Chemotherapy is a common and effective cancer treatment, but it can lead to various side effects. Back pain is a frequently reported symptom that can cause discomfort and impact a patient’s quality of life.
Direct Effects of Chemotherapy on Back Pain
Chemotherapy drugs can directly contribute to back pain by affecting nerves, muscles, and bones. Chemotherapy-induced peripheral neuropathy (CIPN) is a notable side effect where certain drugs damage peripheral nerves, causing pain, numbness, or tingling that can extend to the back. Medications like taxanes (e.g., paclitaxel, docetaxel), platinum-based drugs (e.g., cisplatin, oxaliplatin), and vinca alkaloids (e.g., vincristine) are associated with CIPN. This nerve damage can manifest as sharp, radiating pain, sometimes resembling sciatica, felt in the lower back and potentially extending down the legs.
Some chemotherapy agents also cause myalgia (muscle pain) and arthralgia (joint pain), which can be perceived as back discomfort. Taxane-induced myalgia-arthralgia syndrome (TAPS) causes muscle and joint pain, often in the back, typically starting within 24 to 48 hours of receiving taxanes. Aromatase inhibitors, a hormone therapy for some breast cancers, can also lead to musculoskeletal symptoms like joint stiffness and muscle soreness affecting the back. Additionally, treatments stimulating white blood cell production, such as granulocyte-colony stimulating factors (G-CSFs like filgrastim or pegfilgrastim), can induce bone pain, often felt in the back. This pain arises from the rapid expansion of bone marrow and potential histamine release as new white blood cells are produced.
Related Causes of Back Pain During Chemotherapy
Back pain experienced during chemotherapy is not always a direct consequence of the drugs themselves; other factors frequently contribute to this discomfort. The cancer itself can be a source of back pain, especially if it has spread to the spine’s bones, known as spinal metastasis. Tumors in the spine can damage vertebrae or press on nerves, causing localized pain that may worsen at night or with movement. Cancers like breast, lung, prostate, and multiple myeloma commonly metastasize to the spine.
Other cancer treatments can also induce or worsen back pain. Radiation therapy to the spine, for instance, can cause a temporary pain increase in the treated area, known as a pain flare. Surgical procedures, particularly those involving the spine, can result in post-operative pain or changes in musculoskeletal mechanics leading to back discomfort.
Beyond specific treatments, general chemotherapy side effects can indirectly contribute to back pain. These include fatigue, which may lead to poor posture and muscle strain. Constipation, a common gastrointestinal side effect, can cause abdominal pressure radiating to the lower back, and weight changes can alter body mechanics, placing additional stress on the spine.
Alleviating Chemotherapy-Related Back Pain
Managing back pain during chemotherapy involves a combination of medical and non-pharmacological strategies, always in consultation with the healthcare team. Pain relievers are often prescribed, from over-the-counter options like acetaminophen or NSAIDs to stronger medications like opioids for severe pain. For nerve-related pain (neuropathy), medications such as gabapentin, pregabalin, or duloxetine may be considered; duloxetine is specifically recommended by the American Society of Clinical Oncology for chemotherapy-induced peripheral neuropathy. Corticosteroids can help reduce inflammation, and antihistamines like loratadine have shown promise in alleviating G-CSF-induced bone pain.
Non-pharmacological approaches can complement medical treatments and provide relief. Physical therapy, including gentle exercises and stretching, can maintain mobility and reduce stiffness. Applying heat or cold packs to the affected area can also soothe muscle and joint pain. Massage therapy and acupuncture are other options that some patients find beneficial for pain relief.
Relaxation techniques, such as progressive muscle relaxation or guided imagery, may reduce pain perception and improve coping. Lifestyle adjustments like maintaining good posture, using ergonomic seating, and engaging in light physical activity (as approved by a doctor) can also provide comfort and support.
When to Contact Your Healthcare Team
It is important for patients undergoing chemotherapy to communicate any new or worsening back pain to their healthcare team promptly. Immediate medical attention is recommended if back pain is new, severe, or suddenly worsens, especially if it does not improve with rest or usual pain relief, or if it occurs at night or is constant.
Seeking urgent care is also necessary if back pain is accompanied by new neurological symptoms. These include numbness, tingling, or weakness in the arms or legs, or changes in bowel or bladder control, which could indicate spinal cord compression. Furthermore, back pain alongside fever or chills could signal an infection, requiring prompt evaluation.