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Is bone pain from Neulasta common? If so, how can bone pain be prevented or treated?

38 answers | Last updated: Mar 30, 2015
An anonymous caregiver asked...
My father’s been given a combination of Taxol/Carb and Neulasta one day later and is suffering excruciating bone pain. The doctor prescribed acetominophen, and, finally after I insisted, he prescribed Vicodin. Is this really all anyone can offer? Also, would waiting another day or two for the Neulasta have made the pain less? How can I talk to the doctor and get a more proactive response?

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Andrew Putnam, M.D. is a Palliative Care physician at Smilow Cancer Center at Yale New Haven Hospital and Yale University.
94% helpful

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 See also:
Can You Get Chemo With a Low White Blood Cell Count?

See all 43 questions about Low Blood Cell Counts
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.


More Answers
47% helpful
Survivor26 answered...

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.


8% helpful
JOE ROSENADA answered...

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


40% helpful
melztreazures answered...

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!


17% helpful
JOE ROSENADA answered...

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


50% helpful
Rya answered...

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.


14% helpful
haynesfam answered...

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.


25% helpful
enl answered...

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. :-)


57% helpful
di-star answered...

I just received my first Neulasta shot on Sunday. I am experiencing severe bone pain even four days later. My doctor recommended Claritin, with oxycodone, and Ibuprofen. I should have it all at the house tomorrow. The message board is great but always ask your doctor. For the lady with problems and her dad getting the doctor to listen, tell the doctor to read this message board!


reslient answered...

haynesfam - I have had a similar situation. It has been 10 months since I finished chemo. During the six months of chemo, I was treated with growth factor drugs with each round (i.e., Neupogen or Neulasta). Since finishing treatment, I have continued to have bone marrow pain. Additionally, my blood counts have been suppressed. I am currently working with my oncologist and a hematology oncologist to monitor the blood work. That being said, I am concerned. Have you had any additional opinions on the normalcy of persisting bone marrow pain? Also, have your blood counts come back up?


33% helpful
Jeanine 2012 answered...

I have been taking hue when nuepegen injections daily for ten days! The most awful pain I have ever experienced! Worst than my spinal fusion,radiation, chemo, etc. I thought I would die, two more days left. I am taking claritin today after my second call to my doctor for pain. I was taking oxycodiene 5mg which was up to 10mg then I started throwing up. I pray for all of us that have to go through this! God bless us and the families that are taking care of us.

Diagnosed with multiple myeloma 2011


25% helpful
SchoolBoardLady answered...

On my sixth dose of FOLFOX-6 cocktail, (four prior and two after surgery) my neutrophils went off the cliff (.98 from a slow decline starting at 3.34). So my onco doc insisted on chemo treatment followed by Neulasta and he offered that all their patients seem to have good luck taking Claritin starting one day before the time released injection for at least five days. Chemo nurse also offered that a daily dose could be given if I didn't 'tolerate" the ten day Neulasta 10 day time release product. I opted for the daily injections so we can 'control" this beast a bit, plus I will take the Claritin. Sounds a bit violent to me... so I want to minimize the side effects. I don't want to be the patient with the enlarged spleen. After neupogen shot two, I experienced a huge headache, dizziness, mild nausea but raging insomnia and ear ringing--BUT no bone pain! I plan to wait a day and have my blood counts taken. If the neutrophils are close to normal range (2.0-6.0), I will skip any more Neupogen. Since those Neutrophils only live six hours, what's the point of over stimulating their production and suffering?


17% helpful
Eislinda answered...

Husband just completed his first week of chemo for NH Lymphoma and on Sat had very bad bone pain. Was still very painful on Monday. Asked our oncology nurse if Claritin would harm him in any way and they said no, and that they had never heard of using Claritin for bone pain following chemo. Within 30 minutes of taking Claritin, his pain was greatly relieved. One little pill every 24 hrs. Will now know to use this for his next treatments. We're very thankful for this info - and will be passing it on to our cancer center.


