Cyclical mastalgia: prevalence and associated health and behavioral factors Clinical evaluation of mastalgia. Efficacy of topical nonsteroidal antiinflammatory drugs in mastalgia treatment. Comparison of Naproxen with Placebo for the Management of Noncyclical Breast Pain: A Randomized, Double-Blind, Controlled Trial Role of Centchroman in Regression of Mastalgia and Fibroadenoma Sports Brassiere: Is It a Solution for Mastalgia? A randomised controlled trial of medroxyprogesterone acetate in mastalgia. Incidence of Myofascial Pain Syndrome in Breast Cancer Surgery: A Prospective Study Hyperalgesia and Persistent Pain after Breast Cancer Surgery: A Prospective Randomized Controlled Trial with Perioperative COX-2 Inhibition A phase II trial of Afimoxifene (4-hydroxytamoxifen gel) for cyclical mastalgia in premenopausal women Post-mastectomy pain syndrome: incidence and risks. A double-blind randomized controlled trial of toremifen therapy for mastalgia. A multicenter assessment of the adequacy of cancer pain treatment using the pain management index. Randomized controlled trial of the management of premenstrual syndrome and premenstrual mastalgia using luteal phase-only danazol. The effect of psychoeducation on anxiety and pain in patients with mastalgia Efficacy of Mindfulness-Based Cognitive Therapy on Late Post-Treatment Pain in Women Treated for Primary Breast Cancer: A Randomized Controlled Trial. Centchroman Regresses Mastalgia: A Randomized Comparison with Danazol
Perimenstrual breast pain ( cyclical mastalgia ) is a common problem that can be sufficiently severe to interfere with usual activities , and has been associated with elevated  mammography usage in young women . This study was undertaken to replicate clinic-based research on cyclical mastalgia , and to examine the association between this disorder and health-related behaviors and perceived stress . Using r and om digit dialing throughout Virginia , 874 women aged 18 - 44 were interviewed . Sixty-eight per cent of women experienced cyclical breast symptoms ; 22 % experienced moderate to extreme discomfort ( classified as cyclical mastalgia ) . Hormonal contraceptive usage was associated with significantly less mastalgia and premenstrual syndrome ( PMS ) . Smoking , caffeine consumption and perceived stress were associated with mastalgia ( odds ratios = 1.52 , 1.53 and 1.7 , respectively ) . Young women ( under 35 years ) with mastalgia were more likely to have had a mammogram ( 20.2 % ) than those without mastalgia ( 9.9 % ) . Most women with this disorder ( 77.5 % ) did not have PMS . The prevalence of cyclical mastalgia and its association with mammography replicate clinic-based findings . Associations with smoking and stress had not previously been reported . Prospect i ve research is needed to determine the biopsychosocial factors contributing to this disorder OBJECTIVE To describe an accurate and reproducible method to quantify a patient 's subjective experience of breast pain .  DESIGN Prospect i ve diary study . SETTING Military tertiary care hospital . PATIENTS Thirty female military health care beneficiaries from the Walter Reed Army Medical Center , Washington , DC , gynecology and general surgery clinics . MAIN OUTCOME MEASURES Daily mastalgia was recorded using a visual analog scale and menstrual symptoms were measured using a daily question naire . These measures were correlated with results of a screening question naire completed prior to study entry . RESULTS Patients identified as having cyclical mastalgia based on the  screening question naire ( n= 15 ) were found to have higher peak perimenstrual mastalgia according to their daily diaries than patients who did not meet diagnostic criteria ( n=15 ) ( 5.3+/-0.7 vs 3.5+/-0.5 , P<.001 ) . Applying the same criteria used in the screening question naire to the diary data , 17 of 30 patients met diagnostic criteria for cyclical mastalgia . The ability of the screening question naire to predict the results of the prospect i ve diary data was calculated , and positive and negative predictive values were 73 % and 60 % , respectively . Most patients with cyclical mastalgia also have other perimenstrual psychological and somatic complaints , although a subset of patients has high levels of mastalgia with