{{Infobox medical condition (new) | name = Breast pain | synonym = Mastodynia, mastalgia, breast tenderness | image = Breast_pain_hariadhi.svg | image_size = | alt = | caption = | pronounce = | specialty = Gynecology, General surgery | symptoms = | complications = | onset = | duration = | types = Cyclic, non-cyclic<ref name=AFP2012/> | causes = Menstrual cycle related, birth control pills, hormone therapy, psychiatric medication, breast cancer<ref name=AFP2012/> | risks = | diagnosis = Examination, medical imaging<ref name=AFP2012/> | differential = Gallstones, thoracic outlet syndrome, costochondritis<ref name=BMJ2013/> | prevention = | treatment = Reassurance after ruling out cancer, medications<ref name=BMJ2013/><ref name=AFP2012/> | medication = Paracetamol, NSAIDs<ref name=AFP2012/> | prognosis = >75% resolve without treatment<ref name=AFP2012/> | frequency = 70% of women<ref name=BMJ2013/> | deaths = }} <!-- Definition and symptoms -->
'''Breast pain''' is the symptom of discomfort in either one or both breasts.<ref name=BMJ2013>{{cite journal |last1=Iddon |first1=J |last2=Dixon |first2=JM |title=Mastalgia. |journal=BMJ (Clinical Research Ed.) |date=13 December 2013 |volume=347 |article-number=f3288 |doi=10.1136/bmj.f3288 |pmid=24336097|s2cid=220173019 }}</ref> Pain in both breasts is often described as ''breast tenderness'', is usually associated with the menstrual period and is not serious.<ref name=AFP2012/><ref name="NHS2018">{{cite web |title=Breast pain |url=https://www.nhs.uk/conditions/breast-pain/ |website=nhs.uk |access-date=11 November 2022 |language=en |date=17 October 2017}}</ref> Pain that involves only one part of a breast is more concerning,<ref name=AFP2012/> particularly if a hard mass or nipple discharge is also present.<ref name=NHS2018/>
<!-- Cause and diagnosis --> Causes may be related to the menstrual cycle, birth control pills, hormone therapy, or psychiatric medication.<ref name=AFP2012>{{cite journal |last1=Salzman |first1=B |last2=Fleegle |first2=S |last3=Tully |first3=AS |title=Common breast problems. |journal=American Family Physician |date=15 August 2012 |volume=86 |issue=4 |pages=343–9 |pmid=22963023}}</ref> Pain may also occur in those with large breasts, during menopause, and in early pregnancy.<ref name=AFP2012/><ref name=NHS2018/> In about 2% of cases, breast pain is related to breast cancer.<ref name=Maz2011>{{cite book |last1=Mazza |first1=Danielle |title=Women's Health in General Practice |date=2011 |publisher=Elsevier Health Sciences |isbn=978-0-7295-7871-4 |page=189 |url=https://books.google.com/books?id=_Q7IO4ACO1cC&pg=PA189 |language=en}}</ref> Diagnosis involves examination, with medical imaging if only a specific part of the breast hurts.<ref name=AFP2012/>
<!-- Treatment and epidemiology --> In more than 75% of people, the pain resolves without any specific treatment.<ref name=AFP2012/> Otherwise treatments may include paracetamol or NSAIDs.<ref name=AFP2012/> A well fitting bra may also help.<ref name=NHS2018/> In those with severe pain tamoxifen or danazol may be used.<ref name=AFP2012/> About 70% of women have breast pain at some point in time.<ref name=BMJ2013/> Breast pain is one of the most common breast symptoms, along with breast masses and nipple discharge.<ref name=AFP2012/>
==Causes== Breast pain linked to the menstrual cycle is called cyclic breast pain or cyclic mastalgia. Some degree of cyclical breast tenderness is normal in the menstrual cycle, and is usually associated with menstruation and/or premenstrual syndrome (PMS).<ref name=medline/> Cyclic breast pain is often associated with fibrocystic breast changes or duct ectasia and thought to be caused by changes of prolactin response to thyrotropin.