11% helpful
Debc827 answered...

I've just finished my 5 th round of Chemo on Thursday but my first dose of Taxol and got my 5th Neulasta shot on Friday which never caused me a problem I even use the Claritin the day before and day after this Saturday I woke up with such intense pain I could barely walk pain progressed called oncologist said take Percocet 10-15 mg barely took edge off after reading this I'm adding naproxen and Claritin. Heating pads and ice packs just not helping. Good luck to everyone trust me I feel your pain and I pray we all find comfort and a way to treat this unbareable feeling.


67% helpful
SchoolBoardLady answered...

During my chemo treatment for stage four colon cancer (right now I am "no visible disease) I had one Neulasta-Neupogen event due to one low white blood count and I fought my doctor's urge to treat me with the most potent and most painful course of marrow stimulator. When he prescribed Neulasta (10 day/dose equivalent of Neupogen) I insisted on taking the one injection per day Neupogen for two days at a time followed by a blood test to measure my response. Since I was considered 'such a sensitive" patient, my dear saint of a chemo nurse advised my to take the Claritin starting the day before the first injection and for two days after the last..... The result, two shots of Neupogen raised my white blood count 7 times above normal and I had minimal bone pain. I insisted on coming to the chemo center for each injection and of course the blood count test. I argued I was saving my insurance company money by insisting on one day at a time Neupogen at $2000 per injection vs the atomic bomb of colony stimulators--Neulasta which is billed at $8000 per injection. Another reason to take the day at a time Neupogen and a blood tests is the slow and measured approach protects you against the very serious side effect of Neulasta--spleen rupture. If you over stimulate your marrow and all of those immature white cells storm your spleen (where they migrate to mature) you risk overwhelming the spleen and causing a rupture. Stand up for yourself and insist on more measured chemo treatment and less narcotics to treat pain from over treatment with neulasta. The thought of narcotics on top of usual constipation from Emend or Aloxi anti emetics is more than anyone one person's digestive system can bear. Sorry Doctor Putnam. My chemo nurse was really my friend, advocate and angel of mercy as she dealt with all the drug infusions, blood tests and side effects. She was perfectly fine with the daily injections and more frequent blood work.


Wendysgobbo answered...

I am a 32 year old with Ewing's Sarcoma - a cancer found almost exclusively in 10-20 year olds. After my first round of chemo I was given no warning about the Nulesta side effects. A week later, on Christmas Day, I went from having a backache to having the worst pain possible in my bones. It was in my back, hips, femurs and rib cage. It hurt to breath or move. I went to the hospital and was given several drugs until I ended up on a pain pump for 2 days. After another cycle and the same results we switched to Nupogen to see if the pain would be less intense. No luck. We also tried the Claritin and that didn't do anything, but they only had me take it the day before the shot and not any other days. My 5th and most recent cycle resulted in leg pain, from my hips to my ankles. They docs are trying different meds, but nothing has made much of a difference so far. I'm not sure how I'm going to get through this given that I have 12 more rounds of chemo to go! I pray that we all find some relief!


33% helpful
SchoolBoardLady answered...

Wendysgobbo, i sure hope you can get some relief. At least stay with the Claritan, before the first injection and continuously and up to two days after the last injection. Also, does you doc check your white blood count after two or three successive Neupogen injections? It helped me to check my blood every other day rather than take so much of the colony stimulator. I was scared to death that the Neulasta would over-stimulate my marrow and I would end up with spleen enlargement. Sending prayers your way.


An anonymous caregiver answered...

Not understanding Dr.Putmans write up. When I first started Chemo was told "DO NOT take any aspirin containing medicine" So go by my chemo doctors rules., especially with the blood counts ect.


gjuana answered...