minimal associated symptoms . CONCLUSIONS Accurate assessment of mastalgia can not be done with a retrospective question naire and requires prospect i ve diary evaluation , owing to the variable and subjective nature of symptoms and recall bias . A daily visual analog scale provides reproducible results and is easy for patients to use BACKGROUND The aim of the study was to investigate the effects of topical nonsteroidal antiinflammatory drugs ( NSAIDs ) on mastalgia . STUDY DESIGN A prospect i ve , r and omized , blinded , placebo-controlled study was performed to evaluate the effects of topical NSAIDs on cyclic and noncyclic mastalgia . A total of 108 patients , 60 with cyclic ( group I ) and 48 with noncyclic ( group II ) breast pain were enrolled . Patients within each group were r and omly assigned to receive either topical NSAIDs or placebo three times daily for at least 6 months . Severity of pain was measured before and after 6 months of treatment . RESULTS The pain score decreased significantly when the mean initial breast pain score was compared with the sixth-month breast pain score of the treatment or the placebo group of cyclic ( p = 0.0001 and p = 0.0001 , respectively ) or noncyclic mastalgia ( p = 0.0001 and p = 0.0001 , respectively ) . Significant differences were found when the mean within-person change in pain values in each treatment group were compared with the change in the respective placebo group for either cyclic or noncyclic mastalgia ( p = 0.0001 and p = 0.0001 , respectively ) . Changes in pain within treatment groups or placebo groups for cyclic versus noncyclic mastalgia were not found to be statistically different ( p = 0.53 and p = 0.96 , respectively ) . No side effect was seen in any group . CONCLUSIONS Topical application of NSAIDs was effective in both cyclic and noncyclic mastalgia with minimal side effects Background Breast pain is a common symptom in patients attending breast clinics . Although most patients experience mastalgia of mild to moderate severity , approximately 15 % of patients suffer from severe pain that causes significant distress and some disturbance in their daily life that lead them to seek treatment . Despite a considerable number of drugs suggested for decreasing the severity of mastalgia , there is no st and ard treatment for the complaint . In this study , we investigated the effect of naproxen on reducing the complaint of breast pain compared with placebo . Methods Eighty-one women suffering from noncyclic breast pain were recruited to a r and omized , double-blind , clinical trial between January 2002 and September 2004 . All patients were suffering from this complaint for at least 3 months before the study . Patients were r and omly assigned to two groups . Patients in the case group received naproxen 250 mg BD . Patients in the placebo group took placebo in a similar manner . The intensity of mastalgia was assessed before and twice after intervention by using a Visual Analogue Scale . Results Forty-two of 81 patients were recruited r and omly as cases and the remaining 39 were assigned placebo . Of these 24 and 22 patients fulfilled the study protocol respectively . The mean age of patients was 35 ( SD = 7.5 ; range , 19–55 ) years . The mean pain severity at the beginning of the study was 5.8 and 6.1 in naproxen and placebo groups , respectively . The severity of pain was decreased significantly at the end of the study in both groups ( 3.9 in patients and 3.7 in controls ( P = 0.005 and 0.0001 ) ) . Although the decrease in pain severity in each individual group was statistically significant , it was not significant compared with one another ( P = 0.64 ) . Conclusions Breast pain is a complex symptom that can be relieved significantly with reassurance . According to the result of this study , naproxen has no superiority over placebo in reducing noncyclic breast pain Objectives Centchroman ( Ormeloxifene ) is a novel non-steroidal , selective antiestrogen . Because of its selective antiestrogen action , centchroman has been used for treatment of mastalgia and fibroadenoma .  