they’re safe for you. Always check with your team before NSAIDs due to bleeding risk or interactions. ^{[9] [10]}
• Hydration and nutrition: Adequate fluids and balanced meals support muscle recovery and energy. Small, frequent meals can help if appetite is low. ^[2]
• Pace activities: Break tasks into shorter segments, rest between, and avoid heavy lifting during flares to prevent worsening pain. ^[2]

Medical treatments your team may consider

• Adjusting immunotherapy timing: A short treatment pause (“drug holiday”) may be considered for significant musculoskeletal side effects, based on your oncologist’s judgment. ^[8]
• Prescription analgesics: If pain is moderate to severe, clinicians may use stronger pain medicines carefully and temporarily. ^[10]
• Corticosteroids for immune‑related inflammation: For moderate to severe joint/muscle inflammation from checkpoint inhibitors, short courses of corticosteroids may be used to calm the immune reaction, with close monitoring. ^[9]
• Specialist input: Referral to a rheumatologist or physiatrist can help tailor therapy, exercises, and injections when appropriate. Joint injections are individualized and not advised into unstable joints. ^{[9] [11]}

Watch for other related side effects

• Neuropathy signs: Numbness, tingling, stinging, or burning in hands/feet that may accompany or mimic back pain report these promptly. ^[3]
• Hormone/gland symptoms: Ongoing headaches, extreme tiredness, weight changes, dizziness, mood shifts, feeling unusually cold, or hair loss may suggest thyroid or adrenal involvement. These need lab checks and tailored treatment. ^[4]

Practical daily strategies

• Ergonomics: Use lumbar support when sitting, keep screens at eye level, and change positions every 30–45 minutes to reduce spine strain. ^[2]
• Sleep support: Side‑sleepers can place a pillow between knees; back‑sleepers can use a pillow under knees to unload the lumbar spine. A firm, supportive mattress may ease morning stiffness. ^[2]
• Low‑impact exercise: Swimming, stationary cycling, or gentle yoga can maintain strength without jarring the spine. Build up slowly and stop if pain spikes. ^[2]
• Track symptoms: Note timing relative to infusions, pain location, severity (0–10 scale), and triggers; share this with your team to fine‑tune treatment. ^[12]

Bottom line

• Back pain can be a side effect of immunotherapy, often related to joint/muscle inflammation or nerve irritation, and is documented with multiple checkpoint inhibitors. ^{[1] [5]}
• Early communication with your care team and simple measures like heat, gentle movement, and appropriate pain relievers help most people cope effectively. ^{[2] [9]}
• Seek urgent care for red‑flag symptoms such as weakness, numbness, or bowel/bladder changes, because spinal complications must be ruled out. ^[7]
• Moderate to severe cases may require medical treatments, including corticosteroids and specialist support, to safely control immune‑related pain. ^[9]