I actually went to a pain management doctor. She did blood work on the initial visit and actually called my house that night with results. She told me that my Vitamins D level was 9ng. A level of 20-50ng is adequate for healthy people and less than 12ng indicates Vitamins D deficiency. She told me to start taking vitamin D 5000IU D3 twice daily for 2weeks then Once daily after that. She also gave me B12 injections daily for 2weeks. I finished chemo in 2012 and I still take vitamin D and B12 daily. It helps me greatly. Try it and give feedback. I know everyone is different, so I'm interested to see if it helps anyone else.


50% helpful
msigk answered...

I received my second chemo treatment 3 days ago. Prior to the chemo, and after having my blood drawn to be sure that it was OK to administer chemo that day, I met with my oncologist and told him about the severe bone pain that I experienced 2 weeks ago after I received the Neulasta shot. He suggested that I use over -the-counter Zyrtec the day of and one or two days after the injection. It worked! I'm writing because I just read on this forum about Claritol. I'm certainly not a physician but I guess they both work pretty much the same way. Sure, the pain was still there, but NOWHERE near as bad as my first time, without the Zyrtec. I hope this helps someone to tolerate their treatments a little better. God Bless, Michael K.


An anonymous caregiver answered...

I was told by md not to take nsaid due to chemo. Then rn said to take motrin for bone pain


An anonymous caregiver answered...

I had excruciating bone pain from Neulasta and my solution was acupuncture. I get an acupuncture treatment the day of or the day after the shot, and the pain never comes.


33% helpful
An anonymous caregiver answered...

Take Claritin. Ask your MD if you can double your dose depending on weigh. The antihistamine blocks some receptor or what not and helps the pain decrease.


An anonymous caregiver answered...

I've had NHL and HL, 3 years apart, last time in 2013. I received Neulasta shots that felt like I was getting murdered. Unbelievable pain. Finally a nurse suggested Claritan. So I took ONE tablet as I was getting the shot and the pain never happened. Not even a "1" on the pain scale because it was non-existent. Didn't take another pill at all. When I received a shot (even the big dose one), all I would do was take 1 pill, one time and I was spared the agony.

What REALLY ANNOYS me the fact that this Dr (Andrew Putnam) mentions NOTHING of Claritan but instead recommends all these highly addictive, dangerous drugs. We should all expect more from our so called "Doctors", even though they're just "practicing" medicine. Stay healthy!


An anonymous caregiver answered...

I am on my 7th chemo treatment and received Neulasta shots after each treatment. The first 4 were not extremely painful. I take Zyrtec everyday. The last 3 treatments with the Neulasta shots have been extremely painful. I have done nothing different between the first 4 and the last 3 except for having to take warfarin. So certain meds for me are out. I finally took a hydrocodone on Sunday to stop the pain. Monday it was like a key turning pain off to very little pain.


100% helpful
An anonymous caregiver answered...

After my 1st nulasta shot I thought I was literally going to die! Never have I experienced such terrible pain. Began taking Claritin every day for the rest of my chemo treatments/nulesta shot combinations. Never experienced the pain again. Also, as a side note for those experiencing bone pain long after treatment was finished-I developed rheumatoid arthritis presumably as a result of the chemo so you may want to ask your doctor to just check. Good luck to everyone!


DrC answered...

Antihistamines like Claritin and Zyrtec help a lo of Neulasta patients and they are pretty benign. In some patients (like me) they're not enough. Like many people here I found that narcotics weren't of much help. However, I added montelukast (Singulair) which compliments the usual antihistamine working earlier in the histamine cascade. It worked and the pain had subsided within six hours.


jmende answered...

Chemo ended 2 years ago for me. They say you can't remember pain. I disagree. The pain from the Neulasta injection, that came 4 days later, was excruciating! I still have a lot of bone pain, mainly in the pelvic/hip bones. Some people have posted that they were writhing in pain. That is not an understatement. I must say though, that my counts were always good and I never did get an infection. My oncologist said that the healthier the bone marrow and the younger the person, the pain is worse but more effective.


Meme73 answered...