Material s and Methods Benign breast disease patients up to 35 years of age attending our surgery outpatient department from August 2003 to September 2004 and fulfilling the inclusion criterion were included in this study . They were started on centchroman 30 mg on alternate days for a period of 3 months and were followed up for 6 months . Results were recorded as per clinical examination , visual analog scale ( VAS ) for pain , and ultrasonography for breast lump size . Results A total of 60 patients were included in this pilot study , 42 ( 70 % ) of whom had mastalgia with or without nodularity , and 18 ( 30 % ) had fibroadenoma .  Noncyclical pain was recorded in 38 patients ( 90 % ) , and cyclical pain was recorded in only 4 ( 10 % ) patients . A VAS score of 10 was recorded by 33 ( 80 % ) patients ( severe pain ) , and the remaining 9 patients ( 20 % ) had VAS scores from 7 to 10 . Fibroadenoma size ranged from 1.5 to 5 cm . , single or multiple in one or both breasts . There was a good response in the mastalgia group , with a decrease in the VAS scoring from 10 to 3 in 90 % of the patients in the first week . Almost all of the patients were painless at the end of one month , with complete disappearance of the nodularity . In the fibroadenoma group there was a mixed response , with complete disappearence in 40 % , partial regression in 20 % , and no response at all in the remaining 40 % . There were very few side effects . Conclusions Centchroman is a safe nonsteroidal drug for the treatment of mastalgia and fibroadenoma . It has shown good results in mastalgia and is a safe drug as compared to the drugs of choice used at present ( danazole and bromocriptine ) . Further r and omized studies are in progress and are needed to determine its definitive role in this patient group Breast pain is a very common complaint in women presenting to the outpatient department . It causes a certain degree of discomfort , anxiety leading to repeated investigations , and to some degree disturbs their lifestyle . This prospect i ve study was carried out at King Fahd Hospital of the University , Alkhobar . Two hundred women presenting to the outpatient surgical department with mastalgia were included ; 100 women received treatment with danazole , and the other 100 were asked to wear sports brassieres for 12 weeks . They were requested to answer a structured question naire during the specified period , and an extensive review of the literature was also performed . Patients were compliant with the instructions . The first group had 58 % relief of symptoms , but 42 % experienced drug side effects ; in the second group , all participants had some degree of initial discomfort followed by relief of symptoms in 85 % of cases . Most patients cl aim ed that their lifestyle had changed dramatically after using the sports brassieres . Mastalgia is a common disease that may run a chronic course . Many patients are unsatisfied with prescribed medications and tend to discontinue treatment when side effects develop . Active breast movement on its weak suspensory ligaments may contribute considerably to mastalgia . Good external support by sports brassieres can relieve most of the patient 's symptoms A double-blind crossover study giving 20 mg/day of medroxyprogesterone acetate during the luteal phase was carried out in 26 women with cyclical mastalgia .  Symptomatic response to this progestogen supplementation or placebo was assessed objective ly by clinical examination and subjectively by linear analogue scales and breast pain charts . No significant relief of pain or tenderness was found on placebo or active treatment , irrespective of treatment order , and breast nodularity was similarly unaltered . No evidence of progesterone deficiency or prolactin abnormality was found . Side-effects were incurred in 11 patients ( five on placebo , five on active treatment and one while on both ) and were mostly vague premenstrual symptoms . We conclude that the therapeutic response of medroxyprogesterone acetate in cyclical mastalgia is no better than placebo and that progestogen supplementation can no longer be recommended for routine use in the management of breast pain Background Pain  after breast cancer therapy  is a recognized complication found to have an adverse impact on patient 's quality of life , increasing psychosocial distress . In recent years , case reports about myofascial pain syndrome are emerging in thoracic surgery as a cause