<ref>{{Cite journal| doi = 10.1159/000180038| last1 = Dogliotti| first1 = L| last2 = Faggiuolo| first2 = R| last3 = Ferusso| first3 = A| last4 = Orlandi| first4 = F| last5 = Sandrucci| first5 = S| last6 = Tibo| first6 = A| last7 = Angeli| first7 = A| title = Prolactin and thyrotropin response to thyrotropin-releasing hormone in premenopausal women with fibrocystic disease of the breast| journal = Hormone Research| volume = 21| issue = 3| pages = 137–44| year = 1985| pmid = 3922866}}</ref><ref>{{Cite journal| doi = 10.1007/BF01658413| last1 = Dogliotti| first1 = L| last2 = Orlandi| first2 = F| last3 = Angeli| first3 = A| title = The endocrine basis of benign breast disorders| journal = World Journal of Surgery| volume = 13| issue = 6| pages = 674–9| year = 1989| pmid = 2696218| s2cid = 7420761}}</ref>
Breast pain that is not linked to a menstrual cycle is called noncyclic breast pain. Noncyclical breast pain has various causes and is harder to diagnose, and frequently the root cause is 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.<ref name=medline/> After pregnancy, breast pain can be caused by breastfeeding.<ref name=medline/> 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).<ref name=medline/> Also, shingles can cause a painful blistering rash on the skin of the breasts.<ref name=medline/>
===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.<ref name=BMJ2013/><ref name=Cash2013>{{cite book | last = Cash | first = Jill | title = Family practice guidelines | publisher = Springer Publishing | location = New York | year = 2014 | isbn = 978-0-8261-9782-5 }}, [Electronic book] Section I Guidelines, Chapter Thirteen: Gynecologic Guidelines-Breast Pain</ref><ref name = medline/>
==Diagnosis==
Diagnosis involves breast examination, with medical imaging if only a specific part of the breast hurts.<ref name=AFP2012/> Medical imaging by ultrasound is recommended for all ages, as well in those over 35, it is recommended together with mammography.<ref name=AFP2012/>
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: {{div col|colwidth=20em}} * angina pectoris * bra<ref name=jh>{{cite web|url=http://www.hopkinsmedicine.org/breast_center/breast_cancers_other_conditions/breast_pain.html|title=Breast Pain Causes and Diagnosis: Johns Hopkins Breast Center|first=Ken|last=Brown|access-date=14 August 2017}}</ref><ref name = medline/> * blocked milk duct * breastfeeding<ref name=jh/> * chest wall muscle pain * costochondritis (sore ribs) * cutaneous Candidiasis infection<ref>{{citation-attribution|1={{cite web|url=https://medlineplus.gov/ency/article/007615.htm|title=Thrush in newborns: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|access-date=3 August 2017}}}}</ref> * duct ectasia (often with nipple discharge) * engorgement * fibroadenoma * fibrocystic breast changes<ref name=jh/> * fibromyalgia * gastroesophageal reflux disease<ref name=Cash2013/> * herpes infection<ref name=Mar2011>{{cite book|title=Breastfeeding management for the clinician: using the evidence|last=Walker|first=Marsha|publisher=Jones and Bartlett Publishers|year=2011|isbn=978-0-7637-6651-1|location=Sudbury, Mass|page=533}}</ref> * hormone replacement therapy<ref name=jh/> * mastitis or breast infection<ref name=Cash2013/><ref name = medline/> * menopause<ref name = medline/> * menstruation and Premenstrual syndrome<ref name=jh/><ref name = medline/> * perimenopause<ref name=jh/> * neuralgia * pregnancy<ref name=jh/><ref name = medline/> * physical abuse * pituitary tumor (often with nipple discharge) * puberty in both girls and boys<ref name = medline/> * sexual abuse * shingles * sore nipples and cracked nipples<ref name="Sant2016">{{cite journal|last1=Santos|first1=Kamila Juliana da Silva|last2=Santana|first2=Géssica Silva|last3=Vieira|first3=Tatiana de Oliveira|last4=Santos|first4=Carlos Antônio de Souza Teles|last5=Giugliani|first5=Elsa Regina Justo|last6=Vieira|first6=Graciete Oliveira|title=Prevalence and factors associated with cracked nipples in the first month postpartum|journal=BMC Pregnancy and