Musculoskeletal (MSK) Issues

myalgia - muscle pain | arthralgia - joint pain | neuropathy - nerve pain

Myalgia: muscle pain or soreness, cramps, stiffness, tenderness, weakness. Arthralgia: joint pain, stiffness, loss of flexibility. Peripheral neuropathy: often in the hands and feet, numbness, tingling, stabbing or burning pain, weakness.

When do MSK Issues start and how long do they last?

On average, muscle and joint pain begins within the 1st month after starting treatment. On average, nerve pain begins three months after starting treatment, and lasts for 12 months.

How serious are MSK Issues?

The severity most often experienced is grade 1 or 2.

How likely is it that I will experience MSK Issues?

Lorlatinib: 44% of people will experience any MSK issue. Alectinib: 23% of people will experience muscle pain. Crizotinib: 25% of people will experience nerve pain.

Prevention Strategies

black woman speed walking

  • This includes activities such as walking, swimming, and yoga.

    Why: exercise keeps joints and muscles flexible and can reduce stress on them. Exercise also improves circulation which may support nerve health.

white man holding heavy boxes

  • Start exercise gradually and build up intensity over time.

    Avoid exercise that is hard on joints such as running, tennis, or contact sports.

blood vial with magnifying glass

  • Your healthcare team should monitor CPK levels with blood test every 2 weeks during the first month of treatment.

    Why: elevated CPK levels can cause muscle pain.

Management Strategies

pill bottles labeled ibuprofen and B1

  • Myalgia and arthralgia:

    • take ibuprofen such as Advil or Alive for pain.

    Peripheral neuropathy:

    Talk to your doctor about supplements and medications that might help:

    • supplements such as B1 and B6.

    • medications such as gabapentin and pregabalin.

hot water bottle

  • For arthralgia and myalgia:

    • try warm showers or a hot compress

    • massage and gentle stretching

    For peripheral neuropathy:

    • keep hand and feet warm

start, pause, and stop buttons

  • If CPK elevation is 5 times the normal limit:

    • Medication may be temporarily withheld until CPK levels return to normal.

    • once CPK has returned to normal, medication may be resumed at the same or a reduced dose.

    Sever neuropathy may require a dose modification.

Emergent Symptoms

If you are unsure, it is always safer to seek medical care.
Tell emergency staff you are on an ALK inhibitor for lung cancer.

phone

Call a Healthcare Provider

Call 811 for health advice from a registered nurse OR call your care team

  • New or worse muscle or joint pain

  • Pain that makes it hard to move or do daily tasks

  • Muscle pain that does not get better with rest or pain medicine

  • New or worse weakness

  • Burning, stabbing, or sharp pain

  • Changes in bathroom habits (trouble pooping or peeing)

  • Problems with balance or feeling unsteady

ambulance

Visit an Emergency Room

Call 911 or drive to your closest emergency room

  • Chest pain

  • Trouble breathing

  • Very bad muscle or joint pain with redness or swelling

  • Muscle pain with fever, chills, or extreme tiredness

  • Sudden weakness or numbness on one side

  • Sudden trouble talking, seeing, or walking

  • Weakness that starts in the legs and moves up

  • Trouble breathing or swallowing

  • Passing out or very bad dizziness

  • Very fast, very slow, or uneven heartbeat

  • Loss of bladder or bowel control

Download MSK Issues Info Sheet
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