of postsurgery pain . Myofascial pain syndrome is a regional pain syndrome characterized by myofascial trigger points in palpable taut b and s of skeletal muscle that refers pain a distance , and that can cause distant motor and autonomic effects . Objective The objective of this study was to assess the incidence of myofascial pain syndrome prospect ively 12 months after breast cancer surgery . Methods Each participant was assessed preoperatively , postoperatively between day 3 and day 5 , and at 1 , 3 , 6 , and 12 months after surgery . A physical therapist , expert in the diagnosis of myofascial pain syndrome , performed follow-up assessment s.  Pain descriptions by the patients and pain pattern drawings in body forms guided the physical examination . The patients were not given any information concerning myofascial pain or other muscle pain syndromes . Results One year follow-up was completed by 116 women . Of these , 52 women developed myofascial pain syndrome ( 44.8 % , 95 % confidence interval : 35.6 , 54.3 ) . Conclusion Myofascial pain syndrome is a common source of pain in women undergoing breast cancer surgery that includes axillary lymph node dissection at least during the first year after surgery . Myofascial pain syndrome is one potential cause of chronic pain in breast cancer survivors who have undergone this kind of surgery Background Persistent pain is a challenging clinical problem after breast cancer treatment . After surgery , inflammatory pain and nociceptive input from nerve injury induce central sensitization which may play a role in the genesis of persistent pain . Using quantitative sensory testing , we tested the hypothesis that adding COX-2 inhibition to st and ard treatment reduces hyperalgesia after breast cancer surgery . A secondary hypothesis was that patients developing persistent pain would exhibit more postoperative hyperalgesia . Methods 138 women scheduled for lumpectomy/mastectomy under general anesthesia with paravertebral block were r and omized to COX-2 inhibition ( 2x40 mg parecoxib on day of surgery , thereafter 2x200 mg celecoxib/day until day five ) or placebo . Preoperatively and 1 , 5 , 15 days and 1 , 3 , 6 , 12 months postoperatively , we determined electric and pressure pain tolerance thresholds in dermatomes C6/T4/L1 and a 100 mm VAS score for pain . We calculated the sum of pain tolerance thresholds and analyzed change in these versus preoperatively using mixed models analysis with factor medication . To assess hyperalgesia in persistent pain patients we performed an additional analysis on patients reporting VAS>30 at 12 months . Results 48  COX-2 inhibition  and 46 placebo  patients were analyzed in a modified intention to treat analysis . Contrary to our primary hypothesis , change in the sum of tolerance thresholds in the COX-2 inhibition group was not different versus placebo . COX-2 inhibition had an effect on pain on movement at postoperative day 5 ( p<0.01 ) . Consistent with our secondary hypothesis , change in sum of pressure pain tolerance thresholds in 11 patients that developed persistent pain was negative versus patients without pain ( p<0.01 ) from day 5 to 1 year postoperatively . Conclusions Perioperative COX-2 inhibition has limited value in preventing sensitization and persistent pain after breast cancer surgery . Central sensitization may play a role in the genesis of persistent postsurgical pain Background Many women experience symptoms of cyclical mastalgia , such as breast pain , tenderness , and nodularity . Tamoxifen and other drugs have been used to alleviate cyclical mastalgia symptoms ; however , their use is associated with potentially serious side effects . The current study compared the safety and efficacy of two doses of a topical gel containing 4-hydroxytamoxifen ( Afimoxifene , formerly known as 4-OHT ) with placebo gel for the treatment of moderate to severe cyclical mastalgia . Methods Premenopausal women aged at least 18 years experiencing moderate to severe symptoms were r and omized to receive placebo , 2 mg , or 4 mg of Afimoxifene daily delivered as a transdermal hydroalcoholic gel for 4 menstrual cycles . The primary efficacy parameter was change in mean pain intensity as measured by the Visual Analog Scale ( VAS ) for the seven