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Side Effect: Bone Pain

What is Bone Pain?

Bone pain is a type of pain that originates from the bone tissue itself. Cancer is a common cause of bone pain, particularly in patients with metastatic disease. This can be due to the spread of cancer cells to the bones, which can then weaken the bones and cause fractures, compress nerves causing nerve pain, or cause other complications.

What does Bone Pain look like?

Bone pain can present in different ways, depending on the underlying cause and the location of the pain. It can be described as a dull ache, sharp pain, or throbbing sensation and can be accompanied by swelling, tenderness, or stiffness in the affected area.

Bone Pain

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Who gets Bone Pain?

In patients with cancer, bone pain is a common symptom that occurs with metastatic cancer to the bone. Most solid tumors have the ability to metastasize to the bone with the highest prevalence being breast cancer, prostate cancer, and lung cancer.

However, bone pain is not always due to cancer. Patients receiving granulocyte colony stimulating factors (also known as G-CSF), such as filgrastim or pegfilgrastim can also experience generalized bone pain from increased white blood cell growth within the bone marrow which creates pressure within the bone. While this can vary from slightly uncomfortable to very painful, it usually goes away after a few days when the medication wears off.

How to prevent Bone Pain

Prevention of bone pain in cancer patients involves treating the underlying cancer and addressing risk factors, such as osteoporosis. The use of bone-strengthening medications such as zoledronic acid (Zometa®), pamidronate (Aredia®), and denosumab (Xgeva®) can help prevent bone pain caused by bone metastases.
Some health care providers recommend taking loratadine (Claritin®) to prevent bone pain from filgrastim or pegfilgrastim. While this is effective in some patients, it does not work for everyone. When used, it is often started. On the same day and taken on each day filgrastim is taken, or for 14 days after receiving pegfilgrastim.

How to treat Bone Pain

Treatment of bone pain in patients with cancer typically involves a combination of medications and in some cases, radiation therapy as well. Medications used to prevent bone pain due to cancer include: zoledronic acid (Zometa®), pamidronate (Aredia®), and denosumab (Xgeva®), and these same medications can be used to treat bone pain as well.

Pain management strategies may include use of medications such as acetaminophen (Tylenol®), nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and opioids. In patients with bone pain from filgrastim or pegfilgrastim, use of antihistamines such as loratadine (Claritin®) or cetirizine (Zyrtec®) can help alleviate bone pain in some cases.


1) Jing D, Zhao Q, Zhao Y, et al. Management of pain in patients with bone metastases. Front Oncol. 2023:13:1156618.

2) Gralow J and Tripathy D. Managing metastatic bone pain: the role of bisphosphonates. J Pain Symptom Manage. 2007;33(4):462-72.

3) Milgrom DP, Lad NL, Koniaris LG, and Zimmers TA. Bone Pain and Muscle Weakness in Cancer Patients. Curr Osteoporos Rep. 2017;15(2):76-87.

Created: February 14, 2024 Updated: March 6, 2024