Growth Factor Injections — to Raise Your White Cell Count
If your oncologist has prescribed a growth factor injection after chemotherapy, you may develop severe bone pain within a day or two. This is expected — it means the injection is doing its job. Here is what is normal, what is not, and when to call your team.
Medically reviewed by Dr. Owais Mohammed, Medical Oncologist · Last reviewed September 2026
- The bone pain is a sign it is working — Growth factor injections make your bone marrow produce white cells rapidly, and that expansion causes real pain in the bones.
- Most people are not warned — The pain can be severe enough to alarm you if nobody told you to expect it. It is one of the most common side effects.
- Not every patient needs them — Your oncologist prescribes them based on your chemotherapy and your individual risk of dangerously low counts.
- Fever changes the picture — Bone pain alone is expected. Fever alongside it means go to hospital now — do not wait.
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Growth factor injections tell your bone marrow to produce white cells faster after chemotherapy. Most people are not warned that this causes significant bone and joint pain, usually in the lower back, hips and legs. The pain is expected and temporary. Call your team the same day if it becomes unmanageable or you develop a fever.
If a symptom below applies to you, do not wait for a callback. Call 1800-202-8726 or go to your nearest emergency department.
Why does the injection cause bone pain — and does everyone need it?
Growth factor injections work by signalling your bone marrow to produce white cells at a much faster rate than usual. Your bone marrow lives inside your bones. This rapid increase in activity creates pressure in the bone cavities, and that pressure is what you feel as aching or throbbing pain — most often in the lower back, hips, pelvis, breastbone and thighs.
The pain usually starts within a day or two of the injection. It eases over the following days as your white cell count rises. It is a side effect, not a sign that something is wrong.
Not every patient needs these injections. Your oncologist prescribes them when your chemotherapy regimen carries a significant risk of dropping your white cell count to a dangerously low level. If you are unclear about why you have or have not been given them, ask — understanding the reason helps you know what to watch for.
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Not sure whether this counts as an emergency?
Call the helpline. It is always better to check than to wait.
Is this bone pain expected, or should you call?
| Feature | What to expect | Report to your team or go now |
|---|---|---|
| Where you feel pain | Lower back, hips, breastbone, thighs | Left shoulder or upper left belly — this is a different kind of pain |
| Fever | None | Any fever at all — go to hospital immediately |
| Breathing | Normal | New or worsening shortness of breath |
| Pain intensity | Aching to moderate, manageable with rest | Severe and stops you from functioning |
| Pain trend | Begins to ease as counts recover | Getting worse day on day rather than improving |
| Typically starts | Within a day or two of the injection | — |
What to do on your injection days
- Keep a thermometer at home and check your temperature if you feel shivery, unusually hot, or unwell.
- Save your team's helpline number in your phone before you leave the clinic.
- Tell your team if nobody warned you about bone pain — ask what pain relief is safe for you.
- Do not take any painkiller without checking with your team first, including over-the-counter options. Some can mask a fever.
- Avoid close contact with anyone who has a cold, flu, or any active infection while your counts are recovering.
- Drink enough fluids each day. Your body is working hard to build new white cells.
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Frequently asked questions
How long does the bone pain from growth factor injections last?
The pain usually starts within a day or two of the injection and eases over the following days as your white cell count rises. The timing varies between people and between chemotherapy cycles. If the pain is not beginning to ease, or if it is getting worse rather than better, tell your team. Persistent or worsening pain that does not begin to settle is worth reporting rather than managing on your own at home.
Can I take painkillers for the bone pain?
Ask your oncology team before taking any painkiller, because not all are safe after chemotherapy. Some common over-the-counter options can mask a fever — and fever is the single most important symptom your team needs to know about. Your team will tell you what is safe given your current blood counts and treatment. Do not assume a medicine is safe simply because it does not need a prescription.
Does every chemotherapy patient need a growth factor injection?
No. Your oncologist prescribes them based on your specific chemotherapy regimen, your overall health, your age, and how likely your treatment is to cause dangerously low counts. Some regimens almost always require growth factor support; others rarely do. If you are unsure why you have or have not been given them, it is a reasonable question to put directly to your oncologist.
I have a fever and bone pain at the same time — is the bone pain causing the fever?
No. Bone pain from growth factor injections does not cause fever. If you have both together, treat the fever as an emergency regardless of the bone pain. Fever while your white cell count is low may mean an infection your body cannot fight adequately. Go to the emergency department now — do not wait to see whether the fever comes down, and do not wait for the bone pain to settle first.
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