worst pain score days within a cycle from baseline to the fourth cycle . Results After 4 cycles of treatment , statistically significant improvements relative to placebo were measured in mean VAS score in the 4-mg Afimoxifene group ( −12.71 mm [ 95 % confidence interval , −0.96 to −24.47 ; P = 0.034 ] ) . Patient global assessment of pain , physician ’s assessment of pain , tenderness on palpation , and nodularity following 4 cycles of treatment were significantly more likely to show improvements in the 4-mg group , compared with placebo ( P = 0.010 [ pain ] ; P = 0.012 [ tenderness ] ; P = 0.017 [ nodularity ] ) . Overall , Afimoxifene was well tolerated with few adverse events and no drug-related SAE occurred in any group . There were no changes in menstrual pattern or plasma hormone levels and no breakthrough vaginal bleeding in patients treated with Afimoxifene . Conclusion After 4 months of treatment , daily topical breast application of Afimoxifene result ed in statistically significant improvements in signs and symptoms of cyclical mastalgia across patient- and physician-rated scales with excellent tolerability and safety BACKGROUND Post-mastectomy pain syndrome is defined as a chronic pain that persists beyond the normal healing time of 3 months . It is considered a neuropathic condition that arises after surgery for breast cancer . AIM To evaluate the incidence and risk factors of pain syndromes in patients undergoing surgical treatment of breast cancer in the National Cancer Institute . METHODS This study is a prospect i ve cohort of women undergoing surgical treatment for breast cancer from September 2008 to June 2009 , followed up until 6 months postoperatively . RESULTS AND CONCLUSIONS One hundred seventy-four women were examined . The mean age was 58 years . The incidence of pain syndrome was 52 % . Younger women ( < 40 years ) and those who were su bmi tted to axillary lymph node dissection ( with more than 15 lymph nodes excised ) have shown a significantly increased risk of pain syndrome after surgery for breast cancer ( relative risk ( RR ) = 5.23 95 % confidence interval ( CI ) : 1.11 - 24.64 ) and ( RR=2.01 95 % CI : 1.08 - 3.75 ) HYPOTHESIS Toremifen is effective in reducing  breast pain  and does not increase the incidence of adverse events as a therapy for moderate to severe mastalgia . DESIGN AND PATIENTS In a double-blind r and omized controlled trial , patients with moderate to severe mastalgia received toremifen citrate , 30 mg daily , or a placebo tablet for 3 menstrual cycles and were followed up for breast pain score and adverse events . The serum levels of estradiol , progesterone , and prolactin were examined before treatment and correlated with the response rate to toremifen treatment . RESULTS Seventy-two ( 69.2 % ) of 104 patients receiving toremifen  and 29 ( 31.9 % ) of 91 receiving placebo  responded to the treatment , with reduction in breast pain score of more than 50 % ( P<.001 ) . Among the patients with cyclical mastalgia , the response rate for toremifen was 76.7 % ( 59/77 ) , whereas the response rate for placebo was 34.8 % ( 23/66 ; P<.001 ) . In contrast , the response rate of patients with noncyclical mastalgia was 48.1 % ( 13/27 ) for toremifen and 24.0 % ( 6/25 ) for placebo ( P = .09 ) . Adverse events were observed in 44 ( 42.9 % ) of 104 patients receiving placebo and 46 ( 50.5 % ) of 91 patients receiving toremifen ( P = .45 ) . A positive correlation between baseline breast pain score and serum estradiol level was observed in patients with cyclical mastalgia ( r = 0.35 , P = .003 ) . CONCLUSIONS Toremifen effectively relieves moderate and severe cyclical mastalgia and tends to exert a positive therapeutic effect on noncyclical mastalgia . In addition , toremifen therapy does not increase the incidence of intolerable adverse event . Therefore , it is a feasible therapy for mastalgia , especially cyclical mastalgia PURPOSE S Determine adequacy of management of pain  secondary to bone metastases by physicians referring to specialized outpatient palliative radiotherapy ( RT ) clinics in Canada ; compare geographic differences in adequacy of pain management and pain severity between these cohorts ; compare results with published international literature . METHODS Prospect ively