Solving the Mysteries of Breast Pain March 30

Solving the Mysteries of Breast Pain March 30, 2016

Mastalgia • Definition: pain related to one or both breasts -tenderness and fullness -constant or sporadic -burning or stabbing -related to certain activities -cyclic or non- cyclic

Breast Pain to Report to a Healthcare Provider • • Pain persistent ( more than several weeks) Pain that is sudden and severe Pain in only one breast Pain with a lump in the same breast Pain associated with redness and warmth Pain in a breast with change in skin texture Pain with discharge from one breast Pain associated with large amount of discharge not associated with pregnancy or nursing

Healthcare Provider’s Clinical Exam will Include: • • Personal Hx of any previous illness or disease Person hormonal Hx, age of onset of menses Present hormonal status; pre or peri or post Medication Hx BCP’s, HRT, OTC, supplements Personal of Fam Hx of cancer: breast, ovarian Clinical breast exam MMG or US to evaluate, if problem refer

Cyclic Pain • • Pain occurs in both breast Pain begins the week before onset of menses Pain that increases until menses begin Pain relieved by menstruation Pain described as dull, aching with fullness Pain may radiate to axilla and down arm Pain in the pre menopausal women Pain relieved at menopause unless using HRT

Keep a record! scale 0 -10 • CONTRIBUTING FACTORS; – Caffeine; limit it! – High fat diet, encourage more fiber, lower fat – Increase exercise and healthy lifestyle – Proper fitting bra – Don’t sleep in it! – Hot and cold packs – Dietary Supplements: Vit E, Evening Primrose Oil • Natural progesterone or Beta carotene

Lymphatic Congestion • By far, a primary factor in almost any mastalgia pt • Encourage proper fitting bra • Instructional Video of lymphatic massage technique, easy to learn and do • Helps pt get to know breast tissue as well • Provides symptomatic relief consistently

Prescription Medications • • BCP’s Progesterone Testosterone Danazol (decreases hormonal fluctuation) LHRH Agonist Injections (Lupron) Thyroid Hormone Medication Tamoxifen Bromocriptine (Paroled) prolactin blocker

Remember: • • Cyclic pain is related to hormone fluctuation Cyclic pain is not related to cancer It’s a normal, most women experience it! Monitoring it will identify it’s pattern Diet and supplements can help Wearing a well fitting bra can help Severe cyclic pain can be addressed with Rx but non-aggressive interventions should be tried first

Non Cyclic Pain • • May be continuous, or only occur from time to time Usually localized to a specific area or “trigger zone” Described as sharp, stabbing, or burning sensation Pain often replicated by movement or applying pressure to a specific area

Noncyclic Causes of Breast Pain • Benign Breast Disease/Conditions – Mastitis – Breast Abscess – Cellulitis – Mammary Duct Ectasia; inflammation or infection in and around milk ducts, frequently in smokers – Hematoma – Breast cysts – Fibroadenoma – Galactocele

Other causes of Noncyclic Pain • Chest Wall Conditions – Mondor’s; inflammation of a breast vein – Shingles • Musculoskeletal Conditions – Pinched Nerve – Degenerative conditions or injury – Chostochondritis or Tietze’s Syndrome

Clinical Factors Indicating Risk for Possible Cancer Lump or increased thickness in one breast Nipple discharge from the same breast Nipple or breast retraction Skin Thickening, Peau d’orange, color changes Scaly appearance of the nipple, pruritis, (Paget’s dz) Redness or inflammatory condition, may mimic abscess or mastitis • Chronic irritation of one nipple • Sensation of “pulling” in the breast • • •

Remember: • Non cyclic pain has no pattern, not related to menses, can be chronic or sporadic • Variety of causes: must r/o infection, abscess, injury, chest wall conditions, lymphatic congestion (MOST COMMON) • Usually occurs has a “trigger point” • Physiologic conditions: hypothyroid, galactorrhea can cause pain • Pain with cancer is RARE, but all pain should be evaluated to r/o the possibility of cancer/