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Breast pain
JANET SIMMONS YOUNG
n Agents
n NSAIDs
n Opioids
n Gonadotropin release inhibitors
n Selective estrogen receptor modulators
n Evidence
Pain of the breast is commonly classified as cyclic or noncyclic, depending on
its temporal association with menstruation. Visits to ED typically involve
acute, noncyclic breast pain, with the most common etiologies being blunt
trauma or infection. In all cases, treatment of pain is important. Additionally,
follow-up is vital to provide opportunity for advanced pain therapy (e.g.
tamoxifen, see below) and to assure appropriate evaluation for neoplastic
mastalgia.
Other than discussions of pain associated with cancer or postoperative
discomfort, there are few critical analyses of medication effectiveness in
relieving mastalgia. The agents most often mentioned are NSAIDs, including
the COX-2 selective NSAIDs, and opioids.
NONCYCLIC MASTALGIA
Ketorolac (10 mg PO every 4–6 h) is useful for acute mastalgia and extramammary
pain, especially in instances of breast pain complicated by blunt
thoracic trauma. 1,2 Although ketorolac’s parenteral availability is a potential
advantage, it is reasonable to extend the available evidence on ketorolac’s
efficacy to other NSAIDs. 2
The COX-2 selective NSAIDs are also effective in anti-nociception for breast
pain. There is little available evidence directly addressing acute care use of
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