collected data from three participating centers were used to calculate the Pain Management Index ( PMI ) by subtracting the patient-rated pain score at time of initial clinic visit from the analgesic score . Scores were 0 , 1 , 2 , and 3 when patients reported no pain ( 0 ) , mild ( 1 - 4 ) , moderate ( 5 - 6 ) , or severe pain ( 7 - 10 ) , respectively , on the Edmonton Symptom Assessment System or Brief Pain Inventory . Analgesic scores of 0 , 1 , 2 , and 3 were assigned for no pain medication , nonopioids , weak opioids , and strong opioids respectively . A negative PMI suggests inadequate pain management . RESULTS Overall incidence of negative PMI and moderate to severe pain was 25.1 % and 70.9 % respectively for 2011 patients . Comparing the three participating centers , the incidence of negative PMI was 31.0 % , 20.0 % , and 16.8 % ( p < 0.0001 ) , and severe pain was 55.5 % , 48.2 % and 43.4 % ( p < 0.0001 ) , these correlated with a negative PMI . Patients referred to our clinics were less likely to be undertreated for their pain when compared to study results from international countries . CONCLUSION Geographic differences in adequacy of analgesic management  for painful bone metastases exist between Canadian specialized outpatient palliative RT clinics and between centers globally . Investigating reasons for these differences may provide insight into solutions to improve quality of life for these patients OBJECTIVE Our goal was to evaluate the efficacy and side effects of danazol 200 mg daily given only in the luteal phase of the menstrual cycle to treat premenstrual syndrome and premenstrual mastalgia . STUDY DESIGN We conducted a r and omized , double-blind , placebo-controlled study of 3 menstrual cycles in a postgraduate medical school and National Health Service hospital . The subjects of the study were 100 women who had been referred to the premenstrual syndrome clinic at the North Staffordshire Hospital for the management of premenstrual syndrome and premenstrual breast pain . Outcome measures for the study included assessment of improvement in symptoms measured by specific daily visual analogue scales for 4 principal symptoms of premenstrual syndrome and for premenstrual mastalgia and assessment of side effects and adverse events . RESULTS Significant improvement in symptoms was seen in visual analog scores for mastalgia in months 1 ( P = .03 ) , 2 ( P = .004 ) , and 3 ( P = .01 ) of the study during active therapy compared with placebo . No improvement was seen for any other symptom or for the global premenstrual syndrome score . Side effects on danazol and on placebo were equal and minimal . CONCLUSIONS Luteal phase-only danazol is not effective for the treatment of the general symptoms of premenstrual syndrome but appears highly effective for the relief of premenstrual mastalgia . This approach to therapy is associated with few side effects . Studies of cyclic mastalgia using strict diagnostic criteria are required to see whether the freedom from symptomatic side effects is found in longer-term studies and to determine whether such a regimen avoids potentially detrimental effects on the lipid status Abstract Background : Mastalgia is a debilitating disorder , which has serious effects on one 's daily life and causes significant medical costs . Aim : Mastalgia patients determine the overall approach and improve the quality of life of patients . Methods : In this study , the outcomes of psychoeducation on anxiety and pain in a group of patients with mastalgia without an organic etiology have been investigated . 88 patients were included in this study . The socio-demographic data form , the Symptom Checklist 90 ( SCL-90 ) , the Toronto Alexithymia Scale-20 ( TAS-20 ) , the Hamilton Anxiety Scorer ( HAM-A ) , the State – Trait Anxiety Inventory ( STAI-I , STAI-2 ) and the Visual Analogue Scale ( VAS ) were all applied to the patients . 