Childbirth|volume=16|issue=1|page=209|year=2016|issn=1471-2393|doi=10.1186/s12884-016-0999-4|pmid=27496088|pmc=4975913 |doi-access=free }}</ref><ref name = nhs2>{{cite web|url=http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/sore-cracked-nipples-breastfeeding.aspx|title=Sore or cracked nipples when breastfeeding, Pregnancy and baby guide|publisher=National Health Services (UK)|website=www.nhs.uk|access-date=4 August 2017|archive-date=23 August 2017|archive-url=https://web.archive.org/web/20170823174759/http://www.nhs.uk/conditions/pregnancy-and-baby/pages/sore-cracked-nipples-breastfeeding.aspx|url-status=dead}}</ref> * surgery or biopsy * trauma (including falls) {{div col end}}
Medications can be associated with breast pain and include: {{div col|colwidth=20em}} * Oxymetholone * Chlorpromazine * Water pills (diuretics) * Digitalis preparations * Methyldopa * Spironolactone<ref name = medline>{{citation-attribution|1={{cite web|url=https://medlineplus.gov/ency/article/003152.htm|title=Breast pain: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|access-date=14 August 2017}}}}</ref> {{div col end}}
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).<ref name=Cash2013/>
==Treatment== In more than 75% of people, the pain resolves without any specific treatment.<ref name=AFP2012/> Otherwise treatments may include paracetamol or NSAIDs.<ref name=AFP2012/> A well fitting bra may also help.<ref name=NHS2018/> In those with severe pain tamoxifen or danazol may be used.<ref name=AFP2012/>
Bromocriptine may be used as well.<ref name="SchuilingLikis2011">{{cite book|author1=Kerri Durnell Schuiling|author2=Frances E. Likis|title=Women's Gynecologic Health|url=https://books.google.com/books?id=pj_ourS3PBMC&pg=PA381|year=2011|publisher=Jones & Bartlett Publishers|isbn=978-0-7637-5637-6|pages=381–}}</ref>
Spironolactone, low-dose oral contraceptives, and low-dose estrogen have helped to relieve pain. Topical anti-inflammatory medications can be used for localized pain. Vitamin E is not effective in relieving pain nor is evening primrose oil. Vitamin B<sub>6</sub> and vitamin A have not been consistently found to be beneficial. Flaxseed has shown some activity in the treatment of cyclic mastalgia.<ref name=Cash2013/>
Pain may be relieved by the use of nonsteroidal anti-inflammatory drugs or, for more severe localized pain, by local anaesthetic.<ref name=BMJ2013/><ref name = medline/> Pain may be relieved by reassurance that it does not signal a serious underlying problem, and an active lifestyle can also improve the pain.<ref name=BMJ2013/>
Information regarding how the pain is real but not necessarily caused by disease can help to understand the problem. Counseling can also be used 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 a 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 recommend a reduction in salt, though no evidence supports this practice.<ref name=Cash2013/>
==See also== * Galactagogue * Mammoplasia * Pain management
==References== {{Reflist}}
==Further reading== * {{cite journal |last1=Cornell |first1=Lauren F. |last2=Sandhu |first2=Nicole P. |last3=Pruthi |first3=Sandhya |last4=Mussallem |first4=Dawn M. |title=Current Management and Treatment Options for Breast Pain |journal=Mayo Clinic Proceedings |date=2020 |volume=95 |issue=3 |pages=574–580 |doi=10.1016/j.mayocp.2019.12.014|pmid=32138883 }}
== External links == {{Medical resources | DiseasesDB = 22464 | ICD11 = {{ICD11|GB23.5}} | ICD10 = {{ICD10|N64.4}}, {{ICD10|F45.4}} | ICD9 = {{ICD9|611.71}} | ICDO = {{ICD10|N|64|4|n|60}} | OMIM = | MedlinePlus = 003152 | eMedicineSubj = | eMedicineTopic = | MeshID = }} {{Diseases of the breast}} {{Infants and their care}}
Category:Pain Category:Breast diseases Category:Breastfeeding Category:Hormones Category:Anti-inflammatory agents Category:Gynaecology Category:Endocrine neoplasia Category:Wikipedia medicine articles ready to translate Category:Women's health