Pain and Melanoma Treatment: What to Expect and How to Manage It

Pain can be a side effect of melanoma treatment, and it may arise from the cancer itself or from therapies like surgery, radiation, or systemic treatments. ^[1] Pain management is considered an essential part of cancer care, and you have a right to receive treatment to keep you as comfortable as possible. ^[2]

Is Pain Common During Melanoma Care?

Melanoma treatments can cause side effects such as pain, nausea, and fatigue, and pain can also result from the disease when it spreads or presses on organs and nerves. ^[3] In some cases, procedures are done specifically to relieve pain or discomfort caused by growing cancer. ^[4] Many people with cancer do not receive enough pain treatment, so speaking up early and often about your symptoms is important. Reporting pain helps tailor effective relief and prevents suffering. ^[2]

Typical Sources of Pain

• Surgery (wide local excision, sentinel node biopsy): Post‑operative pain is expected and usually improves with time, but persistent or worsening pain may signal issues like infection, seroma, or nerve irritation and should be evaluated. Care teams plan pain control during hospitalization and after you go home. ^[5] It is normal to have some pain after surgery; if pain does not subside with medication, clinicians should reassess for complications. ^[6]

• Radiation therapy: Radiation can irritate skin and tissues, causing localized pain; its use in melanoma may also be aimed at palliating pain from metastases. Palliative radiation is commonly used to relieve pain in areas of tumor growth. ^[4] Radiation itself can be a cause of treatment‑related pain for some people. ^[2]

• Immunotherapy (checkpoint inhibitors): These medicines can trigger immune‑related side effects that involve joints and muscles, leading to arthralgia (joint pain), myalgia (muscle pain), or inflammatory arthritis. Musculoskeletal immune‑related events with PD‑1/PD‑L1 inhibitors have been documented in melanoma. [PM14] Checkpoint inhibitors can also activate underlying osteoarthritis, causing non‑inflammatory joint pain in typical OA joints (hips, knees, hands), sometimes needing local steroid injections or NSAIDs. Onset can range from days to months after starting therapy. [PM17]

• Targeted therapy (BRAF/MEK inhibitors): While effective, these can cause aches and fatigue; pain symptoms vary and are addressed similarly to other treatment‑related pains. Targeted drugs and immunotherapies are common in melanoma care and may have pain‑related side effects. ^[7]

• Cancer‑related pain: Tumor growth or spread can compress nerves or bones, creating acute or chronic pain; interventions may aim to reduce tumor burden or directly block pain signals. Treating cancer‑related pain is part of comprehensive care and should start early. ^{[1] [8]}

How Pain Is Managed

Pain control is individualized and often uses a stepwise approach that combines medicines, procedures, rehabilitation, and supportive care. ^[2]

Medicines

• For mild pain: Acetaminophen (paracetamol) or non‑steroidal anti‑inflammatory drugs (NSAIDs) are typically first‑line. These are recommended for mild pain and can be combined for stronger pain when needed. [PM15]
• For moderate to severe pain: Depending on severity, clinicians may add stronger agents, including opioids, while monitoring safety and side effects under established cancer pain guidelines. Guidelines exist for opioid use in adults with cancer and survivors to balance relief and risks. ^{[9] [8]}
• For neuropathic (nerve) pain: Agents like gabapentin, duloxetine, or tricyclics may be used when pain has a burning, electric, or shooting quality suggesting nerve involvement. Neuropathic pain often needs specific medications beyond standard analgesics. ^{[10] [11]}

Procedures and Local Therapies

• Nerve blocks or injections: For focal pain, local anesthetic or steroid injections can reduce symptoms without stopping cancer treatment. Local therapies can be effective especially for joint or nerve‑related pain. [PM17]
• Radiation for palliation: Targeted radiation to painful metastases can decrease tumor size and relieve pain. Palliative radiation is commonly used to improve comfort. ^[4]

Rehabilitation and Non‑Drug Measures

• Physical therapy and gentle exercise: Helps maintain mobility, reduce stiffness, and support recovery after surgery. Movement, when guided safely, can reduce pain‑related disability. ^[6]
• Heat/cold therapy, relaxation, mindfulness: These can complement medical treatments and reduce pain perception. Combining non‑drug methods with medications often improves outcomes. ^[2]

Coordinated Pain Care

Specialist pain teams work with oncology and pharmacy to tailor plans for acute and chronic pain across your treatment journey. Dedicated pain services create personalized plans to keep you as comfortable as possible. ^[12] Support continues during treatments and after they end, aiming to manage sudden and lingering pain effectively. ^[13]

When to Call Your Care Team

• New or worsening pain during treatment or after surgery that does not improve with prescribed medicine should be evaluated. Persistent pain may indicate complications or undertreatment. ^[6]
• Pain with new skin changes or growths should be discussed promptly since melanoma can recur and early detection matters. Regular self‑checks and early reporting are important after melanoma. ^[3]
• Joint pain on immunotherapy (especially hips, knees, hands) should be reported; early rheumatology input helps distinguish inflammatory arthritis from activated osteoarthritis and guides safe treatment. Timely referral supports symptom relief without compromising immunotherapy efficacy. [PM17]

Practical Tips You Can Use

• Track your pain: Note location, severity, what worsens or eases it, and timing relative to treatments. Clear descriptions help clinicians select the right therapy. ^[11]
• Ask for a pain plan: Request a written plan covering medicines, rescue options, and non‑drug measures. You are entitled to effective pain control as part of your cancer care. ^[2]
• Use a multimodal approach: Combining medicines, local therapies, and supportive strategies usually works best. Integrated care reduces pain and improves daily function. ^[14]

Bottom Line

Pain can occur during melanoma treatment, but most pain can be managed effectively with a tailored plan that may include medications, local procedures, rehabilitation, and specialist support. Early, honest communication with your team ensures timely adjustments and better comfort throughout care. ^{[1] [2] [12] [13] [9] [8]}