64 r and omly selected patients ( Group 1 ) were given psychoeducation while the remaining 24 ( Group 2 ) were not . All patients were called back after 1 month for repeats of the HAM-A , STAI-I , STAI-2 and VAS tests . Results : The results of this study demonstrated that psychoeducation has positive impacts on the perception of pain besides stationary , contemporary and total anxiety scores . Conclusions : It is concluded that the administration of psychoeducation is a good choice in the degradation of anxiety symptoms and pain PURPOSE To assess the efficacy of mindfulness-based cognitive therapy ( MBCT ) for late post-treatment pain in women treated for primary breast cancer . METHODS A r and omized wait list-controlled trial was conducted with 129 women treated for breast cancer reporting post-treatment pain ( score ≥ 3 on pain intensity or pain burden assessed with 10-point numeric rating scales ) . Participants were r and omly assigned to a manualized 8-week MBCT program or a wait-list control group . Pain was the primary outcome and was assessed with the Short Form McGill Pain Question naire 2 ( SF-MPQ-2 ) , the Present Pain Intensity subscale ( the McGill Pain Question naire ) , and perceived pain intensity and pain burden ( numeric rating scales ) . Secondary outcomes were quality of life ( World Health Organization-5 Well-Being Index ) , psychological distress ( the Hospital Depression and Anxiety Scale ) , and self-reported use of pain medication . All outcome measures were assessed at baseline , postintervention , and 3-month and 6-month follow-up . Treatment effects were evaluated with mixed linear models . RESULTS Statistically significant time × group interactions were found for pain intensity ( d = 0.61 ; P = .002 ) , the Present Pain Intensity subscale ( d = 0.26 ; P = .026 ) , the SF-MPQ-2 neuropathic pain subscale ( d = 0.24 ; P = .036 ) , and SF-MPQ-2 total scores ( d = 0.23 ; P = .036 ) . Only pain intensity remained statistically significant after correction for multiple comparisons . Statistically significant effects were also observed for quality of life ( d = 0.42 ; P = .028 ) and nonprescription pain medication use ( d = 0.40 ; P = .038 ) . None of the remaining outcomes reached statistical significance . CONCLUSION MBCT showed a statistically significant , robust , and durable effect on pain intensity , indicating that MBCT may be an efficacious pain rehabilitation strategy for women treated for breast cancer . In addition , the effect on neuropathic pain , a pain type reported by women treated for breast cancer , further suggests the potential of MBCT but should be considered preliminary We conducted a r and omized trial to evaluate effectiveness of Centchroman in control of mastalgia and compared it with Danazol . Research Question - Is proportion of pain relief achieved by Centchroman similar to or inferior to that achieved by Danazol ? In a r and omized controlled trial of Centchroman vs. Danazol in mastalgia , 81 patients with mastalgia were studied . Thirty-nine patients were r and omized to Danazol arm and 42 in Centchroman arm . The treatment was given for 12 weeks , followed by observation for 12 weeks . The pain was measured by visual analogue scale ( VAS ) of 0–10 . At 12 weeks 89.7 % women achieved reduction in pain score to ≤3 in Centchroman group ( pvalue 0.001 ) . In Danazol group 69.44 % women achieved reduction in pain score to ≤ 3 ( p = 0.001 ) . Three months after stopping therapy , Centchroman was more effective in pain score reduction at 24 weeks as compared to Danazol ( p = 0.019 ) . Centchroman is an effective , safe and inexpensive alternative to Danazol for treatment of mastalgia
RESULTS Reassurance plus bra-fitting advice provides relief for most women .
There is some benefit in reducing dietary coffee and fat intake .
Dopamine agonists are useful , but less effective than endocrine treatments such as Danazol or Tamoxifen .
Of the Selective Oestrogen Receptor Modulator drugs , Ormeloxifene appears most effective , but is not licenced in the United Kingdom .
Relaxation therapy , acupuncture and kinesiology may be useful but currently lack good evidence of effectiveness .
Subsequent drug therapy should be balanced against its side-effects ; topical NSAIDs and Ormeloxifene show greatest benefit with least side-effects .
INTRODUCTION Idiopathic mastalgia ( benign breast pain of unknown origin ) is often poorly managed because of its subjective nature and unclear aetiology .
Mastalgia is a reason for up to 50 % of breast outpatient referrals .
Existing systematic review s discuss date d treatment options that provide limited symptomatic relief .