Breast pain

Breast pain
Synonym Mastodynia, Mastalgia, Breast tenderness
Specialty Gynecology, obstetrics, geriatric oncology, plastic surgery, radiology
Symptoms recurrent or cyclic pain
Complications disease progression
Usual onset puberty
Duration lifetime
Types cyclic and non-cyclic
Breast pain

Breast pain is a medical symptom that is most often associated with a developing disease or condition of the breast. These are usually benign breast diseases or conditions such as mastalgia, mastodynia, and fibrocystic breast changes. These disorders are painful and associated with lumps. Some breast pain is normal and associated with the changes that accompany puberty, pregnancy, lactation and menopause.[1] The pain can be in one breast or both.[2] The pain may be constant, cyclical, or present only on palpation or when it is touched.

Causes

Cyclical breast pain (cyclical mastalgia) is often associated with fibrocystic breast changes or duct ectasia and thought to be caused by changes of prolactin response to thyrotropin.[3][4] Some degree of cyclical breast tenderness is normal in the menstrual cycle, and is usually associated with menstruation and/or premenstrual syndrome (PMS).[1]

Noncyclical breast pain has various causes and is harder to diagnose. Noncyclical pain has frequently its root cause outside the breast. Some degree of non-cyclical breast tenderness can normally be present due to hormonal changes in puberty (both in girls and boys), in menopause and during pregnancy.[1] After pregnancy, breast pain can be caused by breastfeeding.[1] Other causes of non-cyclical breast pain include alcoholism with liver damage (likely due to abnormal steroid metabolism), mastitis and medications such as digitalis, methyldopa (an antihypertensive), spironolactone, certain diuretics, oxymetholone (an anabolic steroid), and chlorpromazine (a typical antipsychotic).[1] Also, shingles can cause a painful blistering rash on the skin of the breasts.[1]

Diagnosis

Ruling out the other possible causes of the pain is one way to differentiate the source of the pain. Breast pain can be due to:

Medications can be associated with breast pain and include:

Diagnostic testing can be useful. Typical tests used are mammogram, excisional biopsy for solid lumps, fine-needle aspiration and biopsy, pregnancy test, ultrasonography, and magnetic resonance imaging (MRI).[2]

Treatment

Danazol, an estrogen biosynthesis inhibitor, tamoxifen, an antagonistic modulator of the estrogen receptor, and bromocriptine, a prolactin-lowering D2 receptor agonist, are the main drugs used in the treatment of mastodynia and are effective.[10]

Other medications and supplements have been found to be of benefit. Spironolactone (Aldactone), low dose oral contraceptives, low-dose estrogen have helped to relieve pain. Topical anti-inflammatory medications can be used for localized pain. For anti hormonal treatment, danazol (Danocrine) can be helpful. Tamoxifen citrate is used in some cases of severe breast pain. Vitamin E is not effective in relieving pain nor is Evening primrose oil. Vitamin B6 and Vitamin A have not been consistently found to be beneficial. Flaxseed has shown some activity in the treatment of cyclic mastalgia.[2]

Pain may be relieved by the use of nonsteroidal anti-inflammatory drugs or, for more severe localized pain, by local anaesthetic.[11][1] Pain may be relieved psychologically by reassurance that it does not signal a serious underlying problem, and an active life style can also effect an improvement.[11]

Information regarding how the pain is real but not necessarily caused by disease can help to understand the problem. Learning breast self-examination helps to orient the woman to normal and expected texture and structure of the breast and nipple. Yearly breast exams may be suggested. Counseling can also be to describe changes that vary during the monthly cycle. Women on hormone replacement therapy may benefit from a dose adjustment. Another non-pharmacological measure to help relieve symptoms of pain may be to use good bra support. Breasts change during adolescence and menopause and refitting may be beneficial. Applying heat and/or ice can bring relief. Dietary changes may also help with the pain. Methylxanthines can be eliminated from the diet to see if a sensitivity is present. Some clinicians recommending a reduction in salt, though no evidence supports this practice.[2]

Breast cancer

Some women who have pain in one or both breasts may fear breast cancer. However, breast pain is not a common symptom of cancer. The great majority of breast cancer cases do not present with symptoms of pain, though breast pain in older women is more likely to be associated with cancer.[11][2][1]

See also

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 "Breast pain: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 14 August 2017. This article incorporates text from this source, which is in the public domain.
  2. 1 2 3 4 5 6 7 Cash, p. no page number.
  3. ↑ Dogliotti, L; Faggiuolo, R; Ferusso, A; Orlandi, F; Sandrucci, S; Tibo, A; Angeli, A (1985). "Prolactin and thyrotropin response to thyrotropin-releasing hormone in premenopausal women with fibrocystic disease of the breast". Hormone research. 21 (3): 137–44. doi:10.1159/000180038. PMID 3922866.
  4. ↑ Dogliotti, L; Orlandi, F; Angeli, A (1989). "The endocrine basis of benign breast disorders". World journal of surgery. 13 (6): 674–9. doi:10.1007/BF01658413. PMID 2696218.
  5. 1 2 3 4 5 6 7 Brown, Ken. "Breast Pain Causes and Diagnosis: Johns Hopkins Breast Center". Retrieved 14 August 2017.
  6. ↑ "Thrush in newborns: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 3 August 2017. This article incorporates text from this source, which is in the public domain.
  7. ↑ Walker, p. 533.
  8. ↑ Santos, Kamila Juliana da Silva; Santana, Géssica Silva; Vieira, Tatiana de Oliveira; Santos, Carlos Antônio de Souza Teles; Giugliani, Elsa Regina Justo; Vieira, Graciete Oliveira (2016). "Prevalence and factors associated with cracked nipples in the first month postpartum". BMC Pregnancy and Childbirth. 16 (1). doi:10.1186/s12884-016-0999-4. ISSN 1471-2393.
  9. ↑ "Sore or cracked nipples when breastfeeding, Pregnancy and baby guide". www.nhs.uk. National Health Services (UK). Retrieved 4 August 2017.
  10. ↑ Kerri Durnell Schuiling; Frances E. Likis (2011). Women's Gynecologic Health. Jones & Bartlett Publishers. pp. 381–. ISBN 978-0-7637-5637-6.
  11. 1 2 3 Iddon J, Dixon JM (2013). "Mastalgia". BMJ (Review). 347: f3288. doi:10.1136/bmj.f3288. PMID 24336097.

Bibliography

  • Cash, Jill (2014). Family practice guidelines. New York: Springer Publishing. ISBN 9780826197825. , [Electronic book] Section I Guidelines, Chapter Thirteen: Gynecologic Guidelines-Breast Pain
  • Walker, Marsha (2011). Breastfeeding management for the clinician : using the evidence. Sudbury, Mass: Jones and Bartlett Publishers. ISBN 9780763766511.
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