Cyclic and non-cyclic breast-pain: A systematic review on pain reduction, side effects, and quality of life for various treatments

Jan-Willem Groen; Sissi Grosfeld; Janneke A Wilschut; Wichor M Bramer; Miranda F Ernst; Magriet M Mullender

doi:10.1016/j.ejogrb.2017.10.018

Cyclic and non-cyclic breast-pain: A systematic review on pain reduction, side effects, and quality of life for various treatments

Eur J Obstet Gynecol Reprod Biol. 2017 Dec:219:74-93. doi: 10.1016/j.ejogrb.2017.10.018. Epub 2017 Oct 18.

Authors

Jan-Willem Groen¹, Sissi Grosfeld², Janneke A Wilschut, Wichor M Bramer³, Miranda F Ernst², Magriet M Mullender⁴

Affiliations

¹ Department of Plastic Surgery and Biostatistics, VU Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Electronic address: j.w.groen@hotmail.com.
² Alexander Monro Clinics, Bilthoven, Professor Bronkhorstlaan 10, 3723 MB, The Netherlands.
³ Medical Library, Erasmus MC, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
⁴ Department of Plastic Surgery and Biostatistics, VU Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.

PMID: 29059585
DOI: 10.1016/j.ejogrb.2017.10.018

Abstract

Cyclic and non-cyclic breast-pain: A systematic review on pain reduction, side effects, and quality of life for various treatments.

Background: No clear systematic-review on all the various treatment regimen for (Non-) cyclical-breast-pain currently exists.

Objectives: The aim of this study was to assess the various forms of therapy for treatment of breast-pain and the evidence for their effectiveness.

Search strategy: Search-terms included 'mastalgia' and 'therapy' or 'hormones' or 'nsaid' or 'psychotherapy' or 'analgesia' or 'surgery', and synonyms.

Selection criteria: The review was conducted according to the Preferred Reporting Items for Systematic-reviews and Meta-Analysis guidelines. RCT's and pro-/retrospective studies reporting on treatment of breast-pain were considered eligible. Minimal follow-up and sample-size criteria were 6 months and 10 patients respectively.

Data collection and analysis: Data was extracted using standardized tables and encompassed number of subjects, type of breast-pain and treatment, efficacy of treatment and clinical complications/side-effects. No pooling of data could be achieved due to heterogeneity amongst studies.

Main results: Twenty-three studies were included, that reported on 2100 patients in total. Topical-Diclofenac was found to reduce pain by 58.7 and 63.3 on a Visual-Analogue-Scale (VAS) in cyclical and non-cyclical-breast-pain respectively. Persistent cyclical-breast-pain can be treated with short courses (2-6 months) of either Bromocryptine (VAS↓=25.4) or Danazol (VAS↓=33.6) as long as benefits outweigh the side-effects. Last-resort options for unresponsive and severe debilitating breast-pain include surgery in the form of bilateral mastectomy with reconstruction.

Conclusions: Pain reduction in patients with breast-pain can be achieved with analgesics, hormonal-regimen and possibly surgery as a last resort. Additional studies are needed with well-described patient-characteristics, robust study set-up, and longer follow-up times.

Keywords: (Non-)cyclical-breast-pain; (Non-)hormonal-therapy; Mastalgia; Mastodynia; Pain management; Surgery.

Publication types

Review
Systematic Review

MeSH terms

Hormone Antagonists / therapeutic use*
Humans
Mastodynia / therapy*

Substances

Hormone Antagonists