Breast pain

Summary

Pain of the breast is commonly classified as cyclic or noncyclic, depending on its temporal association with menstruation. Visits to ED typically involve acute, non-cyclic breast pain, with the most common etiologies being blunt trauma or infection. Ketorolac is useful for acute mastalgia and extramammary pain, especially in instances of breast pain complicated by blunt thoracic trauma. Lactation pain, caused by a combination of breast overfilling, nipple cracking, and ulceration is treated with breast pumping and occasional anti-microbials. The unclear etiology of cyclic breast pain (i.e. usually presenting during luteal phase and resolving with onset of menses) translates into lack of consensus on treatment of this form of mastalgia. The current focus of therapy is based on use of systemic or topical NSAIDs. Selective estrogen receptor modulators such as tamoxifen and afimoxifene may have a role in chronic therapy of mastalgia.