The ingredient in Claritin can be prescribed by your DR. It has worked wonders for the pain from the shot for my mother in law. And Drip Drop for the dehydration she had.


Tsmbakerinpa answered...

I have been battling Breast cancer since April 2014. The bone pain from the Neulasta was excruciating!!!! I've had 2 children, a double mastectomy and over 225 kidneys stones and this is the worst pain I have ever experienced. I hurt in my knees, back or hips, sometimes in all areas at the same time. I URGE YOU TO TAKE CLARITAN THE MORNING OF YOUR INJECTION!!!! It is amazing how much this decreased the pain. I was taking Vicodin and morphine (rotating them) and it wouldn't touch my pain. The nurses finally told me about the CLARITAN and it has been a life saver!! I take it once a day for three days.


Gone crazy answered...

The Pain is unbelievable I'm taking 7.5hydrocodone it helps but the pain is still there I wi buy Claritin in the morning and I agree labor and kidney stones are a walk in the park next to the pain of nuelasta


An anonymous caregiver answered...

I just had my third round of chemo and third neulasta shot and have experienced bone pain each time, though not too severe. I take Claritin before chemo and for a week after every day. I take ibuprofin when needed, my oncologist says it's fine to take it. What really seems to help me though, and I have never heard anyone talk of this, is to exercise as soon as I can again after chemo. Three days after chemo I start with walking and some yoga and the next day with a circuit training dvd with light weights, squats, jumping jacks and so on. I visualize the pain leaving my body as I push through a slightly hard workout (due to chemo I am out of breath quickly). I normally like to exercise, so that helps, but I feel that the stress put on my bones just seems to make the pain get much better.


cory8427 answered...

So breginnjng I can only use Tylenol based no ibuprofen of any short because of my double lung transplant 2 yrs ago. Does Zyrtec do the same as Claritin? And they gave me Dilaudid for pain lol.. Will those help with the aching? I get my shot tomorrow had my first chemo today. Thanks guys!


An anonymous caregiver answered...

My oncolist told me to take Claritin D daily during my upcoming chemo treatment. It seems to help lots of patients with the bone pain.


An anonymous caregiver answered...

To the person asking if Claritan helps - yes, it absolutely helps! You can usually take one per day starting the day before your Neulasta shot and take one each day until a couple of days after the shot stops working (10 days for Neulasta, other timelines for other shots - ask your doctor)... I still had pretty severe pain even with the Claritan after Neulasta, so I took a 200mg (one regular) ibuprofen every few hours to help with the pain... It helped so much! I also swtiched to three consecutive days of Neupogen after my second round of chemo because the Neulasta pain was just too much. (I chose not to take narcotics because I am concerned about addiction). Everyone is different, and you should always consult with your physician before taking any medications (even over the counter or vitamins), as no one knows your condition except your physician... One last thing: drink an obnoxious amount of water if you're able to - this will help your body on many levels while you're in treatments. God bless you on your road to wellness!


sherridawn answered...

I finished 2nd cycle of Chemo last Tuesday, got shot on Wednesday. My doctor told me to take Claritin for 10 days, starting the morning I received the shot. On my 1st cycle, I didn't experience any kind of bone pain. But that all changed this time. It's been 9 days since getting it and my body has felt like it's been run over a million times every day, especially in my chest and legs. My oncologist instructed me NOT to take Tylenol, Ibuprofen or any other related medicine duE to the fact that it will reduce fever and they want to know asap if my fever has hit 100.5 or greater. Like I said, Claritin worked great first time, but not at all this time. My morphine pills did not help either. I know the pain your dad is suffering from and wouldn't wish it upon anyone! Hope he has some relief from it soon.


Jomari answered...

I took one Claritin pill with two Advil gel caps the day before, the day of and 4 days after each chemo treatment (with a Neulasta shot the day after chemo). I experienced NO bone pain AT ALL. I had a powerful "cocktail" every three weeks to treat stage 3 breast cancer.


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