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

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.