Is immunotherapy treatment painful?
Yes, immunotherapy treatment can be painful. The process of infusing immunotherapy drugs into the body through your skin can cause a painful reaction at the needle site. After the immunotherapy kicks in, it can also cause pain and inflammation in other areas of the body weeks or months after treatment has started.
Why is it painful?
The pain experienced when the immunotherapy is being administered is called an infusion reaction. It is a strong response to treatment by the body. The immune system may recognize immunotherapy as a foreign substance and try to fight it off, resulting in painful skin reactions.
Once administered, immunotherapy boosts your immune system to better target cancer cells. In the process of targeting these cells, your immune system may attack healthy tissue in error. Areas such as the skin, chest, abdomen, joints and eyes can all experience inflammation and pain as a result.
What types of pain?
Injection site pain and skin reactions
Infusion-related pain can occur right after treatment is administered. It is a skin reaction at the injection site that causes pain, swelling and soreness. It is the most common side effect of intravenous immunotherapy.
Other than immediate infusion reactions, immunotherapy can also cause redness, blistering, dryness and painful sores on the skin. These types of reactions manifest 2 to 3 weeks after treatment. Inflammation around the nails and fingertips can make dressing and other daily activities difficult and painful.
Mild skin reactions are treated with creams, ointments and oral antihistamines. More severe cases may require immunotherapy to be stopped or the use of oral steroids. Anything more serious may necessitate intravenous steroids along with immunotherapy discontinuation. In rare cases, severe skin reactions such as Stevens-Johnson syndrome or toxic epidermal necrolysis may occur, which require a hospital stay.
The colon may become inflamed, causing severe stomach-area pain or cramping. Diarrhea, colitis and hepatitis may come along with the pain. Diarrhea can be common, and it occurs in over half of patients treated with CTLA-4 inhibitors, a type of immunotherapy. Abdominal pain typically begins 5 to 10 weeks after the first immunotherapy infusion.
Initially, abdominal pain requires managing underlying diarrhea. If it becomes severe, immunotherapy may be stopped until symptoms improve. If not, oral steroids may be started. Intravenous corticosteroids and permanent discontinuation of the immunotherapy are reserved for highly severe cases. If intravenous steroids fail, a medication called infliximab may be considered for gastrointestinal adverse effects.
The inflammation caused by immunotherapy can cause joint or muscle pain. This can sometimes degenerate into a disease called arthritis.
Inflammation in the lungs can cause a cough, which can lead to chest pain.
Pain management options
Pain medication plays a key role in relieving pain caused by immunotherapy treatment.
Outside of pain medications, there are complementary therapies available to control pain. These include treatments such as:
- Breathing and meditation
- Distraction with enjoyable activities
- Hot and cold compresses
- Gentle therapeutic massage
- Physical or occupational therapy
- National Cancer Institute (NCI). New Drugs, New Side Effects: Complications of Cancer Immunotherapy. May 10, 2019. Available at: https://www.cancer.gov/news-events/cancer-currents-blog/2019/cancer-immunotherapy-investigating-side-effects. [Accessed July 20, 2021].
- National Comprehensive Cancer Network (NCCN). Understanding Immunotherapy Side Effects. Available at: https://www.nccn.org/docs/default-source/patient-resources/immunotherapy_infographic.pdf?sfvrsn=f92249ca_2. [Accessed July 20, 2021].
- Cancer Research Institute. Immunotherapy Side Effects. November 2019. Available at: https://www.cancerresearch.org/en-us/immunotherapy-side-effects. [Accessed July 20, 2021].
- American Society of Clinical Oncology (ASCO). Other Ways to Manage Pain. March 2021. Available at: https://www.cancer.net/es/node/24586. [Accessed July 20, 2021].
- Matts C, Beck A. Immunotherapy-Related Adverse Effects When Treating Cancer. Journal of Palliative Medicine. 21 May 2019. Volume 22, Number 6. https://doi.org/10.1089/jpm.2019.0179.
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