Transcript Solving the Mysteries of Breast Pain

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
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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:
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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
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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
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BCP’s
Progesterone
Testosterone
Danazol (decreases hormonal fluctuation)
LHRH Agonist Injections (Lupron)
Thyroid Hormone Medication
Tamoxifen
Bromocriptine (Paroled) prolactin blocker
Remember:
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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
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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
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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
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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/