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Bone Pain and Lymphoma

Medically reviewed by Todd Gersten, M.D.
Written by Victoria Menard
Posted on February 22, 2022

Bone pain is a common symptom of lymphoma. As one MyLymphomaTeam member wrote, “I struggle with fatigue and bone pain daily.” Several factors may cause bone pain in people with lymphoma, including metastasis (the spread of cancer cells to the bones), lymphoma treatments, and a type of lymphoma called primary lymphoma of bone (PLB).

As with any symptom, if you experience new or worsening bone pain, talk to your oncologist. Your doctor can help determine the cause of your pain and work with you to find the best way of managing it.

How Does Lymphoma Cause Bone Pain?

Bone pain can occur in lymphoma for several reasons. The pain may be a side effect of lymphoma treatments or develop as a result of the lymphoma itself. Bone pain can occur in different areas of the body and may affect several body parts at once. As one MyLymphomaTeam member shared, “I’m having a lot of bone pain today. My legs are the worst this morning, and, of course, my back pain.”

Bone Metastasis

Bone metastasis refers to the process in which cancerous cells have spread (metastasized) from their original location into the bones. Although many types of cancer can cause bone metastasis, certain cancers — including lymphoma — are less prone to spreading to the bones. When cancer cells metastasize to the bones, they most commonly migrate to the spine. Bone metastasis may also occur in the pelvis, ribs, upper arm bone (humerus), upper leg bone (femur), or skull.

Bone pain is typically the first indication that lymphoma has metastasized to the bone. This pain may be intermittent — worsening and improving at different times. People with cancer-related bone pain often find that this symptom improves with physical activity or movement and worsens during the nighttime. As bone metastasis progresses, a person’s bone pain may become chronic or constant and can be aggravated by physical activity.

Radiation and Chemotherapy

Cancer treatments like radiation and chemotherapy can have toxic effects on the body, damaging healthy cells alongside cancerous ones. This damage may cause bone pain as a side effect.

Many MyLymphomaTeam members have shared that their bone pain lasts much longer than the duration of their treatment. As one member asked, “Has anyone had leg and bone pain after chemo? It’s been five years, and it gets worse.” Another member wondered when this symptom might go away, writing that they “still wake up with a lot of bone pain” despite finishing their final round of R-CHOP eight weeks prior.

Responses varied: “I don’t know,” wrote one member. “I’ve been in remission for a year, and every so often, I get those bad bone pains.” One responded that they still have bone pain four years after entering remission, while another member shared that their bone pain “comes and goes” four years after treatment.

Primary Lymphoma of Bone

Although most types of lymphoma originate in the lymph nodes, cancer may develop in any area of the body. Pain is the most common symptom of PLB.

PLB begins in the bone marrow, damaging its tissues and causing the bone itself to weaken. People with PLB may experience bone pain even without movement. This subtype of lymphoma is most commonly a type of non-Hodgkin lymphoma known as large B-cell lymphoma.

PLB is very rare — bone metastasis is much more common than lymphoma that originates in the bones.

Bone Marrow Biopsy and Aspiration

Certain diagnostic procedures used for lymphoma may cause bone pain, including bone marrow biopsies and bone marrow aspiration. This pain may last at the procedure site for several days afterward, but this is rare.

As one MyLymphomaTeam member going for a bone marrow aspiration shared, “Preparing myself for the PAIN! They numb the top layer of skin, but [the needle] goes ALL the way down into the bone to extract a piece of the bone and marrow.” They went on to note, however, that the procedure “is quick, and by the time it’s over, the pain subsides!”

However, not everyone finds these procedures equally uncomfortable: one member shared that they “did not find the bone marrow aspiration to be as bad as I feared,” while another wrote, “the one I had last year was almost painless.”

Managing Bone Pain With Lymphoma

Let your health care team know if you’re experiencing bone pain as a symptom or as a side effect of your cancer treatment. They will be able to advise you on pain management options and determine whether adjusting your treatment may help.

To help determine the cause of your bone pain, your health care provider may consult your medical history, perform a physical examination, or use imaging tests, such as magnetic resonance imaging or an X-ray.

Medication for Pain Management

Your doctor may recommend over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs or acetaminophen, to alleviate mild or moderate bone pain. However, you may be advised against taking these medications while undergoing radiation therapy or chemotherapy.

If over-the-counter medications aren’t successful in relieving bone pain, your doctor may prescribe stronger pain relievers. These medications may include combination opioid and analgesic (painkiller) drugs such as Norco (hydrocodone/acetaminophen), morphine, and other opioid medications, such as hydrocodone and oxycodone.

Treatment for Bone Metastasis

Treating bone metastasis may help relieve the associated bone pain. The type of treatment your oncologist recommends typically depends on the type of lymphoma you have, as well as the location of cancer cells in your bones.

Various medications used to treat bone metastasis may help manage bone pain. Steroids, in particular, can help alleviate pain by reducing inflammation around bone tumors or lesions. Medications traditionally used to treat osteoporosis can help increase bone strength, which may also relieve bone pain.

If treatment options for metastasized lymphoma don’t relieve your pain, your doctor may recommend or prescribe potent pain medications like those listed above.

Pain Relief During Bone Marrow Testing

Your health care provider may prescribe medications to help alleviate pain associated with bone marrow biopsies or bone marrow aspiration.

Complementary and Alternative Medicine

Some people find that complementary and alternative medicine approaches, such as acupuncture and massage, help manage lymphoma-related pain.

Meet Your Team

Living with lymphoma can be challenging. Finding a support system can make a world of difference. MyLymphomaTeam is the social network for people with lymphoma. More than 10,000 members come together to ask questions, give advice, and share their experiences with others who understand life with lymphoma.

Have you experienced bone pain and lymphoma? How have you managed the symptom? Share your experience in the comments below or by posting on MyLymphomaTeam.

Posted on February 22, 2022
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Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Victoria Menard is a writer at MyHealthTeam. Learn more about her here.

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