Breast Pain  

In one study, 47% of all visits to the doctor for a breast related issues revolved around breast pain.  Breast pain, otherwise known as mastalgia or mastodynia is often not a cause for concern, but should be given the appropriate attention.

• Pain associated with redness, a lump, fever, swelling or skin changes should always be evaluated immediately by either your primary care provider or a breast specialist.  Although these are all signs of infection in the breast cancer must be ruled out.
  
  
• Muscloskeletal pain (not originating from the breast) tends to be found between the breast as they attach to the chest wall and toward the arm where the pectoral muscle attaches to the shoulder or armpit.  True breast pain is usually within the central and upper regions of the breast.  Musculoskeletal pains can sometimes be confused with breast pain.  Other non breast causes of pain include:  
  
  
• Chest wall muscle strain
• Costochondritis (inflammation of the rib joints)
• Chest wall injury 
• Heart disease 
• Gallbladder disease 
• Reflux

All these non breast causes can be diagnosed by your primary care with a good history and physical examination. 

Cyclic Breast Pain:  Breast pain can be divided into two types, cyclic and noncyclic.  If your pain is cyclic you will note that it is related to your menstrual cycle, it is diffuse and bilateral, radiates to arm or axilla (armpit) and usually involves the upper outer part of your breast.  Cyclic breast pain tends  to be most intense during the week or two before menstruation, even though you can have pain the majority of the month.  It seems to have a strong hormonal associations, even though there is no lab test or study to verify this. However, the fact that pain often decreases or disappears with pregnancy or menopause lends to support this theory.

Noncyclic Breast Pain:  Noncyclic pain is only rarely associated with a identifiable cause.  Causes can include breast cysts, breast trauma, prior breast surgery or benign breast tumors such as fibroadenomas.   Some people believe that there is an imbalance of fatty acids within the cells.  In fact, this is the rationale for taking evening primrose oil capsules to treat breast pain.  This substance contains gamma-linolenic acid (GLA), a type of fatty acid.  GLA is thought to restore the fatty acid balance and decrease the sensitivity of breast tissue to circulating hormone levels.

Medications can also be associated with breast pain.  These include fertility treatments and oral contraceptives, both of which influence hormone balance.  Some common antidepressants such as Prozac and Zoloft may influence breast pain.

Certainly breast size is a factor in the development of breast pain.  This can include neck, shoulder and back pain as a feature of breast pain.