Can Immunotherapy Cause Bone Pain? What to Do

Yes, bone or musculoskeletal pain can occur during cancer immunotherapy, although it varies by drug and by person. Several immune checkpoint inhibitors list bone pain, back pain, arthralgia (joint pain), myalgia (muscle pain), and musculoskeletal pain among reported side effects. ^{[1] [2]} Durvalumab and tislelizumab product information specifically includes “bone pain” among adverse reactions. ^{[3] [4]} Patient education on immunotherapy side effects also highlights new or worsening joint and muscle pain, stiffness, and swelling as recognized issues. ^[5]

Why immunotherapy can lead to pain

• Immune-related inflammation: Immunotherapy “releases the brakes” on the immune system, which can unintentionally inflame joints, muscles, and surrounding tissues, leading to pain and stiffness. [PM16] Rheumatic and musculoskeletal immune-related adverse events (irAEs) are observed in a notable proportion of people receiving checkpoint inhibitors. [PM15]
• Types of painful irAEs: These can look like inflammatory arthritis, myositis (muscle inflammation), or polymyalgia-like syndromes, and may range from mild aches to more severe, function-limiting pain. ^[6] Onset can be delayed and symptoms may persist longer than typical chemotherapy side effects, so early recognition is important. [PM17]

Distinguishing bone pain from other causes

• Cancer-related bone issues: In some cancers (for example, multiple myeloma), the disease itself can weaken bones, cause fractures, and create significant bone pain independent of treatment. ^[7] Doctors often use X-ray, CT, or MRI to locate bone lesions before finalizing pain control plans, because bone pain can come from fractures or tumor pressure on nerves. ^[8]
• Treatment-related vs disease-related: Because immunotherapy can cause musculoskeletal inflammation and some cancers cause structural bone problems, clinicians usually evaluate both possibilities. [PM16] ^[7]

When to seek urgent care

• Red flags:
  • New severe, focal bone pain, especially with weight-bearing, or pain that wakes you at night, could signal fracture risk or spinal cord compression and needs prompt evaluation. ^{[9] [10]}
  • Sudden weakness, numbness, bowel/bladder changes, or rapidly escalating back pain require immediate medical attention. ^[10]
• General rule: Any new, changed, or worsening joint/muscle pain or swelling during immunotherapy should be reported early to your care team. ^[5]

How to cope: step-by-step strategies

• Mild symptoms (Grade 1):
  • Try acetaminophen (paracetamol) and, if appropriate, short courses of NSAIDs like ibuprofen; this is commonly the first-line approach for arthralgia/myalgia. ^{[11] [12]}
  • Gentle movement: low-impact exercise, stretching, and physical therapy can reduce stiffness and improve function. ^[13]
  • Heat/cold packs, rest cycles, and sleep optimization can help comfort and recovery. (General supportive guidance consistent with musculoskeletal care.)
• Moderate symptoms (Grade 2):
  • If pain limits daily activities or persists despite simple measures, clinicians may add or adjust NSAIDs, consider short-term opioids when NSAIDs are contraindicated, and evaluate for inflammatory irAEs. ^[12] [PM16]
  • Lab checks (ESR, CRP) and autoimmune markers (ANA, RF, anti-CCP) can be considered if inflammatory arthritis is suspected. ^[14]
  • Imaging (X-ray/MRI/ultrasound) may be used to distinguish inflammatory arthritis from structural bone disease. [PM14]
• Severe symptoms (Grade 3+):
  • Corticosteroids are often used to calm immune-related inflammation when pain is moderate to severe or clearly inflammatory. ^[11] [PM16]
  • If symptoms are steroid-refractory, targeted immunomodulators may be considered by specialists on a case-by-case basis. [PM19]
  • Your oncology team may temporarily hold immunotherapy depending on severity and organ involvement; decisions are individualized for safety and cancer control. [PM17]

Practical self-care tips

• Track your pain: Keep a simple diary noting location, intensity, triggers, and what helps; share this with your care team to personalize treatment. (Supportive practice consistent with symptom management.)
• Protect your bones: If your cancer increases fracture risk, clinicians may consider bone-strengthening measures and imaging to monitor structural integrity. ^{[7] [8]}
• Stay ahead of stiffness: Short, frequent movement breaks, gentle range-of-motion exercises, and guided physical therapy can prevent deconditioning. ^[13]
• Medication safety: Use NSAIDs only if your team says they’re safe for you, especially if you have kidney issues, stomach ulcers, or are on anticoagulants. ^[12]
• Communicate early: Report new or worsening pain promptly early management typically leads to better outcomes and may prevent complications. [PM16]

What your care team may do

• Assess and rule out emergencies: Exam and imaging if fracture, nerve compression, or spinal issues are suspected. ^{[10] [8]}
• Confirm inflammatory irAEs: Labs, imaging, and sometimes rheumatology referral to identify ICI-induced arthritis or myositis. ^[14] [PM15] [PM14]
• Tailor treatment: From simple analgesics to corticosteroids, and in select cases additional immunomodulators, care is personalized to your symptoms and cancer plan. ^[11] [PM16] [PM19]

Bottom line

Immunotherapy can be associated with bone or musculoskeletal pain, often due to immune-related inflammation, and several checkpoint inhibitors list bone pain among possible side effects. ^{[3] [1] [2]} Early reporting, careful evaluation to exclude structural bone problems, and stepwise management from simple analgesics and activity modifications to corticosteroids for inflammatory irAEs are the keys to coping safely and effectively. ^{[5] [11]} [PM16] ^[8]

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