Is bone pain from Neulasta common? If so, how can bone pain be prevented or treated?
Neulasta is an effective medication to help shorten, but not prevent, post-chemotherapy neutropenia (low white blood cell count). Unfortunately, one common side effect is severe bone pain. It's a growth factor, which means it works by revving up the bone marrow to produce more white blood cells. Since this is the cause of the pain, according to most experts, the intensity of the pain doesn't change based on how many days after chemotherapy it’s given.
Neulasta is a time release form of Neupogen and is the equivalent of ten successive days of injections of the latter medication. Some oncologists try to reduce the pain by giving seven successive days of Neupogen (rather than the usual ten) in place of the Neulasta. The idea being that less total drug would mean less total pain but still be effective to support the white blood cell count. The downside is that daily home injections are required, rather than a one-time Neulasta dose lasting ten days.
Pain medication is important in this situation, and acetominophen is not the most effective choice because it doesn't work to reduce inflammation. A better choice would be an NSAID (non-steroidal anti-inflammatory drug) such as ibuprofen or naproxen. NSAIDS relieve inflammation and swelling and so can be very effective for most types of bone pain. Acetaminophen is not an NSAID and while helpful for many types of pain, it doesn't reduce inflammation and so is less effective here. NSAIDs must be used with care because they can cause stomach pain or ulcers, kidney problems, and bleeding problems, but surprisingly may be more effective than narcotic pain meds for bone pain.
If the ibuprofen/naproxen is not effective, ask your dad's doctor about trying a medication that combines an NSAID with a narcotic such as Combunox (oxycodone and ibuprofen), Percodan (oxycodone and aspirin) or Vicoprofen (hydrocodone and ibuprofen). The other choice is too add a pure narcotic, such as morphine, oxycodone, or hydromorphone to the NSAID as a separate drug. The disadvantage is more pills, but doing this allows you and your father to control separately the amounts of NSAID and narcotic, thereby reducing the possible side effects. Neulasta is an effective medication to help shorten, but not prevent, post-chemotherapy neutropenia (low white blood cell count). Unfortunately, one common side effect is severe bone pain. It’s a growth factor, which means it works by revving up the bone marrow to produce more white blood cells. Since this is the cause of the pain, according to most experts, the intensity of the pain doesn't change based on how many days after chemotherapy it’s given.
I too had sever bone pain after each Neulasta injection. It was so severe that onlu oxycodone would even take the edge off. After reading about it on several blogs, I decided to give Claritin a try. The results were incredible! I took it the morning of my scheduled injection and for the following 3 days that I would normally have pain. I rarely felt more than an occasional 'twinge' that was quickly alleviated by taking 2 Tylenol.
Thank you Dr Putnam so very much for this VERY informative answer. My wife has been fighting Cancer since the age of 26,she is 52 now. First Hodgkins Lymphoma at age 26, treated with Radiation, then Hodgkins again at age 30 for which she received Chemo, then breast cancer 5 yrs ago. And now as if she hasn't suffered enough, Colon cancer Diffuse Large B cell Lymphoma. When the Oncologist gave her the Neulasta injection she never told her any of the side effects. She has Osteoporosis, don't know if this would make the side effects worse? Anyway the bone pains and malice that she suffered were horrific. I will try to implement your suggestions with the next course. Thank you again
First of all, it is vital that you have a doctor or his staff that is accessible at all times for any questions or concerns you may have. I've never waited more than an hour for a return call from my doctor or staff. The chemotherapy and all of the side effects that come with it are difficult enough when well managed. It's so much worse when you feel lost at sea hoping someone will toss you a raft. Claritin worked well for me along with ibuprofen as needed.
Good luck!
Well, we tried the Ibuprofen and it worked like a charm!!! We also supplemented with Oxycodone 5mg q6. I gave her the Ibuprofen for 4 days and then stopped it, I was worried about her platelets. But the pain after the first CHOP+R and Neulasta Was a 10, it was horrible, but the second with the Ibuprofren and Oxy codone was 2-3 It was AMAZING how much better she tollerated her treatment. GOD BLESS YOU Dr Putnam. Im gonna try the claratin for her third cycle. Thank you melztreazures for your input and your hug....keep on trukin baby
I had cancer last year and went through chemo, I am now cancer free. During wich I had 2 bouts of nutropenic ferver, I was given nuepogen the first time and we asked if there were any side effects, the nurse said none, to my suprise several hours later i was rithing in pain. The subsequent treatments of nuepogen and then nuelasta were slightly less painful.My question is now after a year when I get sick( a cold) my bones hurt in a similar way but not as intense. Does anyone have any thoughts or does it happpen to any one else.
I had neulasta last year...finished chemo Dec.2010. I am experiencing the same thing, particularly in my legs...same type of pain as neulasta but not as intense. My family MD feels it could be an ongoing side effect,but the oncologist doesn't feel it's related. I tend to side w. my family MD b/c I know how I feel.
I received my first chemo Thursday and the neulasta shot Friday. By Saturday night, I was in pain. Sunday morning my husband heated two pads in the microwave, and I put them on my thighs. They seemed to help quite a bit. I moved one around to my wrist and it also helped. At the present time, I am only on ibuprofen and prayer. :-)
